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Kakehi T, Zenta M, Ishimori T, Tamura N, Wada H, Bessho M, Kakuda W. Association between Caregivers' Fear of Post-fracture Patients Falling and a Decline in Patients' Activities. Prog Rehabil Med 2023; 8:20230046. [PMID: 38162288 PMCID: PMC10752753 DOI: 10.2490/prm.20230046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives To evaluate caregivers' fear of post-fracture patients falling, we previously developed the Caregivers' Fear of Falling Index (CFFI). In this study, we investigated the relationship between patient performance in activities of daily living (ADLs) and CFFI. Methods We surveyed 55 patients receiving home-visit rehabilitation after fall-related fracture and their primary caregivers. Participants (patient and caregiver pair) were divided into two groups based on patient performance in basic ADLs (BADLs) and instrumental ADLs (IADLs). ROC analysis was conducted to assess the usefulness of CFFI and Falls Efficacy Scale-International (FES-I) in determining declines in performance in BADLs and IADLs. Multivariate logistic regression analysis was performed to examine the association between CFFI and declining performance in BADLs and IADLs. Results ROC analysis showed that CFFI exhibited a higher accuracy than FES-I (AUC: 0.73 in BADLs, 0.77 in IADLs) as an indicator of reduced ADL performance. Multivariate logistic analysis adjusted for age, sex, and physical function showed that CFFI was associated with a decline in patients' performance in IADLs (odds ratio, 0.92; 95% confidence interval, 0.85-0.99). Conclusions Caregivers' fear of post-fracture patients falling was associated with a decline in patients' performance in IADLs. These findings may serve as a guide for supporting caregivers of post-fracture patients.
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Affiliation(s)
- Tomohiro Kakehi
- Department of Rehabilitation Medicine, Graduate School of
Medicine, International University of Health and Welfare, Narita, Japan
- School of Health and Sciences at Narita, International
University of Health and Welfare, Narita, Japan
| | - Masashi Zenta
- Division of Rehabilitation Medicine, International
University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Takuya Ishimori
- Department of Rehabilitation, Institute of Brain and Blood
Vessels, Mihara Memorial Hospital, Isesaki, Japan
| | - Naoki Tamura
- Rehabilitation Center, Ushiku Aiwa General Hospital, Ushiku,
Japan
| | - Hiromu Wada
- Home-visit Nursing Station of Ryugasaki, Ryugasaki,
Japan
| | - Masahiko Bessho
- Department of Orthopaedic Surgery, International University
of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
- Department of Orthopaedic Surgery, School of Medicine,
International University of Health and Welfare, Narita, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, Graduate School of
Medicine, International University of Health and Welfare, Narita, Japan
- Division of Rehabilitation Medicine, International
University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
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Kujala MA, Hongisto MT, Luukkaala T, Stenholm S, Nuotio MS. Pertrochanteric hip fracture is associated with mobility decline and poorer physical performance 4 to 6 months post-hip fracture. BMC Geriatr 2023; 23:722. [PMID: 37940840 PMCID: PMC10631110 DOI: 10.1186/s12877-023-04415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND To study the effect of hip fracture type on physical performance, functional ability and change in mobility four to six months after the injury. METHODS A total of 1331 patients out of consecutive 2052 patients aged ≥ 65 years who underwent hip fracture surgery were included in the study. Patient information was collected on admission, during hospitalization, by phone interview and at the geriatric outpatient clinic 4 to 6 months after the fracture. Of the 1331 eligible patients, Grip strength, Timed Up and Go -test (TUG), Elderly Mobility Scale (EMS), mobility change compared to pre-fracture mobility level, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) were used to determine physical performance and functional ability. Logistic regression was used for the analyses which was adjusted for gender, age, American Society of Anesthesiologists score, diagnosis of cognitive disorder, pre-fracture living arrangements, mobility and need of mobility aid. RESULTS Patients with pertrochanteric hip fracture had an EMS lower than 14 (Odds Ratio (OR) 1.38, 95% confidence intervals (CI) 1.00-1.90), TUG time ≥ 20 s (OR 1.69, 95% CI 1.22-2.33) and they had declined in mobility (OR 1.58, 95% CI 1.20-2.09) compared to femoral neck fracture patients 4 to 6 months post-hip fracture in multivariable-adjusted logistic regression analyses. Grip strength and functional ability (IADL, BADL) 4 to 6 months after hip fracture did not differ between fracture types. There were no statistically significant differences in physical performance in patients with a subtrochanteric fracture compared to patients with a femoral neck fracture. CONCLUSIONS Pertrochanteric hip fracture independently associated with poorer physical performance 4 to 6 months post hip fracture compared to other hip fracture types. Pertrochanteric hip fracture patients should be given special attention in terms of regaining their previous level of mobility.
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Affiliation(s)
- Minna A Kujala
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
- Department of Geriatric Medicine, University of Turku, Turku, Finland.
| | - Markus T Hongisto
- Division of Orthopaedics and Traumatology, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tiina Luukkaala
- Research and Innovation Centre, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Department of Geriatric Medicine, University of Turku and Turku University Hospital, Turku, Finland
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Skuladottir SS, Hjaltadottir I, Launer L, Cotch MF, Siggeirsdottir K, Gudnason V, Sigurdsson G, Steingrimsdottir L, Halldorsson T, Ramel A. Milk intake and hip fracture incidence in community-dwelling old Icelandic adults. Osteoporos Int 2023; 34:1951-1959. [PMID: 37558894 DOI: 10.1007/s00198-023-06883-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
Milk and milk products have been known as important for bone health. Can ingestion of milk and milk products lower hip fracture risk for older adults? In this study, older Icelandic adults who were ingesting higher milk had a lower risk of hip fractures. INTRODUCTION This study describes associations between milk intake and hip fracture risk in older Icelanders. The data indicate that no/low milk consumption is related to greater hip fracture risk. Hip fracture can have a severe effect on the life of older adults. Health authorities recommend milk intake for better bone health. However, previous studies addressing this association have been divergent. METHODS This prospective study included 4614 subjects (mean age 76 years) recruited between 2002 and 2006 into the Age, Gene/Environment Susceptibility-Reykjavik (AGES-Reykjavik) study. Information on hip fractures occurring between recruitment and end of follow-up in 2012 was extracted from hospital records. RESULTS A total of 14% of participants reported milk intake < 0.5 times/day (the lowest category) and 22% of the participants consumed at least milk two times/day (highest category). Milk consumption was positively related to the volumetric bone mineral density at baseline with a sex- and age-adjusted difference of 8.95 ± 2.5 mg/cm3 between the highest compared to lowest milk intake categories (P < 0.001). During the follow-up, 7.4% of participants had a hip fracture, and we observed a decreased risk of incident hip fractures in the highest compared to the lowest milk intake category with a hazard ratio of 0.69 (95% CI: 0.47-0.99) in adjusted model. Further analysis indicated a linear relationship between milk intake and fracture risk (P-value for linear trend < 0.001). CONCLUSION Milk intake is associated with a lower risk of incident hip fracture in a linear way in Icelandic community-dwelling older adults.
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Affiliation(s)
- Sigrun S Skuladottir
- The Icelandic Gerontological Research Institute, Reykjavik, Iceland.
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.
- Faculty of Nursing, University of Iceland, Eiríksgata, 101, Reykjavik, Iceland.
| | | | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute On Aging, Baltimore, MD, USA
| | - Mary-Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | - Alfons Ramel
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
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4
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Phang JK, Lim ZY, Yee WQ, Tan CYF, Kwan YH, Low LL. Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials. BMC Musculoskelet Disord 2023; 24:417. [PMID: 37231406 DOI: 10.1186/s12891-023-06512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Interventions provided after hip fracture surgery have been shown to reduce mortality and improve functional outcomes. While some systematic studies have evaluated the efficacy of post-surgery interventions, there lacks a systematically rigorous examination of all the post-surgery interventions which allows healthcare providers to easily identify post-operative interventions most pertinent to patient's recovery. OBJECTIVES We aim to provide an overview of the available evidence on post-surgery interventions provided in the acute, subacute and community settings to improve outcomes for patients with hip fractures. METHODS We performed a systematic literature review guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). We included articles that were (1) randomized controlled trials (RCTs), (2) involved post-surgery interventions that were conducted in the acute, subacute or community settings and (3) conducted among older patients above 65 years old with any type of non-pathological hip fracture that was surgically treated, and who were able to walk without assistance prior to the fracture. We excluded (1) non-English language articles, (2) abstract-only publications, (3) articles with only surgical interventions, (4) articles with interventions that commenced pre-surgery or immediately upon completion of surgery or blood transfusion, (5) animal studies. Due to the large number of RCTs identified, we only included "good quality" RCTs with Jadad score ≥ 3 for data extraction and synthesis. RESULTS Our literature search has identified 109 good quality RCTs on post-surgery interventions for patients with fragility hip fractures. Among the 109 RCTs, 63% of the identified RCTs (n = 69) were related to rehabilitation or medication/nutrition supplementation, with the remaining RCTs focusing on osteoporosis management, optimization of clinical management, prevention of venous thromboembolism, fall prevention, multidisciplinary approaches, discharge support, management of post-operative anemia as well as group learning and motivational interviewing. For the interventions conducted in inpatient and outpatient settings investigating medication/nutrition supplementation, all reported improvement in outcomes (ranging from reduced postoperative complications, reduced length of hospital stay, improved functional recovery, reduced mortality rate, improved bone mineral density and reduced falls), except for a study investigating anabolic steroids. RCTs involving post-discharge osteoporosis care management generally reported improved osteoporosis management except for a RCT investigating multidisciplinary post-fracture clinic led by geriatrician with physiotherapist and occupational therapist. The trials investigating group learning and motivational interviewing also reported positive outcome respectively. The other interventions yielded mixed results. The interventions in this review had minor or no side effects reported. CONCLUSIONS The identified RCTs regarding post-surgery interventions were heterogeneous in terms of type of interventions, settings and outcome measures. Combining interventions across inpatient and outpatient settings may be able to achieve better outcomes such as improved physical function recovery and improved nutritional status recovery. For example, nutritional supplementation could be made available for patients who have undergone hip fracture surgery in the inpatient settings, followed by post-discharge outpatient osteoporosis care management. The findings from this review can aid in clinical practice by allowing formulation of thematic program with combination of interventions as part of bundled care to improve outcome for patients who have undergone hip fracture surgery.
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Affiliation(s)
- Jie Kie Phang
- Centre for Population Health Research and Implementation (CPHRI), SingHealth Regional Health System, SingHealth, Singapore, Singapore
- Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore, Singapore
| | - Zhui Ying Lim
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
| | - Wan Qi Yee
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
| | - Cheryl Yan Fang Tan
- Bright Vision Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
| | - Yu Heng Kwan
- SingHealth Internal Medicine Residency Programme, Singapore, Singapore
- Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Lian Leng Low
- Centre for Population Health Research and Implementation (CPHRI), SingHealth Regional Health System, SingHealth, Singapore, Singapore.
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore.
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore.
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Department of Post-Acute & Continuing Care, SingHealth Community Hospitals, 10 Hospital Boulevard, Singapore, 168852, Singapore.
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5
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Ravensbergen WM, Timmer IL, Gussekloo J, Blom JW, van Eijk M, Achterberg WP, Evers AWM, van Dijk S, Drewes YM. Self-perceived functioning and (instrumental) activities of daily living questionnaires after a hip fracture: Do they tell the same story? Age Ageing 2022; 51:6834148. [PMID: 36434800 PMCID: PMC9701104 DOI: 10.1093/ageing/afac259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND (Instrumental) activities of daily living ((I)ADL) questionnaires are often used as a measure of functioning for different purposes. Depending on the purpose, a measurement of functioning that includes subjective patient perspectives can be relevant. However, it is unclear to what extent (I)ADL instruments capture self-perceived functioning. OBJECTIVE Explore what functioning means to older persons after a hip fracture and assess the extent to which (I)ADL instruments align with self-perceived functioning. DESIGN Qualitative interview study with framework analysis. SETTING Prospective cohort study on recovery after a hip fracture among older persons in a hospital in a large city in the west of the Netherlands. SUBJECTS Eighteen home-dwelling older persons (≥70 years) who had a hip fracture 6-12 months ago. METHODS Telephone interviews about functioning before and after the hip fracture were coded and analysed using the framework method. RESULTS The activities mentioned by participants to be part of their self-perceived functioning could be split into activities necessary to maintain the desired level of independence, and more personal activities that were of value to participants. Both the 'independence activities' and the 'valued activities' mentioned went beyond the activities included in (I)ADL questionnaires. Due to various coping strategies, limitations in activities that are measured in the (I)ADL questionnaires did not necessarily lead to worse self-perceived functioning. CONCLUSION Self-perceived functioning differs from functioning measured with (I)ADL questionnaires in the items included and the weighing of limitations in activities. Thus, (I)ADL instruments alone are not enough to measure functioning from the perspective of the older person.
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Affiliation(s)
| | - Irie L Timmer
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Sandra van Dijk
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Yvonne M Drewes
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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6
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Joeris A, Kabiri M, Galvain T, Vanderkarr M, Holy CE, Plaza JQ, Tien S, Schneller J, Kammerlander C. Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures. J Bone Joint Surg Am 2022; 104:2026-2034. [PMID: 36053020 DOI: 10.2106/jbjs.21.01516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer's perspective. METHODS The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient's lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses. RESULTS The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (€50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from €0 to €50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%. CONCLUSIONS Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available. LEVEL OF EVIDENCE Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander Joeris
- AO Innovation Translation Center, Clinical Science, AO Foundation, Davos, Switzerland
| | - Mina Kabiri
- Global Provider and Payer Value Demonstration, Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, New Jersey
| | - Thibaut Galvain
- Global Provider and Payer Value Demonstration, Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, New Jersey
| | | | - Chantal E Holy
- Medical Device Epidemiology, Johnson & Johnson, New Brunswick, New Jersey
| | | | - Stephanie Tien
- Global Provider and Payer Value Demonstration, Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, New Jersey
| | - Julia Schneller
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christian Kammerlander
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.,AUVA Trauma Hospital Styria, Graz, Austria.,AUVA Trauma Hospital Styria, Kalwang, Austria
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7
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Sasagawa T, Yokogawa N, Hayashi H, Tsuchiya H, Ando K, Nakashima H, Segi N, Watanabe K, Nori S, Takeda K, Furuya T, Yunde A, Ikegami S, Uehara M, Suzuki H, Imajo Y, Funayama T, Eto F, Yamaji A, Hashimoto K, Onoda Y, Kakutani K, Kakiuchi Y, Suzuki N, Kato K, Terashima Y, Hirota R, Yamada T, Hasegawa T, Kawaguchi K, Haruta Y, Seki S, Tonomura H, Sakata M, Uei H, Sawada H, Tominaga H, Tokumoto H, Kaito T, Iizuka Y, Takasawa E, Oshima Y, Terai H, Tamai K, Otsuki B, Miyazaki M, Nakajima H, Nakanishi K, Misaki K, Inoue G, Kiyasu K, Akeda K, Takegami N, Yoshii T, Ishihara M, Okada S, Aoki Y, Harimaya K, Murakami H, Ishii K, Ohtori S, Imagama S, Kato S. A multicenter study of 1-year mortality and walking capacity after spinal fusion surgery for cervical fracture in elderly patients. BMC Musculoskelet Disord 2022; 23:798. [PMID: 35987644 PMCID: PMC9392237 DOI: 10.1186/s12891-022-05752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older.
Methods
Three hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients’ backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted.
Results
One year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively.
Conclusions
The 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.
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8
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Røpke A, Morville AL, Møller TE, Delkus ECG, Juhl CB. HIP Fracture REhabilitation Program for older adults with hip fracture (HIP-REP) based on activity of daily living: a feasibility study. BMC Geriatr 2022; 22:370. [PMID: 35477380 PMCID: PMC9044869 DOI: 10.1186/s12877-022-03039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background A Rehabilitation Program for older adults with hip fracture (HIP-REP) based on Activity of Daily Living has been developed. The objectives of this study were to assess the feasibility and safety of the HIP-REP program to inform a future randomized controlled trial (RCT). Methods A feasibility study Inspired by the Complex-intervention development (Medical Research Council framework phase II) design using quantitative and qualitative research methods were conducted. Eighteen participants (above 65 years) with hip fracture were recruited from the orthopedic wards. The setting was cross sectoral including Copenhagen University Hospital, Herlev and Gentofte and rehabilitation centers in Herlev, Gentofte and Lyngby-Taarbæk municipalities. A cross-sectoral rehabilitation intervention tailored to the needs of older adults with hip fracture highlighting systematic goal setting and strategies focused on activities of daily living was conducted. Pre-defined feasibility criteria: participants recruitment and retention, duration of measuring the outcome, adherence to intervention, and adverse events, along with self-reported outcomes and an objective measurement of performance in activity of daily living. Focus groups were analyzed using a deductive manifest content analysis approach. Descriptive statistical analysis and paired t-tests were performed for assessing change in outcome measures. Results Recruitment rate was 4.5/month. Outcome measures were performed but length and number of questionnaires were a burden. Thirteen out of eighteen participants completed the study three dropped out and two died. Adherence among the 13 was 100%. Focus group revealed issues regarding coordinating the intervention, ensuring procedural processes across sectors regarding recruitment of participants, and documentation in the database. Participants expressed satisfaction with the intervention and felt safe during intervention. Assessment of Motor and Process Skills showed better increase between (range 0.4 to 1.6) in ADL motor ability measures and better increase between (range 0.4 to 0.7) for process ability. No clear association between outcome improvements and intervention adherence. Conclusions The cross-sectoral intervention based on daily activities was feasible and safe for older adults with hip fracture. A future RCT, with an improved recruitment strategy and reduced number of outcome measures will evaluate the effectiveness in improving independence and safety performance of activity of daily living. Trial registration ClinicalTrials.gov ID: NCT03828240. Registered on January 29, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03039-x.
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Affiliation(s)
- Alice Røpke
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark. .,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Anne-Le Morville
- ADULT Research Group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Trine Elleby Møller
- Municipality of Gentofte, Municipality of Gentofte's Centre for Prevention and Rehabilitation, Copenhagen, Denmark
| | | | - Carsten Bogh Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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9
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Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073992. [PMID: 35409675 PMCID: PMC8997639 DOI: 10.3390/ijerph19073992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 12/14/2022]
Abstract
An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients’ outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes.
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10
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Ravensbergen WM, Blom JW, Kingston A, Robinson L, Kerse N, Teh RO, Groenwold RHH, Gussekloo J. Declining daily functioning as a prelude to a hip fracture in older persons-an individual patient data meta-analysis. Age Ageing 2022; 51:6514236. [PMID: 35077559 PMCID: PMC8789300 DOI: 10.1093/ageing/afab253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Daily functioning is known to decline after a hip fracture, but studies of self-reported functioning before the fracture suggest this decline begins before the fracture. OBJECTIVE Determine whether change in functioning in the year before a hip fracture in very old (80+) differs from change in those without a hip fracture. DESIGN Two-stage individual patient data meta-analysis including data from the Towards Understanding Longitudinal International older People Studies (TULIPS)-consortium. SETTING Four population-based longitudinal cohorts from the Netherlands, New Zealand and the UK. SUBJECTS Participants aged 80+ years. METHODS Participants were followed for 5 years, during which (instrumental) activities of daily living [(I)ADL] scores and incident hip fractures were registered at regular intervals. Z-scores of the last (I)ADL score and the change in (I)ADL in the year before a hip fracture were compared to the scores of controls, adjusted for age and sex. RESULTS Of the 2,357 participants at baseline, the 161 who sustained a hip fracture during follow-up had a worse (I)ADL score before the fracture (0.40 standard deviations, 95% CI 0.19 to 0.61, P = 0.0002) and a larger decline in (I)ADL in the year before fracture (-0.11 standard deviations, 95% CI -0.22 to 0.004, P = 0.06) compared to those who did not sustain a hip fracture. CONCLUSIONS In the very old a decline in daily functioning already starts before a hip fracture. Therefore, a hip fracture is a sign of ongoing decline and what full recovery is should be seen in light of the pre-fracture decline.
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Affiliation(s)
- Willeke M Ravensbergen
- Address correspondence to: Willeke M. Ravensbergen, Dept. of Public Health and Primary Care (Postzone V0-P), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel: +3171 5268259. E-mail:
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11
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Prognostic Factors of 1-Year Postoperative Functional Outcomes of Older Patients with Intertrochanteric Fractures in Thailand: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136896. [PMID: 34199045 PMCID: PMC8297186 DOI: 10.3390/ijerph18136896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 12/30/2022]
Abstract
Restoration of ambulatory status is considered a primary treatment goal for older patients with intertrochanteric fractures. Several surgical-related parameters were reported to be associated with mechanical failure without focusing on the functional outcomes. Our study examines the roles of both clinical and surgical parameters as prognostic factors on 1-year postoperative ambulatory outcomes, reaching a good functional outcome (the New Mobility Score: NMS ≥ 5) and returning to preinjury functional status at one year, of older patients with intertrochanteric fracture. Intertrochanteric fractures patients age ≥65 years who underwent surgical treatment at our institute between January 2017 and February 2020 were included. Of 209 patients included, 149 (71.3%) showed a good functional outcome at one year. The pre-injury ambulatory status (OR 52.72, 95%CI 5.19–535.77, p = 0.001), BMI <23 kg/m2 (OR 3.14, 95%CI 1.21–8.13, p = 0.018), Hb ≥10 g/dL (OR 3.26, 95%CI 1.11–9.57, p = 0.031), and NMS at discharge ≥2 (OR 8.50, 95%CI 3.33–21.70, p < 0.001) were identified as independent predictors for reaching a good postoperative functional outcome. Only aged ≤80 (OR 2.34, 95%CI 1.11–4.93, p = 0.025) and NMS at discharge ≥2 (OR 6.27, 95%CI 2.75–14.32, p < 0.001) were significantly associated with an ability to return to preinjury function. To improve postoperative ambulatory status, orthopedic surgeons should focus more on modifying factors, such as maintaining the preoperative hemoglobin ≥10 g/dL and providing adequate postoperative ambulation training to maximize the patients’ capability upon discharge. While surgical parameters were not identified as predictors, they can still be used as guidance to optimize the operation quality.
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12
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Liu J, Chen L, Long C, Zhang X, Gao F, Duan X, Xiang Z. A retrospective pilot study of preoperative mobilization program for older adults with hip fracture. Geriatr Nurs 2021; 42:908-914. [PMID: 34098444 DOI: 10.1016/j.gerinurse.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the feasible effect of a preoperative mobilization program for older hip fracture patients who waited more than two days before surgery. METHODS A total of 38 patients with hip fracture were analyzed in this retrospective descriptive pilot study. The modified Barthel index (MBI) was used to measure functional outcome. Visual analogue scale (VAS) was used to evaluate the changes of pain degree during preoperative mobilization. The perioperative complications were recorded. RESULTS After the preoperative mobilization program was implemented, the MBI score was improved immediately and further improved after surgery until 3 months after discharge. On the premise of analgesia, no patient experienced severe pain during preoperative mobilization. Perioperative complications occurred in 2 (5.3%) patients. CONCLUSION For older patients with hip fracture, the preoperative mobilization program may be a feasible method, which may have a positive effect on promoting functional recovery and preventing perioperative complications.
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Affiliation(s)
- Jiaxin Liu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Li Chen
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Cheng Long
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Xiang Zhang
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Feng Gao
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Xin Duan
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China.
| | - Zhou Xiang
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
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13
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Lam DMH, Wang C, Lee AKH, Chung YF, Lau TW, Fang C, Leung F, Chan TCW. Multi-Component Care Bundle in Geriatric Fracture Hip for Reducing Post-Operative Delirium. Geriatr Orthop Surg Rehabil 2021; 12:21514593211004530. [PMID: 33954009 PMCID: PMC8056740 DOI: 10.1177/21514593211004530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Delirium in elderly orthopaedic patients poses an enormous medical, social and financial burden to the healthcare system, and causes significant distress to patients and their caregivers. We examined whether a Multi-component Care Bundle (MCB) could reduce the incidence of post-operative delirium (POD) in fractured hip patients. Methods: An observational study was conducted, analyzing 154 patients (mean age ± SD, 85 ± 7.8, 68% women) admitted to Queen Mary Hospital with hip fracture. Half of the patients were cared for in the control group before MCB was introduced, which included installation of orientation aids, introduction of a Caregiver Empowerment Program, and incorporation of ultrasound-guided Fascia Iliaca Block (FIB) into the analgesia protocol. Results: There were fewer patients with POD in the MCB group, compared with the control group (18/76, 23.4% v 34/76, 44.2%, p = 0.006). Patients in MCB group consumed less opioid ( 4/77 v 13/77, p = 0.048), experienced less post-operative dizziness (2/77, 2.6% v 13/77, 16.9%, p = 0.003) and had a shorter median day to start walking post-operatively (day 1 [IQR 1-2] vs day 2 [IQR 2-3]; p = 0.001) than the control group. Length of stay was not affected. Conclusion: MCB effectively reduces POD, postoperative dizziness, opioid consumption, and days to start mobilization postoperatively.
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Affiliation(s)
| | - Cherry Wang
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong
| | | | - Yu Fai Chung
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong
| | - Tak Wing Lau
- Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, University of Hong Kong. Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - Christian Fang
- Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, University of Hong Kong. Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, University of Hong Kong. Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
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14
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Konda SR, Dedhia N, Ranson RA, Tong Y, Ganta A, Egol KA. Loss of Ambulatory Level and Activities of Daily Living at 1 Year Following Hip Fracture: Can We Identify Patients at Risk? Geriatr Orthop Surg Rehabil 2021; 12:21514593211002158. [PMID: 33868763 PMCID: PMC8020397 DOI: 10.1177/21514593211002158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Operative hip fractures are known to cause a loss in functional status in the elderly. While several studies exist demonstrating the association between age, pre-injury functioning, and comorbidities related to this loss of function, no studies have predicted this using a validated risk stratification tool. We attempt to use the Score for Trauma Triage for Geriatric and Middle-Aged (STTGMA) tool to predict loss of ambulatory function and need for assistive device use. Materials and Methods Five hundred and fifty-six patients ≥55 years of age who underwent operative hip fracture fixation were enrolled in a trauma registry. Demographics, functional status, injury severity, and hospital course were used to determine a STTGMA score and patients were stratified into risk quartiles. At least 1 year after hospitalization, patients completed the EQ-5D questionnaire for functional outcomes. Results Two hundred and sixty-eight (48.2%) patients or their family members responded to the questionnaire. Of the 184 patients alive, 65 (35.3%) reported a return to baseline function. Eighty-nine (48.4%) patients reported a loss in ambulatory status. Patients with higher STTGMA scores were older, had more comorbidities, reported greater need for help with daily activities, increased difficulty with self-care, and a reduction in return to activities of daily living (all p ≤ 0.001). Patients with lower STTGMA scores were more likely to never require an assistive device while those with higher scores were more likely to continue needing one (p = 0.004 and p < 0.001). Patients in the highest STTGMA risk groups were 1.5x more likely to have an impairment in ambulatory status (need for ambulatory assistive device or decreased ambulatory capacity) (p = 0.004). Discussion Patients in higher STTGMA risk quartiles were more likely to experience impairment after hip fracture surgery. The STTGMA tool can predict loss of ambulatory independence following hip fracture. At-risk populations can be targeted for enhanced physiotherapy and rehabilitation services for optimal return to prior functioning.
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Affiliation(s)
- Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY, USA
| | - Nicket Dedhia
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Rachel A Ranson
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Yixuan Tong
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY, USA
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15
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Peng G, Guan Z, Hou Y, Gao J, Rao W, Yuan X, Guo J, Huang X, Zhong Z, Lin J. Depicting developing trend and core knowledge of hip fracture research: a bibliometric and visualised analysis. J Orthop Surg Res 2021; 16:174. [PMID: 33663568 PMCID: PMC7931604 DOI: 10.1186/s13018-021-02292-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
Background Hip fracture is common and carries high morbidity and mortality; thus, it has become a vital concern. We aim to analyse the present status, worldwide trends in hip fracture and state of clinical research. Methods Publications from 2000 to 2019 were retrieved from the Web of Science database and analysed using a bibliometric methodology. VOSviewer software was utilised for analysis. Results In total, 6139 publications were included, and publications increased annually from 152 in 2000 to 592 in 2019. U.S. researchers have produced the most publications, the highest H-index and the greatest number of citations. Osteoporosis International has published the most papers on the topic. Leading researchers, contributing institutions, their cooperative relationships and scientific masterpieces have been identified. The publications can be divided into five clusters: ‘mortality’, ‘surgical management’, ‘rehabilitation’, ‘osteoporosis’ and ‘epidemiology’. A clear developing trend was described, which began with fracture epidemiology and prevention, transitioned to perioperative management, orthogeriatric care and patient safety and then to functional recovery, disease burden and national audits in recent times. Conclusions Hip fractures result in conditions that extend far beyond orthopaedics concerning epidemiology and preventive medicine, internal medicine and endocrinology, as well as critical care and gerontology. Interest, research and publications are on the rise.
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Affiliation(s)
- Guanrong Peng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong Province, China.,Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Zhenhua Guan
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Yunfei Hou
- Peking University People's Hospital, No. 11, Xizhimen South Street, Beijing, 100044, Xicheng District, China
| | - Jiaxiang Gao
- Peking University People's Hospital, No. 11, Xizhimen South Street, Beijing, 100044, Xicheng District, China
| | - Wenqun Rao
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Xianyun Yuan
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Jiusheng Guo
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Xiaohua Huang
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China
| | - Zhangrong Zhong
- Yudu People's Hospital, No. 2, Huancheng North Road, Gongjiang Town, Yudu, 342300, Jiangxi Province, China.
| | - Jianhao Lin
- Peking University People's Hospital, No. 11, Xizhimen South Street, Beijing, 100044, Xicheng District, China.
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16
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Measuring daily functioning in older persons using a frailty index: a cohort study based on routine primary care data. Br J Gen Pract 2020; 70:e866-e873. [PMID: 33139330 DOI: 10.3399/bjgp20x713453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are increasingly used for research; however, multicomponent outcome measures such as daily functioning cannot yet be readily extracted. AIM To evaluate whether an electronic frailty index based on routine primary care data can be used as a measure for daily functioning in research with community-dwelling older persons (aged ≥75 years). DESIGN AND SETTING Cohort study among participants of the Integrated Systemic Care for Older People (ISCOPE) trial (11 476 eligible; 7285 in observational cohort; 3141 in trial; over-representation of frail people). METHOD At baseline (T0) and after 12 months (T12), daily functioning was measured with the Groningen Activities Restriction Scale (GARS, range 18-72). Electronic frailty index scores (range 0-1) at T0 and T12 were computed from the EHRs. The electronic frailty index (electronic Frailty Index - Utrecht) was tested for responsiveness and compared with the GARS as a gold standard for daily functioning. RESULTS In total, 1390 participants with complete EHR and follow-up data were selected (31.4% male; median age = 81 years, interquartile range = 78-85). The electronic frailty index increased with age, was higher for females, and lower for participants living with a partner. It was responsive after an acute major medical event; however, the correlation between the electronic frailty index and GARS at T0 and over time was limited. CONCLUSION Because the electronic frailty index does not reflect daily functioning, further research on new methods to measure daily functioning with routine care data (for example, other proxies) is needed before EHRs can be a useful data source for research with older persons.
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17
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van der Sijp MPL, van Eijk M, Tong WH, Niggebrugge AHP, Schoones JW, Blauw GJ, Achterberg WP. Independent factors associated with long-term functional outcomes in patients with a proximal femoral fracture: A systematic review. Exp Gerontol 2020; 139:111035. [PMID: 32739519 DOI: 10.1016/j.exger.2020.111035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The current understanding of prognostic factors of functional recovery after a proximal femoral fracture is limited, and enhancements could improve the prognostic accuracy and target subgroups for additional care strategies. This systematic review aims to identify all studied factors with an independent prognostic value for the long-term functional recovery of patients with a proximal femoral fracture. MATERIALS AND METHODS Observational studies with multivariate analyses on prognostic factors of long-term functional outcome after proximal femoral fractures were obtained through an electronic search performed on November 9, 2018. RESULTS In the 31 included articles, thirteen prognostic factors were studied by at least two independent studies and an additional ten by only one study. Age, comorbidity, functionality and cognition were factors for which the majority of studies indicated a significant effect. The majority of studies which included sex as a factor found no significant effect. The level of evidence for the remaining factors was deemed too low to be conclusive on their relevance for long-term functional outcome. CONCLUSION The identified factors showed overlap with prognostic factors of short-term functional outcomes and mortality. The validity and applicability of prognostic models based on these factors may be of interest for future research.
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Affiliation(s)
- Max P L van der Sijp
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Wing H Tong
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Arthur H P Niggebrugge
- Department of Surgery, Haaglanden Medical Center, P.O. Box 432, 2501 CK the Hague, the Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Gerard J Blauw
- Department of Internal Medicine, Leiden University Medical Center/Haaglanden Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
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van der Sijp MPL, van Eijk M, Niggebrugge AHP, Putter H, Blauw GJ, Achterberg WP. Prognostic Factors for Short-term Recovery of Independence in a Multistate Model for Patients With a Hip Fracture. J Am Med Dir Assoc 2020; 22:1307-1312. [PMID: 32962930 DOI: 10.1016/j.jamda.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study investigates the transitions of community-dwelling patients with a proximal femoral fracture towards recovery of independence using multistate modeling. The prognostic value of factors affecting the short-term rate of recovery of independence in activities of daily living was assessed for the resilient portion of the population. DESIGN An inception cohort was recruited between 2016 and 2019. SETTING AND PARTICIPANTS Only community-dwelling older patients admitted with a proximal femoral fracture were included. MEASURES Follow-up was performed at 6 weeks and 3 months, when the patients' living situation and level of independence were recorded. Multistate modeling was used to study the transition rates of the population through prespecified states of the recovery process. Using this model, prognostic factors for the recovery of independence were identified for resilient patients (defined as those patients who managed to return home at any point in the follow-up after discharge). RESULTS A total of 558 patients were included, and 218 (40.9%) recovered to prefracture levels of independence. Of the resilient patients, 20.7% were discharged home directly, and 79.3% via a rehabilitation home. In this patient group, a more favorable American Society of Anesthesiologists classification, better prefracture mobility, and the absence of a prefracture fear of falling were statistically significantly associated with a successful recovery. A low level of prefracture independence was inversely associated, meaning that patients with a low level of prefracture independence had a higher chance of successful recovery. CONCLUSIONS AND IMPLICATIONS This study identified 4 factors with an independent prognostic value for the recovery of independence in resilient patients after a proximal femoral fracture. These factors could be used to construct clinical profiles that contribute to the assessment of the patient's post-acute care needs and recovery capacity. In addition, multistate modeling has been shown to be an effective and versatile tool in the study of recovery prognostics.
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Affiliation(s)
- Max P L van der Sijp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerard J Blauw
- Department of Internal Medicine, Leiden University Medical Center/Haaglanden Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Kulachote N, Sa-Ngasoongsong P, Sirisreetreerux N, Chulsomlee K, Thamyongkit S, Wongsak S. Predicting Factors for Return to Prefracture Ambulatory Level in High Surgical Risk Elderly Patients Sustained Intertrochanteric Fracture and Treated With Proximal Femoral Nail Antirotation (PFNA) With and Without Cement Augmentation. Geriatr Orthop Surg Rehabil 2020; 11:2151459320912121. [PMID: 32201631 PMCID: PMC7068744 DOI: 10.1177/2151459320912121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/10/2020] [Indexed: 01/31/2023] Open
Abstract
Introduction: Postoperative outcomes in the elderly patients with intertrochanteric fracture were
generally poor with a low rate of return to prefracture ambulatory level (RPAL). Recent
studies showed that proximal femoral nail antirotation (PFNA) with cement augmentation
might be useful for postoperative functional recovery. This study aimed to compare the
outcomes in elderly patients with high surgical risk, American Society of
Anesthesiologist (ASA) grade 3 or 4, who sustained intertrochanteric fractures and were
treated with PFNA with and without cement augmentation, and to correlate perioperative
surgical factors with the RPAL. Methods: A retrospective consecutive series was conducted based on 135 patients with prefracture
ambulation classified as independent in community with or without a single cane (68 in
augmented group and 67 in control group). Perioperative data and data on the
complications within 1-year postsurgery were collected and compared. Predictive factors
for RPAL were analyzed via logistic regression analysis. Results: The overall 1-year postoperative mortality rate was 10% (n = 14) with no significant
difference between groups (P = .273). The proportion of elderly
patients with RPAL in the augmented group was significantly higher than for those in the
control group (48% vs 29%, P = .043). Via univariate analysis, ASA
grade 4 (P = .077), history of stroke (P = .035), and
use of cement augmentation (P = .041) were correlated with RPAL.
However, multivariate regression analysis showed that ASA grade 4 (odds ratio [OR] =
0.40, 95% confidence interval [CI]: 0.18-0.90, P = .026) and use of
cement augmentation (OR = 2.72, 95% CI: 1.22-6.05, P = .014) were the
significant predictors for RPAL. Discussion and Conclusions: The results of the present study showed that PFNA with cement augmentation is safe and
effectiveness in the intertrochanteric fracture treatment of elderly. Postoperative
functional recovery, like RPAL, in elderly patients who sustained intertrochanteric
fractures is relatively low, especially in those with ASA grade 4. However, cement
augmentation with PFNA might be helpful for increasing the RPAL in high-surgical-risk
geriatric patients.
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Affiliation(s)
- Noratep Kulachote
- Department of Orthopedics, Mahidol University, Samut Prakan, Thailand
| | | | | | - Kulapat Chulsomlee
- Department of Orthopedics, Mahidol University, Samut Prakan, Thailand.,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Sorawut Thamyongkit
- Department of Orthopedics, Mahidol University, Samut Prakan, Thailand.,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Siwadol Wongsak
- Department of Orthopedics, Mahidol University, Samut Prakan, Thailand
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20
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Bukowy EA, Thiel E. Decision Making for Patients with Advanced Dementia and a Hip Fracture #388. J Palliat Med 2020; 23:422-423. [DOI: 10.1089/jpm.2019.0624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tam TL, Tsang KK, Lee KB. Development of a prognostic model to predict post-operative mobility of patients with fragility hip fractures: a retrospective cohort study. Int J Orthop Trauma Nurs 2020; 38:100770. [PMID: 32646759 DOI: 10.1016/j.ijotn.2020.100770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/23/2020] [Accepted: 02/17/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Older adults with fragility hip fractures have high 1-year mortality and significant functional loss. This study aimed to identify the factors that predict the post-operative ambulatory prognosis of patients with fragility hip fracture. METHODS A total of 233 patients who were consecutively admitted with fragility hip fracture to the orthopaedic unit of an acute hospital in Hong Kong between March and July 2016, were included in this retrospective observational cohort study. The outcome variable was the binary classification of whether patients could or could not walk independently without assistance for more than10 m at the time of discharge from hospital to community. The prognostic model was developed by using multivariate logistic regression. RESULTS Eighty-nine (38.2%) patients could walk independently upon discharge. The statistically significant factors that affected walking independence on discharge were age (Odds Ratio [OR] = 0.93), Charlson Comorbidity Index (OR = 0.67), baseline Mini-Mental Status Examination score (OR = 1.15) and pre-fracture mobility (p = 0.012). Patients who walked unaided before the fracture had a better prognosis than patients requiring a stick walker (OR = 0.57), quadripod walker (OR = 0.28) or frame walker (OR = 0.12). The area under the ROC curve was 0.848. CONCLUSIONS The model provides healthcare professionals with evidence to personalize the rehabilitation regime according to the patient's age, comorbidity, baseline cognitive function and pre-fracture mobility.
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Affiliation(s)
- Tsz-Lok Tam
- Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
| | - Ka-Kit Tsang
- Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Kin-Bong Lee
- Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
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Harris MJ, Brovman EY, Urman RD. Clinical predictors of postoperative delirium, functional status, and mortality in geriatric patients undergoing non-elective surgery for hip fracture. J Clin Anesth 2019; 58:61-71. [PMID: 31100691 DOI: 10.1016/j.jclinane.2019.05.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 01/28/2023]
Abstract
STUDY OBJECTIVE To identify modifiable preoperative factors that might influence the morbidity and mortality associated with non-elective, inpatient hip fracture surgeries in the geriatric surgical population. DESIGN Retrospective database analysis from the American College of Surgeons National Surgical Quality Improvement Program Geriatric Surgery Pilot Project. SETTING Inpatient, perioperative. PATIENTS Geriatric patients undergoing surgery. INTERVENTIONS Non-elective hip repair surgery. MEASUREMENTS Preoperative demographic, medical, surgical, and anesthetic variables; post-operative rates of delirium, decline in functional status, and 30-day mortality. MAIN RESULTS The 1261 patients in this study were predominantly female (74%), white (89%), and non-Hispanic (92%). Ages were distributed across groups from 65 to over 90 years. Most patients were categorized as American Society of Anesthesiologists Physical Status class 3 (64%). General anesthesia (57%) was the most common anesthetic, followed by spinal (38%). Preoperative functional status was recorded in 79% as independent in activities of daily living (ADLs). About one third of patients had baseline dementia. Post-operatively, 42% experienced delirium, and most patients required partial or total assistance with ADLs (72% and 12%, respectively). Reoperation was required in 2.8% of cases. Mortality at 30 days was 5.0%. In the multivariable analysis, risk factors associated with post-operative delirium included dementia and lack of competency to sign consent. In the analysis for postoperative decline in functional status, the major risk factor was a history of falls, while emergently performed surgery was protective. The analysis for mortality at thirty days was under-powered. CONCLUSIONS Hip fractures remain a major source of morbidity in geriatric patients. Baseline dementia and inability to sign surgical consent are significant risk factors for adverse outcomes after hip fractures and should be considered in the informed consent process. Data from this study and currently ongoing randomized trials will help guide reductions in morbidity and mortality in this population.
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Affiliation(s)
- Mark J Harris
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Richard D Urman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America.
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