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Snowdon DA, Vincent P, Callisaya ML, Collyer TA, Brusco NK, Wang YT, Taylor NF. Allied health assistant management of people with hip fracture is feasible and may improve patient adherence to hip fracture mobilisation guidelines: a feasibility randomised controlled trial. Physiotherapy 2024; 124:51-64. [PMID: 38870622 DOI: 10.1016/j.physio.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 03/03/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Determine the feasibility of allied health assistant (AHA) management of people with hip fracture an acute hospital. DESIGN Assessor-blind, parallel, feasibility randomised controlled trial with qualitative component. SETTING Acute orthopaedic ward. PARTICIPANTS People with surgically-managed hip fracture, who walked independently pre-fracture and had no cognitive impairment. INTERVENTIONS Rehabilitation from an AHA, under the supervision of a physiotherapist, compared with rehabilitation from a physiotherapist. MAIN OUTCOME MEASURES Feasibility was evaluated according to focus areas of demand, acceptability, practicality and implementation. Secondary outcomes included estimates of effect of adherence to hip fracture mobilisation guidelines, discharge destination, 30-day readmission, functional activity, and length of stay. RESULTS Fifty people were allocated to receive rehabilitation from an AHA (n = 25) or physiotherapist (n = 25). AHA rehabilitation had high demand with 60% of eligible participants recruited. Satisfaction with AHA rehabilitation was comparable with physiotherapy rehabilitation (acceptability). The AHA group received an average of 11 min (95% CI 4 to 19) more therapy per day than the physiotherapy group (implementation). The AHA group may have had lower cost of acute care (MD -$3 808 95% CI -7 651 to 35) and adverse events were comparable between groups (practicality). The AHA group may have been 22% (HR 1.22, 95% CI 0.92 to 1.61) more likely to walk on any day and may have had a shorter length of stay (MD -0.8 days, 95% CI -2.3 to 0.7). CONCLUSIONS AHA management of patients with hip fracture was feasible and may improve adherence to mobilisation guidelines and reduce cost of care and length of stay. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12620000877987. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia; Academic Unit, Peninsula Health, Frankston Australia.
| | - Peggy Vincent
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia; Academic Unit, Peninsula Health, Frankston Australia
| | - Taya A Collyer
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
| | - Yi Tian Wang
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Song K, Kong X, Yu Z, Xiao H, Ren Y. Research progress on bariatric surgery for hyperuricemia. BMC Surg 2024; 24:235. [PMID: 39169366 PMCID: PMC11337558 DOI: 10.1186/s12893-024-02525-w] [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: 06/05/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024] Open
Abstract
Hyperuricemia is closely linked to obesity. As lifestyles and dietary patterns evolve, the prevalence of hyperuricemia has been on the rise. Bariatric surgery, an efficacious intervention for morbid obesity and its associated metabolic disorders, not only manages the weight of patients with severe obesity but also exerts beneficial therapeutic effects on hyperuricemia and gout. Moreover, it demonstrates substantial efficacy against other obesity-related metabolic conditions. However, the dramatic fluctuations in serum uric acid levels and acute gouty attacks in the immediate postoperative period are issues that should not be overlooked, and effective preventative strategies for some related adverse complications are still underexplored. This review discusses and reviews the advancements in the treatment of obese patients with hyperuricemia through bariatric surgery. By reviewing pertinent literature, it summarizes the short-term and long-term therapeutic outcomes of bariatric surgery for hyperuricemia, as well as common adverse reactions. Furthermore, by discussing preoperative and postoperative interventional measures and influential factors, this review aims to provide novel perspectives for the clinical management of hyperuricemia and offer insights for the prevention of related complications.
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Affiliation(s)
- Ke Song
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Xiangxin Kong
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Zhenghang Yu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - He Xiao
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Yixing Ren
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
- General Surgery, Chengdu XinHua Hospital Affiliated to North Sichuan Medical College, Chengdu, 610000, Sichuan Province, China.
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Ueyama H, Yamamura M, Koyanagi J, Fukunaga K, Takemura S, Nakamura S. Early Postoperative Functional Recovery in Older Patients With Periprosthetic Femoral Fractures: Comparison Between Cemented and Cementless Stem Revisions. Arthroplast Today 2024; 28:101467. [PMID: 39100417 PMCID: PMC11295462 DOI: 10.1016/j.artd.2024.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/18/2024] [Accepted: 06/10/2024] [Indexed: 08/06/2024] Open
Abstract
Background Early postoperative functional recovery is important in older patients with lower-extremity fractures to prevent disuse, and periprosthetic femoral fractures (PFFs) are no exception. This study aimed to compare the postoperative functional recovery in the early phase after revision for PFF with loose stems between cemented and cementless stems. Methods Eighteen patients with Unified Classification System type B2 PFF were included in this retrospective cohort study with a follow-up period of about 2 years. All patients underwent stem revision and were divided into 2 groups: the cemented stem group (n = 9) and the cementless stem group (n = 9). In postrevision, functional independence measure score, independent walk rate, activities of daily living recovery rate to the original level at 2 weeks postoperatively, the Beals and Tower classification for radiological status, and survival rate for readmission as endpoints were compared between the 2 groups. Results Patients in the cemented group recovered functional mobility earlier than in the cementless group, with higher postoperative functional independence measure functional subscale values (73 vs 50 points, P = .02), higher independent walk rate (89 vs 11%, P < .01), and more postoperative activities of daily living recovery (100% vs 44%, P = .03) at 2 weeks postoperatively. The Beals and Tower classification and survival rates were similar in both groups. Conclusions Revision using a cemented stem for PFF in older patients was a useful surgical procedure in terms of early postoperative functional recovery. Cemented stem revision was comparable with cementless in bone union and safety at 2 years postoperatively.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Mitsuyoshi Yamamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Junichiro Koyanagi
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Kenji Fukunaga
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Susumu Takemura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Sano Memorial Hospital, Izumisanoshi, Osaka, Japan
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Siminiuc D, Gumuskaya O, Mitchell R, Bell J, Cameron ID, Hallen J, Birkenhead K, Hurring S, Baxter B, Close J, Sheehan KJ, Johansen A, Chehade MJ, Sherrington C, Balogh ZJ, Taylor ME, Sarkies M. Rehabilitation after surgery for hip fracture - the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study. BMC Geriatr 2024; 24:629. [PMID: 39044173 PMCID: PMC11264512 DOI: 10.1186/s12877-024-05206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture. METHODS A cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders. RESULTS Of 437 patients, 62% were female, 56% were aged ≥ 85 years, 23% were previously living in a residential aged care facility, 48% usually walked with a gait aid, and 38% were cognitively impaired prior to their injury. The median acute and total LOS were 8 (IQR 5-13) and 20 (IQR 8-38) days. Approximately 71% (n = 179/251) of patients originally living in private residence returned home and 29% (n = 72/251) were discharged to a residential aged care facility. Previously mobile patients had a higher total LOS if they walked day 2-3 (10.3 days; 95% CI 3.2, 17.4) or transferred with a mechanical lifter or did not get out of bed day 1 (7.6 days; 95% CI 0.6, 14.6) compared to those who walked day 1 postoperatively. Previously mobile patients from private residence had a reduced odds of return to private residence if they walked day 2-3 (OR 0.38; 95% CI 0.17, 0.87), day 4 + (OR 0.38; 95% CI 0.15, 0.96), or if they only sat, stood or stepped on the spot day 1 (OR 0.29; 95% CI 0.13, 0.62) when compared to those who walked day 1 postoperatively. Among patients from private residence, each additional physiotherapy session per day was associated with a -2.2 (95% CI -3.3, -1.0) day shorter acute LOS, and an increased log odds of return to private residence (OR 1.76; 95% CI 1.02, 3.02). CONCLUSION Hip fracture patients who walked earlier, were more active day 1 postoperatively, and/or received a higher number of physiotherapy sessions were more likely to return home after a shorter LOS.
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Affiliation(s)
- Daniel Siminiuc
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia
| | - Oya Gumuskaya
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Sydney, Australia
| | - Jack Bell
- Allied Health Research Collaborative, The Prince Charles Hospital, QLD, 4032, Chermside, Australia
| | - Ian D Cameron
- Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health Districtand, University of Sydney, NSW, 2064, St Leonards, Australia
| | - Jamie Hallen
- Neuroscience Research Australia, University of New South Wales, NSW, 2031, Randwick, Australia
| | - Karen Birkenhead
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia
- Implementation Science Academy, Sydney Health Partners, NSW, Camperdown, Australia
| | - Sarah Hurring
- Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Brett Baxter
- Physiotherapy Department, Princess Alexandra Hospital, QLD, 4102, Woolloongabba, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, University of New South Wales, NSW, 2031, Randwick, Australia
- School of Clinical Medicine, University of New South Wales, NSW, 2052, Sydney, Australia
| | - Katie J Sheehan
- Bone & Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Antony Johansen
- School of Medicine, University Hospital of Walesand, Cardiff University, Cardiff, UK
| | - Mellick J Chehade
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydneyand, Sydney Local Health District, Gadigal Land, NSW, 2006, Sydney, Australia
- Sydney School of Public Health and, Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Gadigal Land, NSW, 2006, Sydney, Australia
| | - Zsolt J Balogh
- Department of Traumatology, Trauma and Injury Research Program, John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, NSW, Newcastle, Australia
| | - Morag E Taylor
- Neuroscience Research Australia, University of New South Wales, NSW, 2031, Randwick, Australia
| | - Mitchell Sarkies
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia.
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Sydney, Australia.
- Implementation Science Academy, Sydney Health Partners, NSW, Camperdown, Australia.
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Grabmann C, Hussain I, Zeller A, Kirnaz S, Sullivan V, Sommer F. Early Postoperative Weight-Bearing Ability after Total Hip Arthroplasty versus Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture. J Clin Med 2024; 13:3128. [PMID: 38892839 PMCID: PMC11172539 DOI: 10.3390/jcm13113128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/29/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Femoral neck fractures are among the most common types of fractures and particularly affect elderly patients. Two of the most common treatment strategies are total hip arthroplasty (THA) and bipolar hemiarthroplasty (BA). However, the role of the different treatment strategies in the postoperative weight-bearing ability in the early postoperative phase is still not entirely clear. Methods: Patients who underwent either THA or BA were consecutively included in our prospective cohort study. Gait analysis was performed during the early postoperative period. The gait analysis consisted of a walking distance of 40 m coupled with the turning movement in between. During the gait analysis, the duration of the measurement, the maximum peak force and the average peak force were recorded. Results: A total of 39 patients were included, 25 of whom underwent BA and 14 of whom underwent THA. The maximum peak force during the gait analysis was, on average, 80.6% ± 19.5 of the body weight in the BA group and 78.9% ± 21.6 in the THA group. The additionally determined average peak force during the entire gait analysis was 66.8% ± 15.8 of the body weight in the BA group and 60.5% ± 15.6 in the THA group. Conclusions: Patients with femoral neck fractures undergoing THA and BA can achieve sufficient weight bearing on the operated leg in the early postoperative period. In our study, BA did not allow for a significantly higher average and maximum loading capacity compared with THA.
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Affiliation(s)
- Chiara Grabmann
- University Hospital of Munich, Ludwig Maximilian University, 81377 Munich, Germany
| | - Ibrahim Hussain
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| | - Anne Zeller
- University Hospital of Munich, Ludwig Maximilian University, 81377 Munich, Germany
| | - Sertac Kirnaz
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| | - Vincent Sullivan
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - Fabian Sommer
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
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Lau B, March MK, Harmer AR, Caruana S, Mahony C, Dennis S. Experiences of Boosting Inpatient Exercise After HipFracture Surgery Using An Alternative Workforce - A Qualitative Study. BMC Geriatr 2024; 24:183. [PMID: 38395780 PMCID: PMC10893611 DOI: 10.1186/s12877-024-04756-1] [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: 04/24/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Thrice-daily physiotherapy immediately following surgical repair of hip fracture has been shown to be safe and to reduce total hospital length of stay. However, implementing this is challenging with respect to health service funding and staffing. A novel approach may be to utilize an alternative workforce (allied health staff and student physiotherapists) to deliver two of the three daily treatments. However, how patients and staff may view such an approach is unknown. Thus, the aim of this qualitative study was to explore the views of inpatients with surgical repair of a hip fracture, their carers, health care professionals, and physiotherapy students about the implementation and acceptability of thrice-daily physiotherapy, with two sessions delivered by the alternative workforce (the BOOST study). METHODS Semi-structured interviews and focus groups with patients, carers, health professionals and physiotherapy students. All interviews were digitally recorded and transcribed via verbatim. The transcripts were coded, and the data analysed via inductive thematic analysis. RESULTS A total of 37 interviews (32 one-to-one interviews and five focus group interviews) were analysed. Five main themes were identified: (1) individual perceptions of the intervention: inpatients/carer/staff/student, (2) implementation within the service and organisational context, (3) implementation strategies that were effective, (4) improvements to implementation strategies/barriers to implementation/unsuccessful strategies and (5) future directions of BOOST. CONCLUSIONS The qualitative data revealed that higher frequency physiotherapy was well-received by inpatients and that staff/students involved in providing care perceived it as a safe, acceptable and valuable practice. Implementation of higher daily frequency of physiotherapy using an alternative workforce may feasibly be adopted for inpatients following hip fracture surgery. TRIAL REGISTRATION This study was approved by the Human Research Ethics Committee (HREC) of the Western Sydney Local Health District (2020/ETH02718). Mutual recognition of approval was subsequently obtained from Northern Sydney Local Health District HREC.
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Affiliation(s)
- Benny Lau
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Physiotherapy Department, Fairfield Hospital, South Western Sydney Local Health District, Warwick Farm, Australia
| | - Marie K March
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, Australia.
| | - Alison R Harmer
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Sarah Caruana
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, Australia
| | - Christopher Mahony
- Physiotherapy Department, Hornsby Ku-ring-gai Hospitals, Northern Sydney Local Health District, Hornsby, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Physiotherapy Department, Fairfield Hospital, South Western Sydney Local Health District, Warwick Farm, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
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Danford NC, Mehta S, Lack WD, Kleweno CP. For Surgically Treated Geriatric Acetabular Fractures, Longer Duration between Admission and Surgery Is Associated with an Increase in Post-operative Complications: A Study Using the National Trauma Data Bank. J Am Acad Orthop Surg 2024; 32:e193-e203. [PMID: 38335144 DOI: 10.5435/jaaos-d-23-00511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/02/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION The purpose of this study was to determine whether time from hospital admission to surgery is associated with inpatient complications and mortality for geriatric patients undergoing surgical treatment of acetabular fractures. METHODS This was a retrospective cohort study using the National Trauma Data Bank from 2016 to 2018 of patients presenting to level I through IV trauma centers in the United States. All patients aged 60 years or older with acetabular fractures requiring surgical treatment were included. The main outcome measurements were inpatient mortality and complication rates. RESULTS There were 6,036 patients who met inclusion criteria. The median age was 69 years (interquartile range 64-76 years). The odds of a complication increased by 7% for each additional day between hospital admission and surgery (multivariable regression OR 1.07, 95% CI = 1.04 to 1.10; P < 0.001). Complications were also associated with patient age (OR 1.05, 95% CI = 1.03 to 1.06; P < 0.001) and mCCI ≥ 5 (OR 2.52, 95% CI = 1.4 to 4.2; P = 0.001). Inpatient mortality was not associated with time to surgery (OR 0.97, 95% CI = 0.92 to 1.02; P = 0.30), but was associated with patient age (OR 1.07, 95% CI = 1.05 to 1.10; P < 0.001; P < 0.001) and mCCI ≥ 5 (OR 4.62, 95% CI = 2.31 to 8.50; P < 0.001). DISCUSSION In this database study, time from hospital admission to surgery was associated with a notable increase in inpatient complications but not inpatient mortality after adjusting for potentially confounding variables while age and mCCI were associated with both mortality and complications. Additional research is needed to determine the relationship between time to surgery with longer term mortality and complications and to assess causality. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Nicholas C Danford
- From The Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY (Danford), The Department of Orthopedic Surgery, Stanford University, Palo Alto, CA (Mehta), The Department of Orthopedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA (Lack and Kleweno)
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Mashimo S, Kubota J, Sato H, Saito A, Gilmour S, Kitamura N. The impact of early mobility on functional recovery after hip fracture surgery. Disabil Rehabil 2023; 45:4388-4393. [PMID: 36448297 DOI: 10.1080/09638288.2022.2151652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To examine the effect of early mobility (EM) on functional recovery after hip fracture surgery, and to investigate the potential factors that delay mobility. METHODS In this retrospective observational study, 110 hip fracture patients were divided into two groups according to the days between surgery and mobility referred to as the EM and the delayed mobility groups. Demographic data, perioperative data, functional outcomes, and discharge destination were compared statistically between the groups using univariate analysis and logistic regression analysis. As a sensitivity analysis, the factors associated with the timing of physiotherapy were also assessed. RESULTS The EM group had significantly better walking ability and Barthel index (p < 0.05), and home discharge rate (p = 0.004). The factors associated with delayed mobility (odds ratio; 95% confidence interval) were delayed postoperative physiotherapy initiation (3.59; 1.76-7.33), days from admission to surgery (1.23; 1.04-1.46), and postoperative CRP (1.14; 1.01-1.29) and hemoglobin level (0.72; 0.54-0.96). Furthermore, patients who received surgery on the day before any holiday were significantly delayed in physiotherapy intervention (p = 0.006). CONCLUSIONS This study demonstrated that EM after hip fracture surgery was associated with improving functional recovery and home discharge rate, and early physiotherapy intervention was associated with EM.
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Affiliation(s)
- Shota Mashimo
- Department of Rehabilitation, St. Luke's International Hospital, Tokyo, Japan
| | - Junya Kubota
- Department of Rehabilitation, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroyuki Sato
- Department of Rehabilitation, St. Luke's International Hospital, Tokyo, Japan
| | - Azusa Saito
- Department of Rehabilitation, St. Luke's International Hospital, Tokyo, Japan
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Nobuto Kitamura
- Department of Rehabilitation, St. Luke's International Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
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Chung YY, Baek SN, Park TG, Kim MY. The Effects of COVID-19 Pandemic on the Recovery of Hip Fracture Patients. Hip Pelvis 2023; 35:253-258. [PMID: 38125271 PMCID: PMC10728043 DOI: 10.5371/hp.2023.35.4.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose To figure out how complete control of family visits to prevent infection of coronavirus disease 2019 (COVID-19) affected the activity recovery of hip fracture patients admitted to nursing hospitals. Materials and Methods Eighty-one patients with hip surgery in the two years prior to COVID-19 pandemic were classified as Group A, and 103 patients in the next two years were designated as Group B. The subjects' walking ability was evaluated by using the modified Koval index (MKI). In order to analyze the impact of the family visit control to the subjects, each group was classified into two different groups: (1) inpatients group who admitted to nursing hospitals and (2) home-treated patients. Additionally, statistical elements were processed in consideration of other factors that may affect the results of the experiment. Results The MKI evaluated at 6 months postoperative was 3.31±1.79 in Group A and 2.77±1.91 in Group B, and it was meaningfully low after the pandemic (P=0.04). There was significantly low among both of Group A 2.74±1.76 and Group B 1.93±1.81 after the pandemic (P=0.03) among those treated at the nursing hospital. The rate of deterioration of the MKI was 35 (43.2%) in Group A and 57 (55.3%) in Group B, which increased by 12.1% after the pandemic. Conclusion The pandemic had a negative effect on the recovery of postoperative activities of elderly hip fracture patients who admitted to nursing hospitals when family access was completely restricted to prevent infection.
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Affiliation(s)
- Young Yool Chung
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sung Nyun Baek
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Tae Gyu Park
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Min Young Kim
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Tan S, Vasireddy A. Early mobilisation following fragility hip fracture surgery: current trends and association with discharge outcomes in a local tertiary hospital. Singapore Med J 2023; 64:721-727. [PMID: 34617696 PMCID: PMC10775299 DOI: 10.11622/smedj.2021132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
Introduction Postoperative day 1 (POD 1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD 1 mobilisation at our institution and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination. Methods In this preliminary observational study, data pertaining to demographics, premorbid function, health status, injury and surgical factors, POD 1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD 1 ambulation formed the early ambulation (EA) group, while the remaining patients formed the delayed ambulation (DA) group. Data were analysed for any significant difference between the groups. Results One hundred and fifteen patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD 1 was 80.0% (n=92), which was comparable to the data available from international hip fracture audit databases. There were 55 (47.8%) patients in the EA group and 60 (52.5%) patients in the DA group. The EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20, 95% confidence interval 1.50-56.45; P = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to the DA group (P > 0.05). Conclusion This is the first local study to offer benchmark of the POD 1 mobilisation status for this population. Patients who attained POD 1 ambulation had better early functional recovery.
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Affiliation(s)
- Shumei Tan
- Department of Rehabilitative Services, Changi General Hospital, Singapore
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Aswinkumar Vasireddy
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
- Department of Trauma and Orthopaedic Surgery, King’s College Hospital, London, UK
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Yang TI, Kuo YJ, Huang SW, Chen YP. Minimal short-term decline in functional performance and quality of life predicts better long-term outcomes for both in older Taiwanese adults after hip fracture surgery: a prospective study. J Orthop Surg Res 2023; 18:791. [PMID: 37872535 PMCID: PMC10594772 DOI: 10.1186/s13018-023-04278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Hip fracture can lead to long-term loss of mobility and self-care ability in older adults. Despite initial decreases in functional performance after hip fracture surgery, patients tend to gradually recover. However, recovery can vary, with some regaining their abilities quickly while others becoming functionally dependent. In this study, we investigated whether the level of short-term postoperative decline in activity of daily living (ADL) performance and quality of life (QoL) can predict the 1-year outcomes for both following hip fracture surgery in older Taiwanese adults. METHODS This prospective cohort study included 427 older adults (≥ 60 years) who underwent hip fracture surgery at a single tertiary medical center in Taiwan between November 2017 and March 2021. We collected pre-fracture data, including the patients' demographics, Charlson comorbidity index (CCI) scores, and responses to a questionnaire (Short Portable Mental State Questionnaire [SPMSQ]) for dementia screening. Moreover, their scores on the EuroQol-5D questionnaire (for evaluating QoL) and the Barthel Index (for assessing ADL performance) were collected at pre-fracture status and at 3- and 12-months following surgery. Changes in ADL and QoL three months post-surgery compared to pre-fracture status were evaluated, and the associations of these parameters (and other potential factors) with 1-year outcomes for ADL and QoL were investigated. RESULTS We analyzed the data of 318 patients with hip fracture and complete follow-up data regarding ADL performance and QoL at 3- and 12-months post-surgery. After adjusting for covariates, multivariate linear regression revealed that changes in ADL and QoL at 3 months post-surgery from pre-fracture status were positively and significantly associated with 1-year outcomes for both (p < .001 for both). Furthermore, pre-fracture CCI and SPMSQ scores were independent predictive factors associated with 1-year ADL outcomes (p = .042 and < .001, respectively). CONCLUSIONS Patients who exhibit a smaller decline in functional performance and quality of life three months after hip fracture surgery from pre-fracture status are likely to have improved long-term ADL and QoL. TRIAL REGISTRATION TMU-JIRB N201709053.
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Affiliation(s)
- Tzu-I Yang
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan
- Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, 116, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan.
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Ta CN, Lurie B, Mitchell B, Howard R, Onodera K, Harkin W, Ouillette R, Kent WT. Ambulation Distance Within 72 Hours after Surgical Management Is a Predictor of 90-Day Ambulatory Capacity in Elderly Patients with Hip Fracture. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202308000-00012. [PMID: 37607250 PMCID: PMC10445784 DOI: 10.5435/jaaosglobal-d-23-00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/30/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION The inability to mobilize after surgical intervention for hip fractures in the elderly is established as a risk factor for greater morbidity and mortality. Previous studies have evaluated the association between the timing and distance of ambulation in the postoperative acute care phase with postoperative complications. The purpose of this study was to evaluate the association between ambulatory distance in the acute postoperative setting and ambulatory capacity at 3 months. METHODS Patients aged 65 and older who were ambulatory at baseline and underwent surgical intervention for hip fractures from 2014 to 2019 were retrospectively reviewed. Consistent with previous literature, patients were divided into two groups: those who were able to ambulate 5 feet within 72 hours after surgical fixation (early ambulatory) and those who were not (minimally ambulatory). RESULTS One hundred seventy patients (84 early ambulatory and 86 minimally ambulatory) were available for analysis. Using a multivariable ordinal logistic regression model, variables found to be statistically significant predictors of ambulatory status at 3 months were the ability to ambulate five feet in 72 hours (P < 0.0001), ambulatory distance at discharge (P = 0.012), and time from presentation to surgery (P = 0.039). Patients who were able to ambulate 5 feet within 72 hours had 9 times the odds of being independent ambulators rather than a lower ambulatory class (cane, walker, and nonambulatory). Pertrochanteric fractures were less likely than femoral neck fractures to independently ambulate at 3 months (17.2% vs. 42.3%; P = 0.0006). DISCUSSION Ambulating 5 feet within 72 hours after hip fracture surgery is associated with an increased likelihood of independent ambulation at 3 months postoperatively. This simple and clear goal may be used to help enhance postoperative mobility and independence while providing a metric to guide therapy and help counsel patients and families.
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Affiliation(s)
- Canhnghi N. Ta
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Benjamin Lurie
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Brendon Mitchell
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Roland Howard
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Keenan Onodera
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Will Harkin
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - Ryan Ouillette
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
| | - William T. Kent
- From the University of California San Diego, Arbor Drive, San Diego, CA (Dr. Ta, Dr. Mitchell, Dr. Howard, Dr. Onodera, and Dr. Kent); the University of Nevada Las Vegas, Las Vegas, NV (Dr. Lurie); the Rush University, Chicago, IL (Dr. Harkin); and the UCLA Health, Santa Monica, CA (Dr. Ouillette)
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van Dartel D, Wang Y, Hegeman JH, Vermeer M, Vollenbroek-Hutten MMR. Patterns of physical activity over time in older patients rehabilitating after hip fracture surgery: a preliminary observational study. BMC Geriatr 2023; 23:373. [PMID: 37328743 PMCID: PMC10276437 DOI: 10.1186/s12877-023-04054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/20/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND To investigate patterns of continuously monitored physical activity in older patients rehabilitating after hip fracture surgery and the association with patient characteristics. METHODS Physical activity of surgically treated hip fracture patients aged 70 years or older, who were rehabilitating at a skilled nursing home, was continuously monitored using a tri-axial accelerometer. The intensity of physical activity per day was calculated from the accelerometer signals to describe the daily physical activity levels of the enrolled patients. The patterns of three different aspects of physical activity were investigated: overall physical activity, overall variability, and day-to-day variability. Two experts in the geriatric rehabilitation field helped identifying unique physical activity patterns for each aspect based on visual analysis. Eighteen healthcare professionals independently classified each patient in one of the predefined patterns for each aspect. Differences between physical activity patterns and patient characteristics were assessed using a Kruskal-Wallis or Fisher's Exact Test. RESULTS Physical activity data from 66 older patients were used in this preliminary study. A total of six unique patterns were identified for overall physical activity and overall variability, and five unique patterns for the day-to-day variability. The most common pattern found for the overall physical activity and day-to-day variability had a S-shape, which first slowly increased, then steeply increased, and subsequently flattened (n = 23, 34.8%). A N-shape pattern was found the most common pattern for overall variability, which first slowly increased, then steeply increased, then decreased and lastly increased (n = 14, 21.2%). The functionality at admission to rehabilitation, measured with the Barthel Index, and the duration of rehabilitation stay differed between the patterns of physical activity. CONCLUSIONS Multiple patterns of physical activity among older patients during hip fracture rehabilitation were found in this preliminary study. The functionality at admission to rehabilitation and the duration of rehabilitation stay were associated with the different patterns found in this study. Results of this study highlight the importance of personalized hip fracture treatment.
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Affiliation(s)
- Dieuwke van Dartel
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Ying Wang
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Johannes H. Hegeman
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Miriam M. R. Vollenbroek-Hutten
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Board of Directors, Medisch Spectrum Twente, Enschede, The Netherlands
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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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Liao J, Qi Z, Chen B, Lei P. Association between early ambulation exercise and short-term postoperative recovery after open transforaminal lumbar interbody fusion: a single center retrospective analysis. BMC Musculoskelet Disord 2023; 24:345. [PMID: 37143006 PMCID: PMC10158157 DOI: 10.1186/s12891-023-06395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Early ambulation in patients undergoing transforaminal lumbar interbody fusion (TLIF) surgery is recommended, however, the precise time interval after open surgery has never been specified. Current retrospective analysis was conducted aiming to clarify an accurate time interval. METHODS A retrospective analysis of eligible patients was conducted using the databases of the Bone Surgery Department, Third Affiliated Hospital of Sun Yat-sen University from 2016 to 2021. Data pertaining to postoperative hospital stay length, expenses, incidence of complications were extracted and compared using Pearson's χ2 or Student's t-tests. A multivariate linear regression model was conducted to identify the relationship between length of hospital stay (LOS) and other outcomes of interest. A propensity analysis was conducted to minimize bias and to evaluate the reliability of results. RESULTS A total of 303 patients met the criteria and were included for the data analysis. Multivariate linear regression results demonstrated that a high ASA grade (p = 0.016), increased blood loss (p = 0.003), cardiac disease (p < 0.001), occurrence of postoperative complications(p < 0.001) and longer ambulatory interval (p < 0.001) was significantly associated with an increased LOS. The cut-off analysis manifested that patients should start mobilization within 3 days after open TLIF surgery (B = 2.843, [1.395-4.292], p = 0.0001). Further comparative analysis indicated that patients who start ambulatory exercise within 3 days have shorter LOS (8.52 ± 3.28d vs 12.24 ± 5.88d, p < 0.001), total expenses ( 9398.12 ± 2790.82vs 10701.03 ± 2994.03 [USD], p = 0.002). Propensity analysis revealed such superiority was stable along with lower incidence of postoperative complications (2/61 vs 8/61, p = 0.0048). CONCLUSIONS The current analysis suggested that ambulatory exercise within 3 days for patients who underwent open TLIF surgery was significantly associated with reduced LOS, total hospital expenses, and postoperative complications. Further causal relationship would be confirmed by future randomized controlled trials.
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Affiliation(s)
- Jingwen Liao
- Department of Bone Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhou Qi
- Department of Bone Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Biying Chen
- Department of Bone Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Purun Lei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Turabi RY, Wyatt D, Guerra S, O'Connell MDL, Khatun T, Sageer SA, Alhazmi A, Sheehan KJ. Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review. Osteoporos Int 2023:10.1007/s00198-023-06735-5. [PMID: 37016146 DOI: 10.1007/s00198-023-06735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/24/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults. METHODS Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov , OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach. RESULTS In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses' notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year. CONCLUSION Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes.
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Affiliation(s)
- R Y Turabi
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK.
- Department of Physical Therapy, Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.
| | - D Wyatt
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - S Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - M D L O'Connell
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - T Khatun
- Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S A Sageer
- Department of Orthopaedic, Relief Hospital and Trauma Centre, Kerala, India
| | - A Alhazmi
- Department of Orthopaedic, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - K J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
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Koudouna S, Evangelopoulos DS, Sarantis M, Chronopoulos E, Dontas IA, Pneumaticos S. The Effect of Postoperative Physical Therapy Following Hip Fracture: A Literature Review. Cureus 2023; 15:e37676. [PMID: 37206486 PMCID: PMC10189836 DOI: 10.7759/cureus.37676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/21/2023] Open
Abstract
Hip fractures in the elderly have become a major public health concern as the population ages. Post-operative rehabilitation is associated with improved outcomes and a greater likelihood of returning to pre-operative functional capacity. Several studies have been conducted to investigate various post-operative recovery pathways. However, little is known about which post-operative rehabilitation pathways for hip fractures are most effective in improving patient outcomes. No clear evidence-based guidelines for a standard mobilization protocol for patients are currently available. This review aims to investigate post-operative recovery pathways to help patients suffering from hip fracture return to pre-fracture condition and to quantify pre-operative and post-operative scores for objective rehabilitation evaluation. Measuring pre-operative activity and comparing it to post-operative follow-up values can help predict post-operative rehabilitation functional outcomes.
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Affiliation(s)
- Smaragda Koudouna
- Department of Physiotherapy, General Hospital of Attika 'KAT', Athens, GRC
| | - Dimitrios S Evangelopoulos
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
| | - Michail Sarantis
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
| | - Efstathios Chronopoulos
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
- Department of Orthopedic Surgery, Laboratory for Research of the Musculoskeletal System (LRMS) of the School of Medicine, University of Athens, Athens, GRC
| | - Ismene A Dontas
- Department of Veterinary Medicine, Laboratory for Research of the Musculoskeletal System (LRMS) of the School of Medicine, University of Athens, Athens, GRC
- Department of Veterinary Medicine, General Hospital of Attika 'KAT', Athens, GRC
- Department of Veterinary Medicine, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
| | - Spiros Pneumaticos
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
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van Loon OR, van Loon AJT. Rest is essential for effective therapies, and so it is for preparing a manuscript. Complement Ther Med 2023; 72:102921. [PMID: 36693510 DOI: 10.1016/j.ctim.2023.102921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 01/22/2023] Open
Abstract
Numerous medical articles are commented upon. This suggests that their scientific quality is insufficient. This need not be the case, however: most comments regard the presentation of the data, the conclusions or lacking information in the discussion. Such flaws can commonly be attributed to either too much haste in writing the manuscript, or insufficient time between finishing the manuscript and submission; this last problem seems the most common cause, as it deprives the author from reading his own text critically and with an open mind. The solution for this problem is simple: after having finished a manuscript, it should be laid aside for at least a week, after which the author should read it with the eyes of a reader, not the eyes of an author. Critical, open-minded reading after rest helps increase the quality of the resulting manuscript, just like rest helps a patient during most therapies.
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Affiliation(s)
- Olaf R van Loon
- Privat Klinik im Park, Therapy Department, Badstrasse 50, CH-5116 Schinznach-Bad, Switzerland.
| | - A J Tom van Loon
- College of Earth Science and Engineering, Shandong University of Science and Technology, Qingdao 266590, Shandong, China.
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Wang H, Yan C, Wu Q, Zeng H, Zhang Z, Wang W, Sun X. Acute gout attacks during the perioperative period and risk factors of recurrence after orthopedic surgery among untreated gout patients. J Orthop Surg Res 2023; 18:61. [PMID: 36683056 PMCID: PMC9869566 DOI: 10.1186/s13018-023-03536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND This study aimed to explore the clinical characteristics of perioperative acute gout attacks in patients with varying uric acid levels undergoing orthopedic surgery, identify the risk factors for gout recurrence within the first postoperative year, and provide a disease prevention and diagnostic reference. METHODS This hospital-based retrospective study was conducted between January 2018 and December 2020. According to the blood uric acid levels at admission, the patients were grouped into either the normal uric acid level group or the hyperuricemia group. Patient comorbidities, serum uric acid levels, inflammatory indicators, follow-up recurrence rates, and other indicators were compared. RESULT The uric acid decline ratio and the inflammatory indexes (white blood cell count and C-reactive protein level) at the time of the attack were significantly higher in the normal uric acid level group than in the hyperuricemia group (P < 0.05). Patients in the hyperuricemia group with diabetes and tophi and those administered diuretics were more prone to acute gout attacks than those in the normal uric acid level group (P < 0.05). In the normal uric acid level group, 22 patients (84.6%) exhibited single joint involvement, whereas only 18 patients (47.4%) in the hyperuricemia group demonstrated single joint involvement (P < 0.05). After 1 year of follow-up, the gout recurrence rate in the hyperuricemia group was 44.7%, which was significantly higher that the recurrence rate in the normoglycemic group (11.5%; P < 0.05). Presenting tophi in perioperative orthopedic surgery patients was found to be an independent risk factor for gout recurrence within 1 year (RR = 4.80; P = 0.029). CONCLUSION The recurrence rate of gout in patients with hyperuricemia during perioperative period increased 1 year after operation. Therefore, it is crucial to monitor the uric acid level to prevent acute gout attacks during the perioperative period and recurrence during the 1-year follow-up period. Moreover, the risk of an acute gout recurrence 1 year after operation increased in patients who presented tophi; therefore, it is necessary to maintain appropriate blood uric acid level during perioperative period among patients undergoing orthopedic surgery.
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Affiliation(s)
- Hui Wang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian Province People’s Republic of China ,grid.256112.30000 0004 1797 9307Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Chao Yan
- School of Health Care, MinJiang Teachers College, Fuzhou, 350108 Fujian Province People’s Republic of China
| | - Qiping Wu
- grid.256112.30000 0004 1797 9307Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Hao Zeng
- grid.256112.30000 0004 1797 9307Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Zhihong Zhang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Wanming Wang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian Province People’s Republic of China
| | - Xiaotang Sun
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian Province People’s Republic of China
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Takemoto N, Yoshitani J, Saiki Y, Numata H, Nambu K. Effect of Postoperative Non-Weight-Bearing in Trochanteric Fracture of the Femur: A Retrospective Cohort Study Using Propensity Score Matching. Geriatr Orthop Surg Rehabil 2023; 14:21514593231160916. [PMID: 36875966 PMCID: PMC9974619 DOI: 10.1177/21514593231160916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction The effects of postoperative early weight-bearing (WB) on walking ability, muscle mass, and sarcopenia have been investigated. Postoperative WB restriction is also reportedly associated with pneumonia and prolonged hospitalization; however, its effect on surgical failures has not been studied. This study aimed to assess whether WB restriction after surgery for trochanteric fracture of the femur (TFF) is useful in preventing surgical failure, considering the unstable fracture type, quality of intraoperative reduction, and tip-apex distance. Patients and Methods This retrospective analysis included 301 patients admitted to a single institution between January 2010 and December 2021, diagnosed with TFF, and who underwent femoral nail surgery. Eight patients were excluded, and finally 293 patients were included in the study. Propensity score (PS) matching yielded 123 cases; 41 patients in the non-WB (NWB) group and 82 patients in the WB group were included in the final analysis. The primary outcome was surgical failure (cutout, nonunion, osteonecrosis, and implant failure). The secondary outcomes were medical complications (pneumonia, urinary tract infection, stroke, and heart failure), change in walking ability, period of hospitalization, and sliding distance of the lag screw. Results Five surgical complications occurred in the NWB group and two in the WB group, with significantly more surgical complications in the NWB group (P = .041). Cutout occurred in two cases, each in the NWB and WB groups. Two cases of nonunion and one case of implant failure occurred in the NWB group, but not in the WB group. Osteonecrosis did not occur in both groups. The secondary outcomes were not significantly different between the two groups. Conclusions The results of this retrospective cohort study using a PS matching approach showed that WB restriction after TFF surgery could not decrease the incidence of surgical failures.
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Affiliation(s)
- Naoki Takemoto
- Department of Orthopaedic Surgery, Toyamakensaiseikaitakaoka Hospital, Takaoka, Toyama, Japan
| | - Junya Yoshitani
- Department of Orthopaedic Surgery, Toyamakensaiseikaitakaoka Hospital, Takaoka, Toyama, Japan
| | - Yoshitomo Saiki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Hitoaki Numata
- Department of Orthopaedic Surgery, Toyamakensaiseikaitakaoka Hospital, Takaoka, Toyama, Japan
| | - Koshi Nambu
- Department of Orthopaedic Surgery, Toyamakensaiseikaitakaoka Hospital, Takaoka, Toyama, Japan
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Rix A, Lawrence D, Raper E, Calthorpe S, Holland AE, Kimmel LA. Measurement of Mobility and Physical Function in Patients Hospitalized With Hip Fracture: A Systematic Review of Instruments and Their Measurement Properties. Phys Ther 2022; 103:pzac142. [PMID: 36222144 DOI: 10.1093/ptj/pzac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/09/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting. METHODS Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. RESULTS Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed "Up & Go" Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness over time (effect sizes 0.63-2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] >0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%-60% of patients). The TUG, CAS, and BI all had good clinical utility. CONCLUSION Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting. IMPACT This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes.
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Affiliation(s)
- Alana Rix
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Drew Lawrence
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Eleanor Raper
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Sara Calthorpe
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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22
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Pastor T, Zderic I, Gehweiler D, Gardner MJ, Stoffel K, Richards G, Knobe M, Gueorguiev B. Biomechanical analysis of recently released cephalomedullary nails for trochanteric femoral fracture fixation in a human cadaveric model. Arch Orthop Trauma Surg 2022; 142:3787-3796. [PMID: 34748055 DOI: 10.1007/s00402-021-04239-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recently, two novel concepts for intramedullary nailing of trochanteric fractures using a helical blade or interlocking dual screws have demonstrated advantages as compared to standard single-screw systems. However, these two concepts have not been subjected to a direct biomechanical comparison so far. The aims of this study were to investigate in a human cadaveric model with low bone quality (1) the biomechanical competence of nailing with the use of a helical blade versus interlocking screws, and (2) the effect of cement augmentation on the fixation strength of the helical blade. METHODS Twelve osteoporotic and osteopenic human cadaveric femoral pairs were assigned for pairwise implantation using either a short TFN-ADVANCED Proximal Femoral Nailing System (TFNA) with a helical blade head element or a short TRIGEN INTERTAN Intertrochanteric Antegrade Nail (InterTAN) with interlocking screws. Six osteoporotic femora, implanted with TFNA, were augmented with bone cement. Four groups were created: group 1 (TFNA) paired with group 2 (InterTAN), both consisting of osteopenic specimens, and group 3 (TFNA augmented) paired with group 4 (InterTAN), both consisting of osteoporotic specimens. An unstable trochanteric AO/OTA 31-A2.2 fracture was simulated and all specimens were tested until failure under progressively increasing cyclic loading. RESULTS Stiffness in group 3 was significantly higher versus group 4, p = 0.03. Varus (°) and femoral head rotation around the femoral neck axis (°) after 10,000 cycles were 1.9 ± 1.0/0.3 ± 0.2 in group 1, 2.2 ± 0.7/0.7 ± 0.4 in group 2, 1.5 ± 1.3/0.3 ± 0.2 in group 3 and 3.5 ± 2.8/0.9 ± 0.6 in group 4, being significantly different between groups 3 and 4, p = 0.04. Cycles to failure and failure load (N) at 5° varus or 10° femoral head rotation around the neck axis in groups 1-4 were 21,428 ± 6020/1571.4 ± 301.0, 20,611 ± 7453/1530.6 ± 372.7, 21,739 ± 4248/1587.0 ± 212.4 and 18,622 ± 6733/1431.1 ± 336.7, being significantly different between groups 3 and 4, p = 0.04. CONCLUSIONS Nailing of trochanteric femoral fractures with use of helical blades is comparable to interlocking dual screws fixation in femoral head fragments with low bone quality. Bone cement augmentation of helical blades provides significantly greater fixation strength compared to interlocking screws constructs.
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Affiliation(s)
- Torsten Pastor
- AO Research Institute Davos, Davos, Switzerland.
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | | | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, CA, USA
| | | | | | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Purcell K, Tiedemann A, Kristensen MT, Cunningham C, Hjermundrud V, Ariza-Vega P, Perracini M, Sherrington C. Mobilisation and physiotherapy intervention following hip fracture: snapshot survey across six countries from the Fragility Fracture Network Physiotherapy Group. Disabil Rehabil 2022; 44:6788-6795. [PMID: 34514916 DOI: 10.1080/09638288.2021.1974107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Hip fracture guidelines recommend early mobilisation, multidisciplinary care, physiotherapy and fall prevention interventions. This study documents mobilisation practices and physiotherapy interventions provided post-hip fracture in six countries. MATERIALS AND METHODS Physiotherapists from orthopaedic wards in Denmark, Australia, Spain, Brazil, Norway and Ireland provided information regarding mobilisation and physiotherapy for 10 consecutive hip fracture patients (>60 years), between 2014 and 2018. RESULTS Physiotherapists (n = 107) entered data on 426 patients. Two-thirds of patients (283, 66%) attempted standing 0-1 days after surgery (range: 0% of patients in Spain to 92% in Norway). Fewer patients (199, 47%) attempted walking on day 0-1 (range: 0% Spain/Brazil to 69% Norway). Physiotherapy to mobilise every weekday was provided to 356 patients (84%, range: 60% Ireland to 100% Spain). On weekends, physiotherapy to mobilise was limited (175, 40%, range: 0% Spain to 81% Brazil) but 298 patients (70%) mobilised with non-physiotherapy staff (range: 0% Spain to 96% Denmark/Ireland). Physiotherapy treatments included mobility, gait training, and range-of-motion exercises. Referral to fall prevention interventions was low (93, 22%, range: 0% Spain to 76% Ireland). CONCLUSION Stronger compliance with guideline recommendations on early mobilising, weekend mobilising and referral to fall prevention interventions post hip-fracture is needed in some countries.Implications for rehabilitation This study provides a snapshot of mobilisation and physiotherapy practice for hip fracture patients in six countries. The results suggest a need to improve systems and approaches in some countries to enhance compliance with recommendations specifically relating to: • early attempts at standing and walking post-surgery. • opportunities to mobilise on weekends (with physiotherapist and/or other staff). • broader range of multidisciplinary care e.g., geriatric review, occupational therapy and nutrition advice. • use of standardised tests by physiotherapists post-surgery. • referral to fall prevention interventions.
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Affiliation(s)
- Kate Purcell
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Morten Tange Kristensen
- Departments of Physical Therapy and Orthopedic Surgery, Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Amager - Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Vegar Hjermundrud
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain.,Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, Granada, Spain
| | - Monica Perracini
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
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Rosenberg MJ, Reschke MF, Tomilovskaya ES, Wood SJ. Multiple field tests on landing day: Early mobility may improve postural recovery following spaceflight. Front Physiol 2022; 13:921368. [PMID: 36187781 PMCID: PMC9515505 DOI: 10.3389/fphys.2022.921368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Adaptation to microgravity causes astronauts to experience sensorimotor disturbances during return to Earth leading to functional difficulties. Recently, the Field Test (FT) study involving an incrementally demanding sensorimotor functional test battery has allowed for an unprecedented view into early decrements and recovery from multiple tests conducted on the landing day following 6-months International Space Station missions. Although the protocol was challenging and temporarily increased motion sickness symptoms, there were anecdotal reports that performing these tasks within the first few hours of landing accelerated their recovery. Therefore, results from computerized dynamic posturography (CDP) following return to Houston were used to compare recovery between crewmembers that participated in FT (n = 18) with those that did not (controls, n = 11). While there were significant decrements in postural performance for both groups, some FT participants tended to perform closer to their preflight baseline in the most challenging condition of the CDP sensitive to vestibular function—eyes closed, unstable support and head movements. However, the distribution of difference scores appeared bimodal with other FT participants in the lower range of performance. We attribute these observations to the manner in which the field tests were implemented—some benefitted by encouraging early movement to drive adaptation when performed in a constrained incremental fashion; however, movements above aversive thresholds may have impaired adaptation in others. Challenging the sensorimotor system with increasingly provocative movements performed as close to landing as possible, as long as within individual thresholds, could be a useful intervention to accelerate astronaut’s sensorimotor readaptation that deserves further study.
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Affiliation(s)
| | - Millard F. Reschke
- Neurosciences Laboratory, NASA Johnson Space Center, Houston, TX, United States
| | | | - Scott J. Wood
- Neurosciences Laboratory, NASA Johnson Space Center, Houston, TX, United States
- *Correspondence: Scott J. Wood,
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25
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Kim HS, Lee JE, Choi RJ, Kim CH. Impact of concomitant upper-extremity injuries in patients with hip fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04608-w. [PMID: 36074171 DOI: 10.1007/s00402-022-04608-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Combined hip and upper-extremity fractures raise clinical concerns because upper-extremity fractures may hinder early mobilization, thereby affecting rehabilitation and mortality. This systematic review and meta-analysis aimed to evaluate the effects of combined upper-extremity and hip fractures on rehabilitation and mortality. MATERIALS AND METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published before March 20, 2022, that evaluated the impact of concomitant upper-extremity injuries in geriatric patients with hip fractures. The pooled analysis identified differences in the (1) length of hospital stay, (2) discharge destination, and (3) mortality rates between the isolated and combined hip fracture groups. RESULTS A total of 217,233 patients with isolated hip fractures (n = 203,816) and combined hip and upper-extremity fractures (n = 13,417) from 12 studies were analyzed. The average length of hospital stay was significantly longer in the combined upper-extremity fracture group than in the isolated hip fracture group (mean difference = 1.67 days; 95% confidence interval [CI] 0.63-2.70; P = 0.002). Patients in the combined upper limb fracture group were less likely to be discharged directly home (odds ratio [OR] = 0.64; 95% CI 0.52-0.80; P < 0.001) and showed significantly higher 30-day mortality (OR = 1.44; 95% CI 1.32-1.58; P < 0.001). The mortality rate after 30 days was not significantly different between the two groups. CONCLUSIONS Concomitant upper-extremity fractures have debilitating effects on rehabilitation and early mortality in geriatric patients with hip fractures. Therefore, more focus should be placed on the early ambulation of patients with hip fractures and simultaneous upper limb fractures to promote rehabilitation and alleviate the public health burden. LEVEL OF EVIDENCE III meta-analysis.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Jung Eun Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Rak Jun Choi
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 06973, Republic of Korea.
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Fairhall NJ, Dyer SM, Mak JC, Diong J, Kwok WS, Sherrington C. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2022; 9:CD001704. [PMID: 36070134 PMCID: PMC9451000 DOI: 10.1002/14651858.cd001704.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Improving mobility outcomes after hip fracture is key to recovery. Possible strategies include gait training, exercise and muscle stimulation. This is an update of a Cochrane Review last published in 2011. OBJECTIVES To evaluate the effects (benefits and harms) of interventions aimed at improving mobility and physical functioning after hip fracture surgery in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, trial registers and reference lists, to March 2021. SELECTION CRITERIA All randomised or quasi-randomised trials assessing mobility strategies after hip fracture surgery. Eligible strategies aimed to improve mobility and included care programmes, exercise (gait, balance and functional training, resistance/strength training, endurance, flexibility, three-dimensional (3D) exercise and general physical activity) or muscle stimulation. Intervention was compared with usual care (in-hospital) or with usual care, no intervention, sham exercise or social visit (post-hospital). DATA COLLECTION AND ANALYSIS Members of the review author team independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We used the assessment time point closest to four months for in-hospital studies, and the time point closest to the end of the intervention for post-hospital studies. Critical outcomes were mobility, walking speed, functioning, health-related quality of life, mortality, adverse effects and return to living at pre-fracture residence. MAIN RESULTS We included 40 randomised controlled trials (RCTs) with 4059 participants from 17 countries. On average, participants were 80 years old and 80% were women. The median number of study participants was 81 and all trials had unclear or high risk of bias for one or more domains. Most trials excluded people with cognitive impairment (70%), immobility and/or medical conditions affecting mobility (72%). In-hospital setting, mobility strategy versus control Eighteen trials (1433 participants) compared mobility strategies with control (usual care) in hospitals. Overall, such strategies may lead to a moderate, clinically-meaningful increase in mobility (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.10 to 0.96; 7 studies, 507 participants; low-certainty evidence) and a small, clinically meaningful improvement in walking speed (CI crosses zero so does not rule out a lack of effect (SMD 0.16, 95% CI -0.05 to 0.37; 6 studies, 360 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to short-term (risk ratio (RR) 1.06, 95% CI 0.48 to 2.30; 6 studies, 489 participants; low-certainty evidence) or long-term mortality (RR 1.22, 95% CI 0.48 to 3.12; 2 studies, 133 participants; low-certainty evidence), adverse events measured by hospital re-admission (RR 0.70, 95% CI 0.44 to 1.11; 4 studies, 322 participants; low-certainty evidence), or return to pre-fracture residence (RR 1.07, 95% CI 0.73 to 1.56; 2 studies, 240 participants; low-certainty evidence). We are uncertain whether mobility strategies improve functioning or health-related quality of life as the certainty of evidence was very low. Gait, balance and functional training probably causes a moderate improvement in mobility (SMD 0.57, 95% CI 0.07 to 1.06; 6 studies, 463 participants; moderate-certainty evidence). There was little or no difference in effects on mobility for resistance training. No studies of other types of exercise or electrical stimulation reported mobility outcomes. Post-hospital setting, mobility strategy versus control Twenty-two trials (2626 participants) compared mobility strategies with control (usual care, no intervention, sham exercise or social visit) in the post-hospital setting. Mobility strategies lead to a small, clinically meaningful increase in mobility (SMD 0.32, 95% CI 0.11 to 0.54; 7 studies, 761 participants; high-certainty evidence) and a small, clinically meaningful improvement in walking speed compared to control (SMD 0.16, 95% CI 0.04 to 0.29; 14 studies, 1067 participants; high-certainty evidence). Mobility strategies lead to a small, non-clinically meaningful increase in functioning (SMD 0.23, 95% CI 0.10 to 0.36; 9 studies, 936 participants; high-certainty evidence), and probably lead to a slight increase in quality of life that may not be clinically meaningful (SMD 0.14, 95% CI -0.00 to 0.29; 10 studies, 785 participants; moderate-certainty evidence). Mobility strategies probably make little or no difference to short-term mortality (RR 1.01, 95% CI 0.49 to 2.06; 8 studies, 737 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to long-term mortality (RR 0.73, 95% CI 0.39 to 1.37; 4 studies, 588 participants; low-certainty evidence) or adverse events measured by hospital re-admission (95% CI includes a large reduction and large increase, RR 0.86, 95% CI 0.52 to 1.42; 2 studies, 206 participants; low-certainty evidence). Training involving gait, balance and functional exercise leads to a small, clinically meaningful increase in mobility (SMD 0.20, 95% CI 0.05 to 0.36; 5 studies, 621 participants; high-certainty evidence), while training classified as being primarily resistance or strength exercise may lead to a clinically meaningful increase in mobility measured using distance walked in six minutes (mean difference (MD) 55.65, 95% CI 28.58 to 82.72; 3 studies, 198 participants; low-certainty evidence). Training involving multiple intervention components probably leads to a substantial, clinically meaningful increase in mobility (SMD 0.94, 95% CI 0.53 to 1.34; 2 studies, 104 participants; moderate-certainty evidence). We are uncertain of the effect of aerobic training on mobility (very low-certainty evidence). No studies of other types of exercise or electrical stimulation reported mobility outcomes. AUTHORS' CONCLUSIONS Interventions targeting improvement in mobility after hip fracture may cause clinically meaningful improvement in mobility and walking speed in hospital and post-hospital settings, compared with conventional care. Interventions that include training of gait, balance and functional tasks are particularly effective. There was little or no between-group difference in the number of adverse events reported. Future trials should include long-term follow-up and economic outcomes, determine the relative impact of different types of exercise and establish effectiveness in emerging economies.
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Affiliation(s)
- Nicola J Fairhall
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Jenson Cs Mak
- Healthy Ageing, Mind & Body Institute, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wing S Kwok
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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27
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Fisher ND, Parola R, Bi AS, Konda SR, Egol KA. Ambulation on hip fracture postoperative day 1: a marker for better outcomes following hip fracture surgery in patients 55 years or older. Hip Int 2022:11207000221107853. [PMID: 35773620 DOI: 10.1177/11207000221107853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to investigate if early postoperative ambulation metrics affect hospital quality measures and 1-year outcomes in operative hip fracture patients. METHODS A consecutive series of hip fracture patients [OTA/AO 31A, 31B, 32A-C] who underwent operative treatment were reviewed for demographic and clinical data. Chart review was performed to determine participation with physical therapy [PT] and ambulation distance on postoperative day (POD) 1, 3, and 5. POD1 ambulators and non-ambulators were statistically compared. Outcome correlates of postoperative ambulation distance were investigated by univariate and multivariate linear and logistic regression. RESULTS 1044 patients were identified with 546 (52.3%) able to ambulate on POD1. Those able to ambulate on POD1 were significantly younger (78.4 ± 10.9 vs. 82.1 ± 10.4, p < 0.001), had fewer co-morbidities (CCI 1.22 ± 1.60 vs. 1.73 ± 1.82, p < 0.001), and were more likely to be preoperative community ambulators (82.2% vs. 68.3%, p < 0.001). Patients unable to ambulate on POD1 had significantly higher rate of inpatient mortality (2.8% vs. 0.5%, p = 0.004), 1-year mortality (14.6% vs. 6.9%, p < 0.001), and a longer length of stay (7.94 ± 4.73 vs. 6.43 ± 4.02 days, p < 0.001). Non-ambulators more often required the intensive care unit postoperatively (18.7% vs. 7.1%, p < 0.001), and had increased rates of major complications (15.5% vs. 5.7%, p < 0.001). Patients with OTA 31B or 32A fractures were 1.63 times more likely to ambulate on POD1 while patients with an assistive device at baseline were 0.51 times less likely to ambulate on POD1. Increasing postoperative ambulation distance correlated with shorter length of stay (p < 0.001 for POD1, 3, and 5) and every foot walked was associated with 0.57% decreased odds of a hospital complication (p = 0.0353). CONCLUSIONS Failure to ambulate on POD1 following hip fracture surgery in >55 years is associated with an increased risk of in-hospital complications and mortality. Every effort should be made address this modifiable risk factor and mobilise patients on POD1 to improve patient outcomes.
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Affiliation(s)
| | - Rown Parola
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Andrew S Bi
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Sanjit R Konda
- NYU Langone Orthopedic Hospital, New York, NY, USA
- Jamaica Hospital Medical Center, Queens, NY, USA
| | - Kenneth A Egol
- NYU Langone Orthopedic Hospital, New York, NY, USA
- Jamaica Hospital Medical Center, Queens, NY, USA
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Poulsen LK, Ilvig PM, Brendstrup L, Rasmussen CL, Pedersen KA, Ditlevsen P, Henriksen SE, Kirk JW. Development, implementation and evaluation of an optimized cross-sectoral rehabilitation program after acute hip fracture surgery: A mixed-methods study. EVALUATION AND PROGRAM PLANNING 2022; 91:102021. [PMID: 34756708 DOI: 10.1016/j.evalprogplan.2021.102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
Fall-related hip fracture (HF) is a frequent trauma in Scandinavia with a yearly incidence of 8,000 among ≥65-year-old citizens in Denmark. The rising incidence and global predictions are alarming since a HF is a major, and potentially fatal, trauma to the citizen, requiring acute surgery, a multimodal approach and post-operative crosssectoral rehabilitation. However, continuity of the rehabilitation program is frequently interrupted in the transition between sectors, compromising optimal recovery of frail citizens. Thus, there is a need to develop and implement optimized cross-sectoral rehabilitation after HF. The purpose of this explorative study was to develop, implement and evaluate an optimized cross-sectoral rehabilitation program (OCRP) after HF surgery using validated theoretical frameworks. OCRP was developed, implemented and evaluated in one municipality using a pragmatic user-centered approach, quantitative and qualitative data collection and theoretical frameworks including the Behavior Change Wheel (BCW) and RE-AIM. Results of OCRP showed optimized rehabilitation based on motivated health professionals, high patient satisfaction and tendencies of improved levels of physical function. No re-referrals to rehabilitation were reported after OCRP. The BCW, RE-AIM and user-centered approach to program development, implementation and evaluation are useful to apply in program development and evaluation processes across sectors, professions, and medical specialties.
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Affiliation(s)
- Lise Kronborg Poulsen
- University College Copenhagen, Faculty of Health, Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Education in Physiotherapy, Copenhagen, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Pia Maria Ilvig
- Rehabilitation Hvidovre, Hvidovre Municipality, Copenhagen, Denmark
| | | | | | | | - Peter Ditlevsen
- Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark
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Tyas B, Lukic J, Harrison J, Singisetti K. A comparative study of hip fracture care and outcomes in major trauma centres versus trauma units. Injury 2022; 53:1455-1458. [PMID: 35168760 DOI: 10.1016/j.injury.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/28/2022] [Accepted: 02/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is good evidence to support that major trauma networks significantly reduce morbidity and mortality in severely injured patients. However, following the introduction of major trauma centres (MTCs) in England in 2012, early concerns were raised regarding the effect on hip fracture patients. The aim of our study was to review data from the National Hip Fracture Database for fractured neck of femur (FNOF) patients, comparing patient outcomes between MTCs and trauma units (TUs), and the national regions of the UK. METHODS NHFD data from 2018 for all hospitals in England, Wales and NI was collected using the charts and dashboards available online. We recorded data for the following outcomes: time to surgery, acute hospital length of stay, overall hospital length of stay, discharge to original residence within 120 days, crude 30-day mortality and adjusted 30-day mortality. We conducted a one-way ANOVA test to calculate statistical differences for each outcome measure by MTC vs TU and then separately for the regions of the UK divided into England, Wales and Northern Ireland (NI). RESULTS Data for 175 hospitals are included in this study; 22 of which were MTCs. The total number of operative cases were 65,848. 9668 of these occurred in MTC compared to 56,180 in TUs. This equates to an annual average of 439 per MTC and 367 per TU. Despite this, there was no statistically significant difference observed in all outcomes for MTC vs TU. Patients in NI waited longer for their surgery (60.3 h, p < 0.001), whilst patients in Wales had the longest overall hospital length of stay (31.6 days, p < 0.001). However, there was no difference in patients' crude 30-day mortality (p = 0.480) or adjusted 30-day mortality (p = 0.191). CONCLUSION These findings are reassuring for MTCs in England. We found no evidence to suggest that FNOF patients are treated inferiorly, or have worse outcomes, at MTCs vs TUs. FNOF patients in NI waited longer for their surgery but this did not have any significant difference on 30-day mortality rates. The care of FNOF patients in NI may warrant further study.
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Affiliation(s)
- Ben Tyas
- Core Surgical Trainee, Health Education North East, United Kingdom.
| | - John Lukic
- Clinical Fellow, Gateshead Health NHS Foundation Trust, United Kingdom
| | - John Harrison
- Trauma and Orthopaedic Surgeon, Gateshead Health NHS Foundation Trust, United Kingdom
| | - Kiran Singisetti
- Trauma and Orthopaedic Surgeon, Gateshead Health NHS Foundation Trust, United Kingdom
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Thornburgh Z, Samuel D. Factors Influencing Length of Stay and Discharge Destination of Patients with Hip Fracture Rehabilitating in a Private Care Setting. Geriatrics (Basel) 2022; 7:44. [PMID: 35447847 PMCID: PMC9030989 DOI: 10.3390/geriatrics7020044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Rehabilitation after a hip fracture has long-term importance, prompting some patients to utilise private services. Insufficient data regarding private rehabilitation in the UK can cause ambiguity and potential problems for all involved. Aim: The present study, involving patients with hip fractures rehabilitating in a private UK care setting, examined relationships between length of stay (LoS), discharge destination (DD) and 12 predictor variables. Methods: The variables included the retrospective measurement of the Functional Independence Measure. The variables were informed by a literature review and patient and public involvement. Retrospective data from the records of patients with hip fractures were utilised. Data were analysed using Spearman's rho, Mann-Whitney U, Kruskal-Wallis H and chi-squared tests as appropriate. Odds ratios, distribution quartiles and survivor analysis were also utilised. Results: The median length of stay (LoS) was 20.5 days: 82% returned home, 6.5% died and 11.5% remained as long-term residents. Significant relationships existed between LoS and age (p = 0.004), comorbidities (p = 0.001) and FIMadmission (p = 0.001). DD was associated with age (p = 0.007), delirium (p = 0.018), comorbidities (p = 0.001) and both FIMpre-fracture and FIMadmission (p = 0.000). Conclusions: Factors associated with length of stay were identified, but further research incorporating multiple sites is required for greater predictor precision. Discharge destination was evident by 90 days, facilitating long-term planning.
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Affiliation(s)
| | - Dinesh Samuel
- Faculty of Environmental and Life Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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Xiang Z, Chen Z, Wang P, Zhang K, Liu F, Zhang C, Wong TM, Li W, Leung F. The effect of early mobilization on functional outcomes after hip surgery in the Chinese population - A multicenter prospective cohort study. J Orthop Surg (Hong Kong) 2022; 29:23094990211058902. [PMID: 34818933 DOI: 10.1177/23094990211058902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the functional status and quality of life (QoL) between patients who underwent an early mobilization scheme and those who underwent a late mobilization scheme after hip fracture fixation surgery in elderly Chinese patients. METHODS This was a prospective cohort study. Patients (≥65 years old) with unstable intertrochanteric fractures treated with intramedullary nails were recruited from nine centers in China. Study centers either performed early mobilization or late mobilization scheme. All patients performed immediate in-bed mobilization after surgery and followed a standardized daily exercise program at home during the first 12 weeks. Functional status was measured by the Modified Barthel Index at postoperative visit, 6 weeks, and 12 weeks. QoL was measured by the EuroQol-5D (EQ-5D) at 12 weeks. RESULTS One hundred and forty-eight patients were enrolled to early mobilization, and 136 to late mobilization. At 6 weeks, early mobilization resulted in a significantly better Modified Barthel Index than late mobilization (mean [SD]: 83.7 [12.0] vs. 67.0 [17.5], p < .001). Adjusted mixed effects model showed significantly higher Modified Barthel Index for early mobilization at postoperative visit, 6 weeks, and 12 weeks (all p < .001). Patients in the early mobilization group had slightly better EQ-5D Index at 12 weeks than patients in the late mobilization group (mean: 0.91 vs 0.87, p = .002). CONCLUSIONS Early postoperative mobilization resulted in better functional outcomes up to 12 weeks. QoL was rated statistically significantly better in the early mobilization group, but the difference was small and may not be clinically relevant.
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Affiliation(s)
- Zhou Xiang
- 34753West China Hospital of Sichuan University, Chengdu, China
| | - Zhong Chen
- Yunnan Second People Hospital, Kunming, China
| | - Pengcheng Wang
- 74725The Third Hospital of Hebei, Medical University of Hebei, Hebei, China
| | | | - Fan Liu
- 74567Affiliated Hospital of Nantong University, Nantong City, China
| | | | - Tak-Man Wong
- The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Wilson Li
- Queen Elisabeth Hospital, Pok Fu Lam, Hong Kong
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The influence of weight-bearing status on post-operative mobility and outcomes in geriatric hip fracture. Eur J Trauma Emerg Surg 2022; 48:4093-4103. [PMID: 35290469 PMCID: PMC9532285 DOI: 10.1007/s00068-022-01939-6] [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: 08/24/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022]
Abstract
Purpose We hypothesized that unrestricted or full weight-bearing (FWB) in hip fracture would increase the opportunity to mobilize on post-operative day 1 (POD1mob) and be associated with better outcomes compared with restricted weight-bearing (RWB). Methods Over 4 years, 1514 geriatric hip fracture patients aged 65 and above were prospectively recruited. Outcomes were compared between FWB and RWB patients. The primary outcome was 30-day mortality. Secondary outcomes were immobility-related adverse events, length of stay (LOS), and reoperation for failure. Causal effect modelling and multivariate regression with mediation analyses were performed to examine the relation between weight-bearing status (WBS), POD1mob, and known mortality predictors. Results FWB was allowed in 1421 (96%) of 1479 surgically treated patients and RWB enforced in 58 (4%) patients. Mortality within 30 days occurred in 141 (9.9%) of FWB and 3 (5.2%) of RWB patients. In adjusted analysis, RWB did not influence 30-day mortality (OR 0.42, 95% CI 0.15–01.13, p = 0.293), with the WBS accounting for 91% of the total effect on mortality and 9% contributed from how WBS influenced the POD1mob. RWB was significantly related to increased DVT (OR 7.81, 95% CI: 1.81–33.71 p = 0.002) but no other secondary outcomes. Patients that did not have the opportunity to mobilize had increased 30-day mortality (OR 2.31, 95% CI 1.53–3.48 p < 0.001). Conclusion Restricted weight-bearing was not associated with increased 30-day mortality. Only a small proportion of this effect was mediated by POD1mob. Whilst post-surgical WBS may be difficult to influence for cultural reasons, POD1mob is an easily modifiable target that is likely to have a greater effect on 30-day mortality. Level of evidence Level III, observational study.
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Rizkalla JM, Nimmons SJB, Helal A, Prajapati P, Jones AL. Relation of mobilization after hip fractures on day of surgery to length of stay. Proc AMIA Symp 2022; 35:305-308. [DOI: 10.1080/08998280.2022.2029730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- James M. Rizkalla
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
- Coptic Medical Association of North America (CMANA), Research Institute, Dallas, Texas
| | | | - Asad Helal
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
| | - Purvi Prajapati
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
| | - Alan L. Jones
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
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Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dragosloveanu Ș, Dragosloveanu CD, Cotor DC, Stoica CI. Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study. Exp Ther Med 2022; 23:106. [PMID: 34976148 PMCID: PMC8674970 DOI: 10.3892/etm.2021.11029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Abstract
In unstable pertrochanteric fractures, there are still debates regarding the complications and long-term benefits after internal fixation using short or long cephalomedullary nails. Therefore, a study was developed regarding this idea. From May 2017 to April 2020, 61 patients with unstable (AO 31-A2) and intertrochanteric fractures (AO 31-A3) were surgically operated on. During follow-up, 8 patients were excluded (lost or deceased). A total of 26 patients received internal short nail system fixation and 27 received a long nail system. All cases followed the standard 6-week rehabilitation protocol. Follow-up was at 3, 6 weeks, 3, 6 and 12 months, and clinical and functional assessment were determined by a different surgeon using the Visual Analogue Scale (VAS), Harris Hip Score (HHS) and Functional Ambulation Categories (FAC). A total of 42 (79.2%) had a 31.A2 fracture (21 in the long nail group and 21 in the short nail group) and 11 (20.8%) had a 31.A3 fracture (6 in long nail group and 5 in the short nail group). Surgical time was significantly longer (P<0.05) in the long nail group (an average of 81.38±12.01 min), compared with the short nail group (53.11±8.36 min). Blood loss was significantly higher (P<0.05) in the long nail group (210±12.1 ml) compared to the short nail group (75.4±14.8 ml). No statistical differences were noted regarding tip-apex distance (TAD) and VAS score. At 6 months, HHS was better for the short nail group (84.76±3.68) (P<0.05). Regarding the FAC scale, no significant statistical differences were identified. Cut-out occurred in 2 cases in the short nail group and 1 case from the long nail group. Only 1 peri-implant fracture occurred in a patient with a long cephalomedullary nail. In conclusion, the long cephalomedullary nail requires a longer surgical time and is associated with an increase in intraoperative blood loss without improving the functional outcome after 12 months postoperatively. A larger sample of cases is required to thoroughly analyze the postoperative complications.
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Affiliation(s)
- Șerban Dragosloveanu
- Department of Orthopedics, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Orthopedic Surgery, ‘Foişor’ Orthopedics-Traumatology and Osteoarticular TB Hospital, 030167 Bucharest, Romania
| | | | - Dragoș C. Cotor
- Department of Orthopedic Surgery, ‘Foişor’ Orthopedics-Traumatology and Osteoarticular TB Hospital, 030167 Bucharest, Romania
| | - Cristian I. Stoica
- Department of Orthopedics, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Orthopedic Surgery, ‘Foişor’ Orthopedics-Traumatology and Osteoarticular TB Hospital, 030167 Bucharest, Romania
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Identification of hip fracture patients at risk for postoperative mobilisation complications via handgrip strength assessment. Arch Orthop Trauma Surg 2022; 142:997-1002. [PMID: 33484304 PMCID: PMC9110466 DOI: 10.1007/s00402-021-03756-9] [Citation(s) in RCA: 2] [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: 07/22/2020] [Accepted: 01/01/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Treatment of older adult hip fracture patients can be challenging and requires early postoperative mobilisation to prevent complications. Simple clinical tools to predict mobilisation/weight-bearing difficulties after hip fracture surgery are scarcely available and analysis of handgrip strength could be a feasible approach. In the present study, we hypothesised that patients with reduced handgrip strength show incapability to follow postoperative weight-bearing instructions. MATERIALS AND METHODS Eighty-four patients aged ≥ 65 years with a proximal femur fracture (trochanteric, n = 45 or femoral neck, n = 39), who were admitted to a certified orthogeriatric center, were consecutively enrolled in a prospective study design. Five days after surgery (intramedullary nailing or arthroplasty), a standardised assessment of handgrip strength and a gait analysis (via insole forcesensors) was performed. RESULTS Handgrip strength showed positive correlation with average peak force during gait on the affected limb (0.259), postoperative Parker Mobility Score (0.287) and Barthel Index (0.306). Only slight positive correlation was observed with gait speed (0.157). These results were congruent with multivariate regression analysis. CONCLUSION Assessment of handgrip strength is a simple and reliable tool for early prediction of postoperative mobilisation complications like the inability to follow weight-bearing instructions in older hip fracture patients. Follow-up studies should evaluate if these findings also match with other fracture types and result in personalised adjustment of current aftercare patterns. In addition, efforts should be made to combine objectively collected data as handgrip strength or gait speed in a prediction model for long-term outcome of orthogeriatric patients.
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Kristensen PK, Falstie-Jensen AM, Madsen M, Johnsen SP. Patient-related healthcare disparities in the quality of acute hip fracture care: a 10-year nationwide population-based cohort study. BMJ Open 2021; 11:e051424. [PMID: 35446782 PMCID: PMC8718470 DOI: 10.1136/bmjopen-2021-051424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To characterise and quantify possible patient-related disparities in hip fracture care including temporal changes. DESIGN Population-based cohort study. SETTING All Danish hospitals treating patients with hip fracture. PARTICIPANTS 60 275 hip fracture patients from 2007 to 2016. INTERVENTIONS Quality of care was defined as fulfilment of eligible care process measures for the individual patient recommended by an expert panel. Using yearly logistic regression models, we predicted the individual patient's probability for receiving high-quality care, resulting in a distribution of adjusted probabilities based on age, sex, comorbidity, fracture type, education, family mean income, migration status, cohabitation status, employment status, nursing home residence and type of municipality. Based on the distribution, we identified best-off patients (ie, the 10% of patients with the highest probability) and worst-off patients (ie, the 10% of patients with the lowest probability). We evaluated disparities in quality of care by measuring the distance in fulfilment of outcomes between the best-off and worst-off patients. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was fulfilment of all-or-none, defined as receiving all relevant process measures. Secondary outcomes were fulfilment of the individual process measures including preoperative optimisation, early surgery, early mobilisation, assessment of pain, basic mobility, nutritional risk and need for antiosteoporotic medication, fall prevention and a postdischarge rehabilitation programme. RESULTS The proportion of patients receiving high-quality care varied over time for both best-off and worst-off patients. The absolute difference in percentage points between the best-off and worst-off patients for receiving all-or-none of the eligible process measures was 12 (95% CI 6 to 18) in 2007 and 23 (95% CI 19 to 28) in 2016. Disparities were consistent for a range of care processes, including assessment of pain, mobilisation within 24 hours, assessment of need for antiosteoporotic medication and nutritional risk assessment. CONCLUSIONS Disparity of care between best-off and worst-off patients remained substantial over time.
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Affiliation(s)
- Pia Kjær Kristensen
- Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | | | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Aalborg Universitet, Aalborg, Denmark
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Yoo J, Lee BJ. Anthropometric, biochemical, and nutritional risk factors for osteoporosis in Korean adults based on a large cross-sectional study. PLoS One 2021; 16:e0261361. [PMID: 34898647 PMCID: PMC8668121 DOI: 10.1371/journal.pone.0261361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Osteoporosis a common bone disorder characterized by decreases in bone mass, tension, and strength. Although many previous studies worldwide have sought to identify the risk factors for osteoporosis, studies that simultaneously examine a variety of factors, such as biochemical, anthropometric and nutritional components, are very rare. Therefore, the objective of this study was to simultaneously examine the association of osteoporosis with biochemical profiles, anthropometric factors, and nutritional components in a large-scale cross-sectional study. Method This cross-sectional study was based on data from the Korea National Health and Nutrition Examination Survey (KNHANES VI-VII) from 2015 to 2018. Based on data from 16,454 participants, logistic regression was used to examine the association between various parameters in a crude analysis and in models adjusted for confounders. Results In men, osteoporosis was significantly associated with the anthropometric variables height and weight; the biochemical components hemoglobin, hematocrit, urea nitrogen and urine pH and creatinine; and the nutritional components total food intake, energy, water, protein, phosphorus, and kalium. However, these associations disappeared in adjusted model 2. In women, osteoporosis was significantly related to the anthropometric measures height, weight, and systolic blood pressure; the biochemical components hemoglobin, hematocrit and urine pH; and the nutritional components total food intake, water, calcium, phosphorus, and kalium. Most of these associations were maintained in the adjusted models. Conclusion Osteoporosis was linked to various anthropometric, biochemical and urine and nutritional components in Korean women, but the association between osteoporosis and risk factors differed according to sex.
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Affiliation(s)
- Junghun Yoo
- KM Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Bum Ju Lee
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- * E-mail:
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Mo DKC, Lau KKM, Fung DMY, Ma BHM, Lau TFO, Law SW. Does additional weekend and holiday physiotherapy benefit geriatric patients with hip fracture? - A case-historical control study. Hong Kong Physiother J 2021; 41:109-118. [PMID: 34177199 PMCID: PMC8221979 DOI: 10.1142/s1013702521500104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/05/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training. METHODS A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals. RESULTS With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II ( p = 0 . 015 ) and significant higher MBI scores ( mean ± standard deviation, median; Study group: 47 . 4 ± 19 . 6 points, 51 points; Control group: 43 . 0 ± 20 . 0 points, 43 points; p = 0 . 042 ) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: 8 . 2 ± 5 . 5 points, 7 points; Control group: 8 . 4 ± 6 . 1 points, 6 points; p = 0 . 998 ) and MBI scores (Study group: 63 . 0 ± 23 . 4 points, 68 points; Control group: 61 . 2 ± 26 . 1 points, 64 points; p = 0 . 743 ) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: 7 . 7 ± 3 . 9 days, 7 days; Control group: 7 . 4 ± 5 . 0 days, 6 days; p = 0 . 192 ). The average LOS in rehabilitation hospital (Study group: 20 . 0 ± 5 . 5 days, 20 days; Control group: 24 . 3 ± 9 . 9 days, 23 days; p < 0 . 001 ) and total in-patient LOS (Study group: 26 . 7 ± 6 . 4 days, 26 days; Control group: 30 . 7 ± 11 . 2 days, 28 days; p < 0 . 001 ) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, p < 0 . 001 ). CONCLUSION Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.
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Affiliation(s)
| | - Ken Kin Ming Lau
- Physiotherapy Department, Tai Po Hospital, Hospital Authority, Hong Kong
| | - Donna Mei Yee Fung
- Physiotherapy Department, Tai Po Hospital, Hospital Authority, Hong Kong
| | | | - Titanic Fuk On Lau
- Physiotherapy Department, Tai Po Hospital, Hospital Authority, Hong Kong
| | - Sheung Wai Law
- Department of Orthopaedic Rehabilitation, Tai Po Hospital, Hospital Authority, Hong Kong
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Rubinger L, Khalik HA, Gazendam A, Wolfstadt J, Khoshbin A, Tushinski D, Johal H. Very Distal Femoral Periprosthetic Fractures: Replacement Versus Fixation: A Systematic Review. J Orthop Trauma 2021; 35:573-583. [PMID: 33993176 DOI: 10.1097/bot.0000000000002080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To synthesize all-cause reoperations and complications data as well as secondary clinical and functional outcomes, after the management of very distal femur periprosthetic fractures (vDFPFs) in a geriatric patient population with either a distal femoral locking plate (DFLP) or distal femoral replacement (DFR). DATA SOURCES MEDLINE, Embase, and Web of Science were searched for English language articles from inception to March 16, 2020, in accordance to the PRISMA guidelines. STUDY SELECTION Studies reporting the management of vDFPFs in adults older than 65 years with either a DFLP or DFR were included. To ensure this review solely focused on very distal femoral periprosthetic fractures, only fractures of the following classifications were included: (1) Lewis and Rorabeck type II or III, (2) Su and Associates' Classification of Supracondylar Fractures of the Distal Femur type III, (3) Backstein et al type F2, and/or (4) Kim et al type II or III. DATA EXTRACTION Three reviewers independently extracted data from the included studies. Study validity was assessed using the methodological index for nonrandomized studies (MINORS), a quality assessment tool for nonrandomized controlled studies in surgery. DATA SYNTHESIS Twenty-five studies with 649 vDFPFs were included for analysis. There were 440 knees in the DFLP group (mean age range: 65.9-88.3 years) and 209 knees in the DFR group (mean age range: 71.0-84.8 years). Because of the literature's heterogeneity, the data were qualitatively synthesized. CONCLUSIONS vDFPFs in the elderly treated with DFR underwent fewer reoperations relative to DFLP (0%-45% vs. 0%-77%, respectively). Time to weight-bearing was observably shorter in DFR studies relative to DFLP studies. Functional outcomes and postoperative range of motion indicated a trend for DFLP knees to outperform DFR knees. Future research should include prospective studies and cost-effectiveness evaluations to better understand the utility of DFR for these fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Luc Rubinger
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Hassaan Abdel Khalik
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Jesse Wolfstadt
- Granovsky Gluskin Division of Orthopedic Surgery, Sinai Health System, University of Toronto, Toronto, ON, Canada; and
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Daniel Tushinski
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
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Shorter acute hospital length of stay in hip fracture patients after surgery predicted by early surgery and mobilization. Arch Osteoporos 2021; 16:162. [PMID: 34718871 DOI: 10.1007/s11657-021-01027-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Time to surgery, early mobilization, fracture type, and ASA grades independently affect acute hospital length of stay after hip fracture surgery. Modifiable factors can be audited to reduce length of stay, and non-modifiable factors can be used for consideration of a tiered bundled payment reimbursement model. INTRODUCTION As hip fracture incidence rises with our ageing global population, there will be an increase in consumption of healthcare resources. We hypothesized that hospital management and patient factors can affect healthcare burden load. Using length of stay (LOS) as a surrogate for consumption, the aim of this study is to elucidate the effect of hospital management and patient-related factors on length of stay (LOS) for patients after hip fracture surgery. We studied modifiable and non-modifiable factors influencing LOS, and identification of these modifiable factors accords opportunities for mitigating these factors. METHODS This retrospective study examines hip fracture data from a large tertiary hospital in Singapore over the period of 2017 to 2020. Data collected on the electronic medical record included age, gender, race, marital status, payer type, ASA score, TTS, type of surgery, fracture type, POD1 mobilization, discharge position, and presence of pressure sores, and they were correlated with LOS using binary logistic regression on SAS. RESULTS A total of 1045 patients were included in this study with 704 females and 341 males. The mean age was 79.5 ± 8.57 years (range 60-105) with an average LOS 13.64 ± 10.0 days (range 2-114). On binary logistic regression, ASA and trochanteric fracture remains a significant non-modifiable factor for LOS with OR = 1.486 (95% CI 1.106, 1.996, p = 0.0086) and OR 1.522 (95% CI 1.149, 2.015, p = 0.0034) respectively. Significant modifiable factors were TTS > 48 h (OR = 1.819, 95% CI 1.205, 2.746, p = 0.0044) and POD1 mobilization (OR = 0.441, 95% CI 0.257, 0.756, p = 0.0029). CONCLUSIONS Our analysis showed TTS and POD1 are significant modifiable factors for LOS, and resources can be diverted towards them for the management of hip fracture patients and pre-empting the increasing load on our healthcare system.
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Hulsbæk S, Juhl C, Røpke A, Bandholm T, Kristensen MT. Exercise therapy is effective at improving short- and long-term mobility, ADL and balance in older patients following hip fracture: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2021; 77:861-871. [PMID: 34387664 DOI: 10.1093/gerona/glab236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A systematic review and meta-analysis was performed to evaluate the short- and long-term effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, and secondly, whether the effect was modified by trial level characteristics such as intervention modality, duration and initiation timepoint. METHODS Medline, CENTRAL, Embase, CINAHL and PEDro was searched up-to November 2020. Eligibility criteria was randomized controlled trials investigating the effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, initiated from time of surgery up-to 1-year. RESULTS Forty-nine studies involving 3905 participants showed a small to moderate effect of exercise therapy at short term (end of intervention) on mobility (Standardized mean difference, SMD 0.49, 95%CI 0.22-0.76); Activities of Daily Living (ADL) (SMD 0.31, 95%CI 0.16-0.46); lower limb muscle strength (SMD 0.36, 95%CI 0.13-0.60); balance (SMD 0.34, 95%CI 0.14-0.54). At long term (closest to 1-year), small to moderate effects were found for mobility (SMD 0.74, 95%CI 0.15-1.34); ADL (SMD 0.42, 95%CI 0.23-0.61); balance (SMD 0.50, 95%CI 0.07-0.94) and Health related Quality of Life (HRQoL) (SMD 0.31, 95%CI 0.03-0.59). Certainty of evidence was evaluated using GRADE ranging from moderate to very low, due to study limitation and inconsistency. CONCLUSION We found low certainty of evidence for a moderate effect of exercise therapy on mobility in older patients following hip fracture at end-of-treatment and follow-up. Further, low evidence was found for small to moderate short-term effect on ADL, lower limb muscle strength and balance.
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Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
| | - Carsten Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Røpke
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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de Sire A, Invernizzi M, Baricich A, Lippi L, Ammendolia A, Grassi FA, Leigheb M. Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation. World J Orthop 2021; 12:456-466. [PMID: 34354934 PMCID: PMC8316838 DOI: 10.5312/wjo.v12.i7.456] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
Fractures of femur proximal extremity (FFPE) are the most common fragility fractures requiring hospitalization, with a high risk of mortality, low independence in the activities of daily living and severe consequences on health-related quality of life. Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines. Early surgery (within 48 h from hospital admission) allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes. Therefore, time for surgery could be considered as a comorbidity marker. The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature, but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery. In light of these considerations, the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs. Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes, the feasibility of a comprehensive approach in clinical practice is still a challenge. In particular, the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings. Therefore, the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE, highlighting the benefits, feasibility and limitations of this approach.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia,” Catanzaro 88100, Italy
| | - Marco Invernizzi
- Physical Medicine and Rehabilitation, Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
- Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria 15121, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation, Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
| | - Lorenzo Lippi
- Physical Medicine and Rehabilitation, Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia,” Catanzaro 88100, Italy
| | - Federico Alberto Grassi
- Orthopaedics and Traumatology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
| | - Massimiliano Leigheb
- Orthopaedics and Traumatology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
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Goubar A, Martin FC, Potter C, Jones GD, Sackley C, Ayis S, Sheehan KJ. The 30-day survival and recovery after hip fracture by timing of mobilization and dementia : a UK database study. Bone Joint J 2021; 103-B:1317-1324. [PMID: 34192935 DOI: 10.1302/0301-620x.103b7.bjj-2020-2349.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study to compare 30-day survival and recovery of mobility between patients mobilized early (on the day of, or day after surgery for a hip fracture) and patients mobilized late (two days or more after surgery), and to determine whether the presence of dementia influences the association between the timing of mobilization, 30-day survival, and recovery. METHODS Analysis of the National Hip Fracture Database and hospital records for 126,897 patients aged ≥ 60 years who underwent surgery for a hip fracture in England and Wales between 2014 and 2016. Using logistic regression, we adjusted for covariates with a propensity score to estimate the association between the timing of mobilization, survival, and recovery of walking ability. RESULTS A total of 99,667 patients (79%) mobilized early. Among those mobilized early compared to those mobilized late, the weighted odds ratio of survival was 1.92 (95% confidence interval (CI) 1.80 to 2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03 to 1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32 to 1.78) by 30 days. The weighted probabilities of survival at 30 days post-admission were 95.9% (95% CI 95.7% to 96.0%) for those who mobilized early and 92.4% (95% CI 92.0% to 92.8%) for those who mobilized late. The weighted probabilities of regaining the ability to walk outdoors were 9.7% (95% CI 9.2% to 10.2%) and indoors 81.2% (95% CI 80.0% to 82.4%), for those who mobilized early, and 7.9% (95% CI 6.6% to 9.2%) and 73.8% (95% CI 71.3% to 76.2%), respectively, for those who mobilized late. Patients with dementia were less likely to mobilize early despite observed associations with survival and ambulation recovery for those with and without dementia. CONCLUSION Early mobilization is associated with survival and recovery for patients (with and without dementia) after hip fracture. Early mobilization should be incorporated as a measured indicator of quality. Reasons for failure to mobilize early should also be recorded to inform quality improvement initiatives. Cite this article: Bone Joint J 2021;103-B(7):1317-1324.
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Affiliation(s)
- Aicha Goubar
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, London, UK
| | - Finbarr C Martin
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, London, UK.,Guy's and St. Thomas's National Health Service Foundation Trust, London, UK
| | - Chris Potter
- Guy's and St. Thomas's National Health Service Foundation Trust, London, UK
| | - Gareth D Jones
- Guy's and St. Thomas's National Health Service Foundation Trust, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, London, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, London, UK
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Said CM, Delahunt M, Hardidge A, Smith P, Tran P, McDonald L, Kefalianos E, Daniel C, Berney S. Recumbent cycling to improve outcomes in people with hip fracture: a feasibility randomized trial. BMC Geriatr 2021; 21:394. [PMID: 34187387 PMCID: PMC8244148 DOI: 10.1186/s12877-021-02321-8] [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] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background Early mobilization after surgery is a key recommendation for people with hip fracture, however this is achieved by only 50% of people. Recumbent bike riding has been used in other populations with limited mobility and has potential to allow early exercise in people post hip fracture. The primary aim of this pilot trial was to demonstrate the feasibility of a trial protocol designed to determine the effect of early post-operative cycling in bed on outcomes in people with hip fracture. Methods Single-blinded, multi-site randomized controlled pilot trial. Fifty-one people with hip fracture were recruited within 4 days of surgery from two sites in Victoria. Participants were randomly allocated to receive either usual care (n = 25) or usual care plus active cycling in bed (n = 26). The cycling intervention was delivered on weekdays until the participant could walk 15 m with assistance of one person. The primary outcomes were trial feasibility and safety. Clinical outcomes, including mobility (Modified Iowa Level of Assistance Scale) and delirium were measured at day seven post-operatively and at hospital discharge by an assessor blinded to group. Additional outcomes at discharge included gait speed, cognition and quality of life. Results The intervention was safe, feasible and acceptable to patients and staff. Delivery of the intervention was ceased on (median) day 9.5 (IQR 7, 12); 73% of scheduled sessions were delivered; (median) 4 sessions (IQR 2.0, 5.5) were delivered per participant with (median) 9 min 34 s (IQR 04:39, 17:34) of active cycling per session. The trial protocol was feasible, however at day seven 75% of participants had not met the criterion (able to walk 15 m with assistance of one person) to cease the cycling intervention.. Conclusion In bed cycling is feasible post-operatively following hip fracture, however seven days post-operatively is too early to evaluate the impact of the cycling intervention as many participants were still receiving the intervention. A fully powered RCT to explore the effectiveness and cost efficiency of this novel intervention is warranted. Trial registration The trial was prospectively registered (25/09/2017) with the Australian New Zealand Clinical Trials Registry ACTRN12617001345370.
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Affiliation(s)
- Catherine M Said
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia. .,Physiotherapy Department, Western Health, St Albans, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Australia. .,Physiotherapy Department, Austin Health, Heidelberg, Australia.
| | - Marisa Delahunt
- Physiotherapy Department, Austin Health, Heidelberg, Australia
| | - Andrew Hardidge
- Orthopaedics, Austin Health, Heidelberg, Australia.,The University of Melbourne, Melbourne, Australia
| | - Paul Smith
- Physiotherapy Department, Austin Health, Heidelberg, Australia
| | - Phong Tran
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Australia.,Department of Orthopaedic Surgery, Western Health, Footscray, Australia
| | - Luke McDonald
- Physiotherapy Department, Austin Health, Heidelberg, Australia
| | | | - Cathy Daniel
- Nursing, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia
| | - Sue Berney
- Physiotherapy Department, Austin Health, Heidelberg, Australia
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Keenan OJF, Ross LA, Magill M, Moran M, Scott CEH. Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures. Knee Surg Relat Res 2021; 33:19. [PMID: 34172101 PMCID: PMC8229296 DOI: 10.1186/s43019-021-00097-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aimed to determine whether unrestricted weight-bearing as tolerated (WBAT) following lateral locking plate (LLP) fixation of periprosthetic distal femoral fractures (PDFFs) is associated with increased failure and reoperation, compared with restricted weight-bearing (RWB). MATERIALS AND METHODS In a retrospective cohort study of consecutive patients with unilateral PDFFs undergoing LLP fixation, patients prescribed WBAT were compared with those prescribed 6 weeks of RWB. The primary outcome measure was reoperation. Kaplan-Meier and Cox multivariable analyses were performed. RESULTS There were 43 patients (mean age 80.9 ± 11.7 years, body mass index 26.8 ± 5.7 kg/m2 and 86.0% female): 28 WBAT and 15 RWB. There were more interprosthetic fractures in the RWB group (p = 0.040). Mean follow-up was 3.8 years (range 1.0-10.4). Eight patients (18.6%) underwent reoperation. Kaplan-Meier analysis demonstrated no difference in 2-year survival between WBAT (80.6%, 95% CI 65.3-95.9) and RWB (83.3%, 95% CI 62.1-100.0; p = 0.54). Cox analysis showed increased reoperation risk with medial comminution (hazard ratio 10.7, 95% CI 1.5-80; p = 0.020) and decreased risk with anatomic reduction (hazard ratio 0.11, 95% CI 0.01-1.0; p = 0.046). Immediate weight-bearing did not significantly affect the risk of reoperation compared with RWB (relative risk 1.03, 95% CI 0.61-1.74; p = 0.91). CONCLUSIONS LLP fixation failure was associated with medial comminution and non-anatomic reductions, not with postoperative weight-bearing. Medial comminution should be managed with additional fixation. Weight-bearing restrictions additional to this appear unnecessary and should be avoided.
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Affiliation(s)
- Oisin J F Keenan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
| | - Lauren A Ross
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Matthew Magill
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Matthew Moran
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
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Min K, Beom J, Kim BR, Lee SY, Lee GJ, Lee JH, Lee SY, Won SJ, Ahn S, Bang HJ, Cha Y, Chang MC, Choi JY, Do JG, Do KH, Han JY, Jang IY, Jin Y, Kim DH, Kim DH, Kim IJ, Kim MC, Kim W, Lee YJ, Lee IS, Lee IS, Lee J, Lee CH, Lim SH, Park D, Park JH, Park M, Park Y, Ryu JS, Song YJ, Yang S, Yang HS, Yoo JS, Yoo JI, Yoo SD, Choi KH, Lim JY. Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures. Ann Rehabil Med 2021; 45:225-259. [PMID: 34233406 PMCID: PMC8273721 DOI: 10.5535/arm.21110] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. METHODS Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. RESULTS A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. CONCLUSION This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
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Affiliation(s)
- Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | | | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sangwoo Ahn
- Physical Therapy, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youri Jin
- Department of Food and Nutrition Services, Hanyang University Hospital, Seoul, Korea
| | - Dong Hwan Kim
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Jong Kim
- Howareyou Rehabilitation Clinic, Seoul, Korea
| | - Myung Chul Kim
- Department of Physical Therapy, Eulji University, Seongnam, Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Jung Lee
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea
| | - In Seok Lee
- Nutrition Team, Kyung Hee University Medical Center, Seoul, Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - JungSoo Lee
- Department of Rehabilitation Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Chang-Hyung Lee
- Department of Physical Medicine and Rehabilitation, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Myungsook Park
- Department of Nursing, Konkuk University, Chungju, Korea
| | - Yongsoon Park
- Department of Food and Nutrition, Hanyang University, Seoul, Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jin Song
- Occupational Therapy, Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman’s University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Ji Sung Yoo
- Department of Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jun-il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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van Dartel D, Vermeer M, Folbert EC, Arends AJ, Vollenbroek-Hutten MMR, Hegeman JH. Early Predictors for Discharge to Geriatric Rehabilitation after Hip Fracture Treatment of Older Patients. J Am Med Dir Assoc 2021; 22:2454-2460. [PMID: 33933417 DOI: 10.1016/j.jamda.2021.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Data from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included. METHODS Patients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors. RESULTS Higher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively. CONCLUSIONS AND IMPLICATIONS This study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL.
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Affiliation(s)
- Dieuwke van Dartel
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands.
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Ellis C Folbert
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Arend J Arends
- Department of Geriatrics, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
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Said CM, Delahunt M, Ciavarella V, Al Maliki D, Boys AM, Vogrin S, Berney S. Factors Impacting Early Mobilization Following Hip Fracture: An Observational Study. J Geriatr Phys Ther 2021; 44:88-93. [PMID: 33534334 DOI: 10.1519/jpt.0000000000000284] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Hip fracture guidelines emphasize mobilization within 48 hours of surgery. The aims of this audit were to determine the proportion of patients with hip fracture who mobilize within 48 hours, identify factors associated with delayed mobilization, and identify barriers to mobilization. METHODS Single-site prospective audit of 100 consecutive patients (age 82 ± 9 years) admitted for surgical management of hip fracture. Data collected included time to mobilization, factors that may impact mobilization (age, weight-bearing status, additional injuries, premorbid mobility status, time to surgery, dementia, delirium, and postoperative complications), and barriers to mobilization as identified by the physical therapist. RESULTS AND DISCUSSION Mobilization within 48 hours of surgery was achieved by 43% of patients. Multivariate logistic regression demonstrated odds of mobilizing early increased with higher New Mobility Scores, representing better premorbid mobility (odds ratio [OR] = 1.30; 95% confidence interval [CI], 1.06-1.60); odds reduced if delirium was present on day 1 or 2 (OR = 0.25; 95% CI, 0.08-0.79). New Mobility Scores 5 or more, which indicate independent premorbid mobility inside and outside the house, best predicted early mobilization in patients who did not develop delirium. No cutoff score was identified for those with delirium. Identified barriers to mobilization included patient confusion, manual handling risk, patient declined, and hypotension. CONCLUSIONS Less than half of this cohort achieved the guideline of mobilization within 48 hours of surgery. Patients who develop delirium within the first 2 days of surgery or who had premorbid mobility limitation were less likely to mobilize. Identification of patients likely to have delayed mobilization will assist physical therapists with delivering appropriate management to patients with hip fracture during their acute hospital stay.
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Affiliation(s)
- Catherine M Said
- Physiotherapy, The University of Melbourne, Melbourne, Australia
- Physiotherapy, Western Health, St Albans, Australia
- Australian Institute for Musculoskeletal Science, St Albans, Australia
- Physiotherapy, Austin Health, Heidelberg, Australia
| | | | | | | | | | - Sara Vogrin
- Australian Institute for Musculoskeletal Science, St Albans, Australia
| | - Sue Berney
- Physiotherapy, Austin Health, Heidelberg, Australia
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50
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Morri M, Forni C, Guberti M, Chiari P, Pecorari A, Orlandi AM, Gazineo D, Bozzo M, Ambrosi E. Post-hospital care pathway for individuals with hip fracture: what is the optimal setting and rehabilitation intensity? An observational study. Disabil Rehabil 2021; 44:4241-4248. [PMID: 33725460 DOI: 10.1080/09638288.2021.1897692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Health systems are using ever-increasing resources on treating hip fractures. Optimal post-hospital care needs to be defined to design an effective care pathway. The aim of the present study was to describe the post-hospital care pathway of individuals with hip fracture and to assess its association with the degree of recovery of independence achieved four months after surgery. MATERIALS AND METHODS A prognostic multicentric cohort study was conducted. All patients aged 65 years and over who were admitted with a diagnosis of fragility hip fracture were enrolled. After the hospital discharge, the patients were followed either at an inpatient rehabilitation facility with an intensive or extensive regimen, a nursing home, a long-term care facility or at home. Among the various care pathways, the intensity of rehabilitation differed according to its duration, frequency of sessions, and activities proposed. Primary outcome was the patient's degree of independence achieved four months after surgery, as measured with Activities of Daily Living scale. Several covariates were collected to test the correlation between the different post-hospital care pathways and the recovery of independence. RESULTS A total of 923 patients completed the follow-up. A post- hospital rehabilitation pathway was indicated for 88.2% of the patients. The extensive rehabilitation pathway, indicated for 36.7% of the patients, was the most common. The intensive rehabilitation pathway gave better results in terms of independence at four-month follow up, leading to a median ADL score of 1.4 (95% CI 1.0-2.0). The other care pathways did not show significant difference between each other. CONCLUSIONS High-intensity rehabilitation was associated to better results in terms of recovering of Activities of Daily Living.IMPLICATIONS FOR REHABILITATIONPost-hospital care pathways that include an intensive rehabilitation treatment should be improved/supported to make them available to a larger number of hip fracture patients.Patient selection criteria for post-hospital rehabilitation pathways should be standardized to optimize available healthcare resources.A cost-effectiveness analysis should be performed to analyze the economic sustainability of each post-hospital care pathway.
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Affiliation(s)
- Mattia Morri
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Cristiana Forni
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Monica Guberti
- Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Chiari
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italia
| | | | - Antonella Magli Orlandi
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Domenica Gazineo
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italia
| | - Maria Bozzo
- Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Ambrosi
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italia
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