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Ishimoto R, Mutsuzaki H, Shimizu Y, Takeuchi R, Matsumoto S, Hada Y. Association between Sarcopenia and Balance in Patients Undergoing Inpatient Rehabilitation after Hip Fractures: A Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:742. [PMID: 38792925 PMCID: PMC11123061 DOI: 10.3390/medicina60050742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/21/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Sarcopenia is characterized by a decline in skeletal muscle mass, strength, and function and is associated with advancing age. This condition has been suggested as a factor that negatively influences the functional outcomes of patients with hip fractures. However, the association between sarcopenia and balance impairment in patients undergoing inpatient rehabilitation after hip fractures remains unclear. In this retrospective cohort study, we aimed to investigate the impact of sarcopenia on balance outcomes in patients undergoing inpatient rehabilitation following hip fractures. Materials and Methods: Baseline sarcopenia was diagnosed using skeletal muscle mass index and handgrip strength, with cut-off values recommended by the Asian Working Group for Sarcopenia. The primary outcome was balance, which was assessed using the Berg Balance Scale (BBS) at the time of discharge. A multiple linear regression model analyzed the association between sarcopenia and balance. The model was adjusted for age, sex, comorbidities, and cognitive function. Results: Among the 62 patients (mean age: 78.2; sex: 75.8% women), 24.2% had sarcopenia. Patients with sarcopenia had significantly lower BBS scores than did those without sarcopenia (41 vs. 49 points, p = 0.004). Multiple linear regression analysis revealed that baseline sarcopenia was independently associated with BBS scores at discharge (β = -0.282, p = 0.038). Conclusions: Following inpatient rehabilitation, patients with baseline sarcopenia had inferior balance outcomes than did those without sarcopenia at discharge. Sarcopenia should be assessed on admission to consider and provide additional care for those with a higher risk of poor functional outcomes. More studies are needed to investigate the association between sarcopenia and functional outcomes, examine the impact of sarcopenia treatment on these outcomes, and reduce the risk of recurrent falls and fractures in patients with hip fractures.
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Affiliation(s)
- Ryu Ishimoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan;
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Ryoko Takeuchi
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
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Şahın İG, Gültaç E, Can Fİ, Kılınç CY, Aydoğan NH. An Evaluation of the Fear of Falling, Balance Levels, and Prognostic Blood Parameters Among the Geriatric Population With Hip Fractures. Cureus 2022; 14:e21704. [PMID: 35242472 PMCID: PMC8883147 DOI: 10.7759/cureus.21704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background In this study, we determined that among patients who had been operated upon for hip fractures at our hospital, prognostic factors for mortality and functional recovery in the preoperative period were indicated via laboratory parameters using the International Falls Efficacy Scale (FES-I) and Berg Balance Scale (BBS) scores. Methodology Between January 2020 and January 2021, the results of 64 patients who had been surgically treated for a hip fracture and 57 patients who had scheduled elective surgery were compared retrospectively. The groups’ demographic data and blood parameters were compared. We used the FES-I and BBS scores to determine patients’ physical functional status and fear of falling. Results The case group’s statistically significant FES-I score was high, and its BBS score was low (p = 0.001/0.001). As expected, the case group’s D-dimer measurement was higher than the control group’s (p = 0.001). In addition, hemoglobin, platelet, lymphocyte, albumin, total protein, and calcium levels were lower in the case group (p = 0.001 for all levels). No significant difference was found for other parameters. Conclusions The scales are used by physical therapy, neurology, and orthopedics professionals to evaluate the geriatric population’s physical functional status and fear of falling. We believe prevention and cost-effective treatments for hip fractures can be achieved by determining geriatric patients’ hemoglobin, platelet, lymphocyte, albumin, total protein, and calcium levels upon hospital admission and by directing these patients to relevant clinics using the fear-of-falling and balance scales.
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Tamura S, Miyata K, Kobayashi S, Takeda R, Iwamoto H. Development of Cut-off Values on the Berg Balance Scale for Predicting Walking Independence in Older Adults with Hip Fracture. Prog Rehabil Med 2022; 7:20220043. [PMID: 36118148 PMCID: PMC9411036 DOI: 10.2490/prm.20220043] [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: 03/25/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of the current study was to identify a cut-off value for predicting walking independence at discharge in older adults with hip fracture based on their Berg Balance Scale (BBS) score at admission to a convalescent rehabilitation ward. Methods: This was a retrospective, multicenter, observational study of 187 older adults with hip fractures (mean age 83.7, range 66–97 years). Data was collected on the patients’ age, sex, treatment, and physical function evaluation. An ordinal logistic regression analysis was used to identify predictors associated with the degree of independence in walking at discharge. Receiver operating characteristic curves were used to estimate cut-off values to predict independent and supervised walking at discharge based on the BBS score at admission. The accuracy of the classification was assessed using the area under the curve (AUC). Results: The BBS score at admission was a significant factor predicting the degree of walking independence at discharge (odds ratio = 1.09, 95%CI: 1.06–1.11). The cut-off values of the BBS score at admission for predicting independent walking and supervised walking at discharge were 28 points (AUC = 0.76, 95%CI: 0.69–0.83) and 21 points (AUC = 0.84, 95%CI: 0.77–0.91), respectively. Conclusions: The BBS scores of older adults with hip fracture on admission to a rehabilitation ward are useful for predicting the degree of independence in walking at discharge and can help to structure therapy according to the predicted degree of independence.
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Affiliation(s)
- Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Sota Kobayashi
- Department of Rehabilitation, Public Nanokaichi Hospital, Tomioka, Japan
| | - Ren Takeda
- Department of Basic Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Hiroki Iwamoto
- Department of Rehabilitation, Hidaka Rehabilitation Hospital, Takasaki, Japan
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Ratnayake H, Crabtree A, Hunter P, Parikh S, Tay B, Anthonisz B, Moran C. Evaluation of a dedicated outpatient hip fracture clinic. Australas J Ageing 2021; 41:325-329. [PMID: 34837298 DOI: 10.1111/ajag.13020] [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] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is a lack of guidance on how to manage the multiple post-discharge issues of older people following minimal trauma hip fracture. We developed a geriatrician-staffed outpatient service for people aged ≥65 years admitted with a hip fracture who were not discharged to a nursing home. We aimed to evaluate the potential benefits of the addition of a dedicated hip fracture follow-up clinic by measuring the actions performed by such a clinic. METHODS We evaluated the potential benefit of the clinic through a retrospective review of the medical records of all those referred to the clinic over a 2-year period. RESULTS A total of 80 people were provided a clinic appointment, with 43 (54%) attending. The median age of clinic attendees was 81 years. A total of 40/43 (93%) of attendees received inpatient rehabilitation in a sub-acute facility before discharge. At the dedicated outpatient clinic, multiple issues were identified and managed including further fall reduction strategies (n = 12), commencement of anti-resorptive medications (n = 11) and medication deprescribing (n = 11). CONCLUSIONS We found that the introduction of a dedicated hip fracture outpatient clinic identified and managed a broad range of issues. It is unclear if these needs would have been met by previously existing services. Further work is required to clarify whether managing these issues translates into improved patient outcomes and whether a dedicated clinic is a cost-effective practice of achieving this.
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Affiliation(s)
- Hasanka Ratnayake
- Health of Older People, Alfred Health, Melbourne, Victoria, Australia
| | - Amelia Crabtree
- Health of Older People, Alfred Health, Melbourne, Victoria, Australia
| | - Peter Hunter
- Health of Older People, Alfred Health, Melbourne, Victoria, Australia
| | - Seema Parikh
- Health of Older People, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Brenton Tay
- Health of Older People, Alfred Health, Melbourne, Victoria, Australia
| | - Brian Anthonisz
- Department of Rehabilitation Services, Alfred Health, Melbourne, Victoria, Australia
| | - Chris Moran
- Health of Older People, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Aged Care, Peninsula Health, Melbourne, Victoria, Australia
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Assessing the Outcome of Rehabilitation after Hip Fracture with a Wearable Device-A Study Protocol for a Randomized Control Trial in Community Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910165. [PMID: 34639466 PMCID: PMC8508243 DOI: 10.3390/ijerph181910165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The increase of the aging population is a challenge to society, as age is related to dependence. Injuries such as hip fractures cause morbidity, loss of independent life, and mortality. The purpose of this protocol is to describe a randomized control trial, with three intervention arms, aiming at investigating if there are any differences in outcomes after hip fracture between different rehabilitation interventions including (1) High-Intensity Functional Exercise (HIFE), (2) HIFE with the addition of continuous measures of movement and body positions with a wearable device, or (3) standard rehabilitation. A secondary aim is to evaluate physiotherapists' satisfaction with using the wearable device in rehabilitation. METHOD Patients with hip fracture that require rehabilitation at home will be invited to participate and randomly assigned to one intervention arm. The primary outcome is balance, measured by postural sway using an Inertial Measurement Unit and by Functional Balance test for Geriatric patients. Secondary outcomes are functional independence in everyday activities, measured with the Barthel Index, and health-related quality of life measured with EuroQol 5 Dimension questionnaire and EuroQol Visual Analogue Scale for health and user satisfaction measured by the User Satisfaction Evaluation Questionnaire. DISCUSSION This study protocol is the first step in securing the research process before performing a full randomized controlled trial. The next step will be a pilot- and feasibility study.
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Kaizu Y, Miyata K, Arii H, Yamaji T. Inpatient knee pain after hip fracture surgery affects gait speed in older adults: A retrospective chart-referenced study. Geriatr Gerontol Int 2021; 21:830-835. [PMID: 34342386 DOI: 10.1111/ggi.14255] [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] [Received: 02/26/2021] [Revised: 06/28/2021] [Accepted: 07/17/2021] [Indexed: 12/25/2022]
Abstract
AIM Post-hip fracture knee pain (PHFKP) develops in 28-37.4% of patients with hip fracture and contributes to prolonged hospitalization. Although reduced balance and gait speed contribute to falls, the effects of PHFKP remain unclear. This study aimed to clarify whether PHFKP is a factor in balance and gait speed. METHODS We retrospectively reviewed the medical records of patients after hip fracture. Development of PHFKP, basic information, and physical function were examined. Berg balance scale (BBS) and maximum walking speed (MWS) were collected at discharge. These parameters were compared with the presence or absence of PHFKP. In addition, multiple analyses were conducted with BBS and MWS as dependent variables and PHFKP as one of the independent variables. RESULTS Of the 146 patients enrolled, 43 (29.5%) developed PHFKP, and 37.2% of patients with PHFKP showed residual symptoms at discharge. Intensity of PHFKP was mostly mild to moderate. The PHFKP group showed an extended length of stay (+13.3 days) and a tendency toward more discharges to facilities compared with the control group. Knee extension range of motion limitation, knee extensor strength, and BBS did not differ between groups, while MWS was significantly lower in the PHFKP group (0.85 ± 0.32 m/s vs. 1.07 ± 0.39 m/s). Multiple analyses showed that development of PHFKP was not associated with BBS, but was associated with decreased MWS (standardized beta = -0.202, P = 0.005). CONCLUSIONS PHFKP was identified as an independent factor in gait speed decline. PHFKP patients should be monitored for reduced gait speed during rehabilitation. Geriatr Gerontol Int 2021; 21: 830-835.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Hospital, Takasaki, Japan.,Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ami-Machi, Japan
| | - Hironori Arii
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takehiko Yamaji
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
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Sociodemographic predictors of pain in old people : Serbian population-based study. Wien Klin Wochenschr 2020; 133:578-585. [PMID: 33296029 DOI: 10.1007/s00508-020-01783-x] [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: 04/25/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND With the growing increase in the older proportion of the world population, there is also an increase in specific age-related chronic diseases and conditions, including pain. We aimed to evaluate the association of sociodemographic factors with the presence and different degrees of pain intensity in people aged 65 years and older. METHODS The population-based study, conducted in 2013, included 3540 individuals from Serbia. As pain predictors, we analyzed further sociodemographic characteristics: gender, age, body mass index, level of education, marital status, and wealth index. For pain assessment, we used the pain domain of the SF-36 version 2.0 questionnaire. RESULTS People over the age of 85 years are 27% more likely to have moderate pain than younger respondents; however, pain is less likely reported by men (by 42%), persons with overweight (by 23%) or obesity (by 21%), respondents with secondary (by 50%) or university education (29%), as well as those belonging to the upper household wealth index (by 22%), than by their counterparts. CONCLUSION Pain is less likely in people of age below 85 years, male gender, those with higher educational level and higher wealth index, as well as overweight or obese individuals. Also, we have demonstrated that sociodemographic predictors differently correlate with the onset of the pain and its severity degree in persons of 65 years and older.
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Predictors of balance in older hip fracture patients undergoing standard motor rehabilitation. Eur Geriatr Med 2020; 12:69-77. [PMID: 32974887 DOI: 10.1007/s41999-020-00402-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Little is known about the factors predicting balance in hip fracture patients. The aim of this retrospective observational study was to assess balance before and after inpatient rehabilitation and, secondarily, to identify factors predicting the balance levels in older hip fracture patients after motor rehabilitation. METHODS Data were collected in 124 hip fracture patients over a 2-year period. All patients underwent a standard motor rehabilitation program. A modified version of Berg Balance Scale (BBS) score after rehabilitation, daily gain and percentage of improvement in BBS were the outcome measures. Multivariate regression analysis was performed to identify the predictors of balance. RESULTS The mean BBS score was 8.33 ± 7.23 at admission and 21.79 ± 12.15 at the end of rehabilitation (p < 0.001). The daily gain in BBS score was 0.39 ± 0.31 and the percent improvement was 32.28 ± 23.04%. Standing with one foot in front and standing on one foot were the BBS items with the lowest score at discharge and the lowest daily gain and percent improvement. The Cognitive-Functional Independence Measure (cognitive-FIM), hip muscles strength, and Katz index at discharge had moderate-to-strong relationships with final score, daily gain and percentage of improvement in BBS. Cognitive-FIM was a predictor of final BBS score (beta 0.49, p < 0.001), daily gain in BBS (beta 0.34, p < 0.001) and percent improvement in BBS (beta 0.44, p < 0.001). Conversely, hip muscles strength was a predictor of final BBS score (beta 0.32, p = 0.001), and Cumulative Illness Rating Scale severity, a predictor of daily gain in BBS (beta -0.29, p = 0.001). The R2 value of the models were, respectively, 0.39, 0.23, and 0.19. CONCLUSIONS Cognitive function, comorbidities and hip muscles strength are important predictors of balance in hip fracture patients. Knowledge of these specific factors can be useful for physicians to identify patients needing specific rehabilitation programs for balance.
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Feld JA, Plummer P. Patterns of cognitive-motor dual-task interference post stroke: an observational inpatient study at hospital discharge. Eur J Phys Rehabil Med 2020; 57:327-336. [PMID: 32935952 DOI: 10.23736/s1973-9087.20.06273-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many ambulatory stroke survivors are discharged to community settings where they will confront highly attention-demanding mobility situations. Very little is known about cognitive-motor interference during walking in acutely rehabilitating stroke survivors. AIM To examine the magnitude and patterns of cognitive-motor dual-task interference at hospital discharge post stroke and explore the characteristics associated with distinct interference patterns. DESIGN Observational study. SETTING Acute care and inpatient rehabilitation centers. POPULATION Forty-seven adults with hospital admission for stroke who were being discharged to home. Mean age was 59.5 years (SD=11.7) and median days post stroke was 14 (IQR=7-21). METHODS Gait and cognitive (category naming task) performance were assessed under single- and dual-task conditions at hospital discharge. Dependent variables were gait speed, stride duration, stride duration variability, stride length, cadence, and correct response rate. Single and dual-task values were compared to assess the effects of dual-tasking on gait and category naming. Relative dual-task effects on gait speed and cognitive performance were plotted to identify patterns of dual-task interference. Exploratory analysis compared clinical characteristics between subgroups defined by pattern of interference. RESULTS There were significant dual-task declines in gait speed, with corresponding dual-task effects on stride length, cadence, and stride duration, but no dual-task effects on stride duration variability or correct response rate. Dual-task effects on the category naming task were not significant due to large between-subject variability. Three predominant patterns of cognitive-motor interference were evident: mutual interference (37% of participants), gait interference (30% of participants), and cognitive-priority trade-off (22% of participants) - these patterns reflect the consistently observed negative dual-task effect on gait speed with positive, negative, or null effects on category naming. Participants who demonstrated cognitive-priority trade-off pattern of interference had significantly worse single-task category-naming performance, while those with mutual interference had greater overall stroke severity. CONCLUSIONS Cognitive-motor dual-task interference on gait speed is highly prevalent in ambulatory stroke survivors with mild cognitive-linguistic impairments at hospital discharge. Variability in cognitive-task performance under dual-task conditions has implications for the reliability of dual-task assessment after stroke. CLINICAL REHABILITATION IMPACT Assessment of dual-task walking is feasible as a predischarge evaluation of attention-demanding mobility function after stroke.
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Affiliation(s)
- Jody A Feld
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Prudence Plummer
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA -
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Gender and Musculoskeletal Comorbidity Impact on Physical Functioning in Elderly after Hip Fracture: The Role of Rehabilitation. Healthcare (Basel) 2020; 8:healthcare8010031. [PMID: 32033047 PMCID: PMC7151143 DOI: 10.3390/healthcare8010031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/15/2022] Open
Abstract
The study aim was to evaluate the effects of presence and level of musculoskeletal impairment along with gender on physical functioning outcome after the rehabilitation program in aged adults with a hip fracture. We analyzed 203 elderly people with hip fractures above 65 years of age that were treated after the hip surgery. According to the time of examination, patients were tested three times: at admission, discharge, and at three months post-discharge. Musculoskeletal impairments were analyzed, and for the estimation of severity of degree impairment, we used a cumulative index rating scale for geriatrics (CIRS-G). Regarding the gender, we separately analyzed males and females. To evaluate physical functioning of aged adults after a hip fracture, we used the physical functioning component (PFC) from the quality of life (SF-36) questionnaire. For males, on all three occasions we found non-significant differences were found in SF-36 PFC values between different degrees of CIRS-G musculoskeletal impairment. A significant difference was noticed in females three months post-discharge. Effects size of different examination periods for every CIRS-G severity degree of musculoskeletal impairment were high, where males had higher values for severity degrees 1 and 2, and females had higher values for severity degrees 0 and 3. Our findings might suggest that there is a certain degree of different rehabilitation treatment effects for males versus females. Moreover, it might be assumed that other factors could influence different degrees of functional improvement and outcome of individuals after a hip fracture with musculoskeletal impairment.
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Min TJ, Cho J, Ha YC, Lim JY, Kang SH, Kim DK, Seo KM, Beom J. Correlation Between Mechanography and Clinical Parameters at Six Months After Hip Fracture Surgery. Ann Rehabil Med 2019; 43:642-649. [PMID: 31918527 PMCID: PMC6960088 DOI: 10.5535/arm.2019.43.6.642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/04/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate the correlation between mechanography and clinical parameters in older people at 3 and 6 months after hip fracture surgery. METHODS A longitudinal follow-up study was conducted in university hospitals with 38 patients at 3 months and 29 patients at 6 months after hip fracture surgery. Subjects 65 years and older completed measurements on the Berg Balance Scale (BBS), Functional Ambulation Category (FAC), walking ability by Koval, Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale, and hand grip strength. The Romberg test with center of foot pressure (COP), chair rise test (CRT), and maximal power (W/kg) were conducted using the Leonardo Mechanograph. RESULTS COP area and pathway length were correlated with BBS at 3 and 6 months. Change in BBS was correlated with change in COP area, but not with change in COP length. COP area and pathway length were correlated with K-FRAIL at 3 months after hip fracture surgery. The same COP variables showed correlations with FAC and walking ability by Koval at 6 months after surgery. Maximal power during CRT had correlation with chair rise time but not with other clinical parameters. CONCLUSION The study revealed correlations between mechanography and clinical parameters in older people at 3 and 6 months after hip fracture surgery. Both the clinical assessment and objective test with mechanography may be required for the quantitative and sensitive measurement of postural balance and lower limb muscle power.
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Affiliation(s)
- Tae Jun Min
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Junmo Cho
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Si Hyun Kang
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Mook Seo
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jaewon Beom
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Shimoda K, Imai H, Tsuji T, Tsuchiya K, Tajima H, Kanemaki H, Tozato F. Factors affecting the performance of activities of daily living in patients with advanced cancer undergoing inpatient rehabilitation: results from a retrospective observational study. J Phys Ther Sci 2019; 31:795-801. [PMID: 31645809 PMCID: PMC6801346 DOI: 10.1589/jpts.31.795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/04/2019] [Indexed: 01/19/2023] Open
Abstract
[Purpose] Many clinicians believe that rehabilitation for patients with advanced cancer
is futile. We determined factors affecting the performance of activities of daily living
in patients with advanced cancer based on age, gender, marital status, living arrangement,
rehabilitation intensity, type of cancer, impairment, metastasis, and active cancer
treatment. [Participants and Methods] We assessed the Barthel Index to evaluate the
performance of activities of daily living. Of the 120 adult patients with cancer who
underwent inpatient rehabilitation, we analyzed the Barthel Index scores, consisting of 10
items, and reviewed the clinical characteristics from the medical records of 48 patients
who completed supportive or palliative rehabilitation according to Dietz and showed an
increased or maintained total Barthel Index score at final evaluation. [Results] The
median total Barthel Index score increased from 45 (5–95) to 72.5 (5–100); the
rehabilitation intensity was 320 (40–1,240) minutes. The analytical results showed that
the increase of total Barthel Index score was positively associated with rehabilitation
intensity (β=0.350) and negatively associated with the initial grooming score (β=−0.277).
[Conclusion] Adequate rehabilitation positively affects performance of activities of daily
living, especially in patients with advanced cancer who lost their grooming ability at the
onset of rehabilitation. Importantly, rehabilitation may be beneficial for patients with
advanced cancer.
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Affiliation(s)
- Kaori Shimoda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences: 3-39-22 Showa-machi, Maebashi-shi, Gunma 371-8514, Japan
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences: 3-39-22 Showa-machi, Maebashi-shi, Gunma 371-8514, Japan
| | - Hiroshi Tajima
- Division of Rehabilitation, Gunma Prefectural Cancer Center, Japan
| | - Hatsumi Kanemaki
- Division of Rehabilitation, Gunma Prefectural Cancer Center, Japan
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Jeon YT, Kim BR, Han EY, Nam KW, Lee SY, Park YG, Suh MJ, Kim JH. Post-operative Physical Performance Factors Associated With Gait Speed in Patients Surgically Treated for Hip Fracture: A Cross-Sectional Study. Ann Rehabil Med 2019; 43:570-580. [PMID: 31693847 PMCID: PMC6835134 DOI: 10.5535/arm.2019.43.5.570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/24/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To determine post-operative physical performance factors associated with gait speed in patients surgically treated for hip fracture. METHODS Cross-sectional data from 59 patients (16 males and 43 females; mean age, 79.2±9.1 years) who underwent hip fracture surgery were enrolled. Patients completed a 10-meter walk test (10MWT) to assess gait speed. Additional physical performance tests included the Timed Up and Go test (TUG), the Berg Balance Scale (BBS), maximum voluntary isometric contraction (MVIC) of the knee extensors and flexors on the operated and non-operated sides as well as of the hip abductors (all tested using air-resistance weight machines), and analysis of spatio-temporal gait parameters at about 6 weeks after hip surgery. RESULTS Bivariate analyses revealed a significant positive correlation between the post-operative 10MWT and the post-operative TUG, age, swing phase duration, and gait cycle duration along with a significant negative correlation between post-operative BBS score, MVIC of the knee extensors and flexors on the operated and non-operated sides, MVIC of the hip abductors, and cadence and stance phase duration. Linear regression analyses revealed that the post-operative TUG (β=0.85, p<0.01), gait cycle duration (β=0.17, p=0.02), and osteoporosis (β=-0.18, p=0.02) were associated with the post-operative 10MWT. CONCLUSION The presence of osteoporosis, post-operative balance, and isometric muscle strength in the operated and non-operated legs were statistically associated with post-operative gait speed early after hip fracture surgery.
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Affiliation(s)
- Young Tae Jeon
- Department of Rehabilitation Medicine, Jeju National University College of Medicine–Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University College of Medicine–Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University College of Medicine–Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Kwang Woo Nam
- Department of Orthopaedic Surgery, Jeju National University College of Medicine–Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University College of Medicine–Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Yong Geun Park
- Department of Orthopaedic Surgery, Jeju National University College of Medicine–Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Min Ji Suh
- Department of Rehabilitation Medicine, Jeju National University College of Medicine–Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Jong Hyun Kim
- Department of Rehabilitation Medicine, Jeju National University College of Medicine–Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
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Fukuda T, Imai S, Nakadera M, Wagatsuma Y, Horiguchi H. Postoperative daily living activities of geriatric patients administered general or spinal anesthesia for hip fracture surgery: A retrospective cohort study. J Orthop Surg (Hong Kong) 2019; 26:2309499017754106. [PMID: 29366390 DOI: 10.1177/2309499017754106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Maintaining independence after hip fracture repair is important for geriatric patients and general welfare. We investigated the effects of anesthetic methods on postoperative activities of daily living (ADLs) following hip fracture surgery in elderly patients. METHODS The medical records of 12,342 patients aged ≥65 years who underwent typical surgeries for hip fracture using either general anesthesia or spinal anesthesia were reviewed. To adjust for baseline differences and minimize selection bias for the chosen method of anesthesia, patients were matched by propensity scores. Factors affecting the deterioration in ADLs during hospital stay were also investigated in all subjects using a multivariate logistic regression analysis. Eating, grooming, toileting, bathing, and walking were selected as the ADL parameters, as they are considered important for an independent life. RESULTS Of the 12,342 patients, 6918 (56.1%) received general anesthesia and 5424 (43.9%) received spinal anesthesia. After the propensity score matching, the anesthesia types were not associated with ADL scores except toileting at discharge. Results from the multivariate logistic regression analysis showed that the types of anesthesia were not associated with deterioration in ADL scores. Advanced age, male sex, high Charlson Comorbidity Index scores, psychiatric disease, no administration of nonsteroidal anti-inflammatory drugs, and short length of hospital stay were associated with deterioration in ADL scores. CONCLUSION The anesthesia types were not associated with ADL dependency except toileting at discharge. Spinal anesthesia adversely affected toilet use at hospital discharge. However, anesthesia types were not factors that affected deterioration in ADL during hospital stay in elderly patients who underwent hip fracture surgery.
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Affiliation(s)
- Taeko Fukuda
- 1 University of Tsukuba, Tsukuba, Ibaraki, Japan.,2 Faculty of Medicine, Department of Anesthesiology, Tsuchiura Center for Medical Education and Training (National Hospital Organization, Kasumigaura Medical Center), Tsuchiura, Ibaraki Prefecture, Japan
| | - Shinobu Imai
- 3 Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization, Meguro-ku, Tokyo, Japan
| | - Masaya Nakadera
- 3 Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization, Meguro-ku, Tokyo, Japan
| | - Yukiko Wagatsuma
- 1 University of Tsukuba, Tsukuba, Ibaraki, Japan.,4 Faculty of Medicine, Department of Clinical Trial and Clinical Epidemiology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiromasa Horiguchi
- 3 Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization, Meguro-ku, Tokyo, Japan
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Sociodemographic Predictors of Physical Functioning in the Elderly: A National Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010037. [PMID: 30586888 PMCID: PMC6338915 DOI: 10.3390/ijerph16010037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/11/2018] [Accepted: 12/21/2018] [Indexed: 01/26/2023]
Abstract
We aimed to evaluate the prevalence of sociodemographic factors with the presence and different degrees of walking difficulties in elderly above 65 years, and to analyze association between evaluated variables and the presence and degree of waking difficulties. In the population based study, 3540 individuals age above 65 years from Serbia were recruited. Further predictors were analyzed: gender, age, level of education, marital status, body mass index (BMI), index of well-being and place of residence. We assessed difficulty in walking half a km on level ground without the use of any aid (Group-1); and difficulty in walking up or down 12 steps (Group-2). Walking difficulties were categorized as no difficulty, some difficulty, a lot of difficulty and cannot do at all. For present difficulty significant predictors were: age (Group-1 (OR-3.022)/Group-2 (OR-3.825)), gender (Group-1 (OR-0.337)/Group-2 (OR-0.311)), educational level (Group-1 (OR-0.689)/Group-2 (OR-0.556)) and place of residence (Group-2 (OR-1.523)) while for non-performing the task, significant predictors were: age (Group-1 (OR-1.998)/Group-2 (OR-2.096)), gender (Group-1 (OR-0.629)/Group-2 (OR-0.495)), BMI (Group-1 (OR-1.219)/Group-2 (OR-1.305)), marital status (Group-1 (OR 0.764)/Group-2 (OR-0.769)), educational level (Group-1 (OR-0.679)/Group-2 (OR-0.719)) and index of well-being (Group-2 (OR-0.764)). Understanding of predictors, and their role on functional decline in elderly is of great importance for the development of specific population-based health programs to prevent further functional loss and preserve achieved functional gains.
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Kim IH, Lee SU, Jung SH, Lee SJ, Lee SY. Effectiveness of the computerized balance rehabilitation after hip fracture surgery: A study protocol of a prospective and open-label clinical trial. Medicine (Baltimore) 2018; 97:e12199. [PMID: 30200127 PMCID: PMC6133532 DOI: 10.1097/md.0000000000012199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Although balance problems in older populations are directly correlated with hip fractures, the overall physical gain afforded by balance rehabilitation itself has not yet been fully investigated. Here we describe a protocol for an open-label clinical trial to evaluate the effectiveness of computer-based balance-specific exercise (BSE) on the performance and balance of elderly women who underwent hip fracture surgery (HFS). METHODS AND ANALYSIS Elderly female patients (≥65 years old) who underwent surgery for femoral neck, intertrochanteric, or subtrochanteric fracture regardless of surgery type will be included. The BSE will be conducted using a computed posturographic system for a 2-week intervention period following HFS. The primary outcome of this study is Berg balance scale score. All functional outcomes will be measured at 1 and 3 weeks and at 3 and 6 months after the surgical intervention. The data will be analyzed using the intention-to-treat principle.
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Affiliation(s)
- In-Hee Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital
| | | | | | - Soong Joon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Ju J, Jiang Y, Zhou P, Li L, Ye X, Wu H, Shen B, Zhang J, He X, Niu C, Xia Q. Evaluation of the reliability and validity for X16 balance testing scale for the elderly. BMC Geriatr 2018; 18:112. [PMID: 29807543 PMCID: PMC5971429 DOI: 10.1186/s12877-018-0803-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Balance performance is considered as an indicator of functional status in the elderly, a large scale population screening and evaluation in the community context followed by proper interventions would be of great significance at public health level. However, there has been no suitable balance testing scale available for large scale studies in the unique community context of urban China. Methods A balance scale named X16 balance testing scale was developed, which was composed of 3 domains and 16 items. A total of 1985 functionally independent and active community-dwelling elderly adults’ balance abilities were tested using the X16 scale. The internal consistency, split-half reliability, content validity, construct validity, discriminant validity of X16 balance testing scale were evaluated. Results Factor analysis was performed to identify alternative factor structure. The Eigenvalues of factors 1, 2, and 3 were 8.53, 1.79, and 1.21, respectively, and their cumulative contribution to the total variance reached 72.0%. These 3 factors mainly represented domains static balance, postural stability, and dynamic balance. The Cronbach alpha coefficient for the scale was 0.933. The Spearman correlation coefficients between items and its corresponding domains were ranged from 0.538 to 0.964. The correlation coefficients between each item and its corresponding domain were higher than the coefficients between this item and other domains. With the increase of age, the scores of balance performance, domains static balance, postural stability, and dynamic balance in the elderly declined gradually (P < 0.001). With the increase of age, the proportion of the elderly with intact balance performance decreased gradually (P < 0.001). Conclusions The reliability and validity of the X16 balance testing scale is both adequate and acceptable. Due to its simple and quick use features, it is practical to be used repeatedly and routinely especially in community setting and on large scale screening. Electronic supplementary material The online version of this article (10.1186/s12877-018-0803-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jingjuan Ju
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yu Jiang
- Changning Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Peng Zhou
- Changning Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Lin Li
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiaolei Ye
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Hongmei Wu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Bin Shen
- Changning Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Jialei Zhang
- Changning Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Xiaoding He
- Changning Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Chunjin Niu
- Changning Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Qinghua Xia
- Changning Center for Disease Control and Prevention, Shanghai, People's Republic of China.
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Kabboord AD, van Eijk M, Fiocco M, van Balen R, Achterberg WP. Assessment of Comorbidity Burden and its Association With Functional Rehabilitation Outcome After Stroke or Hip Fracture: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2016; 17:1066.e13-1066.e21. [DOI: 10.1016/j.jamda.2016.07.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023]
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Radosavljevic N, Nikolic D, Lazovic M, Hrkovic M, Ilic-Stojanovic O. COMORBIDITY IMPACT ON SOCIAL FUNCTIONING AFTER HIP FRACTURE: THE ROLE OF REHABILITATION. ACTA ORTOPEDICA BRASILEIRA 2016; 24:213-216. [PMID: 28243177 PMCID: PMC5035695 DOI: 10.1590/1413-785220162404156874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective: To analyze the impact of rehabilitation treatment on social functioning in elderly patients after hip fracture during a rehabilitation program. Methods: This study included 203 patients with hip fracture. Four groups were analyzed on rehabilitation: Group 1, at admission, Group 2, at discharge, Group 3, three months after discharge and Group 4, six months after discharge. The analyzed parameters included: musculoskeletal, neurological and cognitive impairments. Impairment severity was graded by cumulative index rating scale for geriatrics (CIRS-G). Evaluation of social functioning was completed by social functioning component (SFC) from quality of life (SF-36) questionnaire. Results: There was a significant improvement in SF-36 SFC values for observed impairments from admission to six months after discharge for each severity degree (p<0.01), except for CIRS-G severity degree 4 for cognitive impairment, where significance was p<0.05. For the group of patients with musculoskeletal impairment, there was a significant difference between the values of SF-36 SFC concerning different severity degrees of CIRS-G only at six months after discharge (p<0.05). Patients with neurological or cognitive impairments have shown significant differences between the values of SF-36 SFC in regard to severity degrees of CIRS-G in all observational groups. Conclusion: Different degrees of observed impairments influence the degree of social functioning recovery in the elderly after hip fracture.Level of Evidence II, Prognostic Studies .
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Affiliation(s)
| | - Dejan Nikolic
- University of Belgrade, Serbia; University Children's Hospital, Serbia
| | - Milica Lazovic
- Institute for Rehabilitation, Serbia; University of Belgrade, Serbia
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Palanisamy AM, Doshi HK, Selvaraj D, Chan W, Naidu G, Ramason R. Fixation Versus Replacement in Geriatric Hip Fractures: Does Functional Outcome and Independence in Self-Care Differ? Geriatr Orthop Surg Rehabil 2015; 6:258-62. [PMID: 26623159 PMCID: PMC4647188 DOI: 10.1177/2151458515595435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Although there is evidence of improved functional outcomes with our “integrated care pathway” for geriatric hip fractures, we do not know if there is a significant difference in functional recovery of activities of daily living and attainment of independence in self-care between patients who underwent fixation and those treated with arthroplasty. Objective: To determine whether such a difference exists in surgically fixed hip fractures. Materials and Methods: Patients with hip fracture treated surgically were divided into group A (internal fixation, n = 213) and group B (arthroplasty, n = 199). Demographic data, Charlson comorbidity index (CCI) score, time to surgery, and length of stay were recorded. Inpatient complications and mortality rates were also documented. Modified Barthel Index (MBI) scores were recorded for the following intervals: prefall, discharge, 6-month, and at 1-year follow-up. Results: The mean age (A: 80 years and B: 81years), CCI (A: 5.41 and B: 5.43), and length of stay (A: 13.6 days and B: 15.2 days) were not significantly different. However, there was a significant difference (P < .05) in time to surgery (A: 102.2 hours and B: 86.6 hours). Complication rates were about 6% in both groups (A = 6.57%: urinary infections = 13, wound infections = 1 and B = 6.03%: urinary infections = 10, wound infections = 1, pressure ulcer = 1). The preinjury MBI scores were significantly different (P < .05; A: 91.65 and B: 88.19), however, there was no significant difference in scores measured at discharge (A: 60.79 and B: 59.39), 6 months (A: 77.65 and B: 77.47) and 1 year (A: 80.71 and B: 83.03). Patients who underwent surgery for hip fracture had overall recovered 90.9% of their preinjury function (overall MBI at 1 year: 81.83). Conclusion: The MBI scores reflect the extent of attainment of independence in self-care, and actual functional recovery is gauged from the percentage of recovery of preinjury function at 1 year postsurgery. We conclude that the type of surgery may not be a significant factor in determining independence in self-care although patients who had arthroplasty had recovered more function at 1 year postsurgery than those who underwent fixation (percentage recovery of preinjury function—A: 88.1% and B: 94.1%).
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Affiliation(s)
| | - H K Doshi
- Department of Orthopaedics and Traumatology, Tan Tock Seng Hospital, Singapore
| | - Dahshaini Selvaraj
- Department of Orthopaedics and Traumatology, Tan Tock Seng Hospital, Singapore
| | - William Chan
- Department of Rehabilitation medicine, Tan Tock Seng Hospital, Singapore
| | - G Naidu
- Department of Orthopaedics and Traumatology, Tan Tock Seng Hospital, Singapore
| | - R Ramason
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
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González-Zabaleta J, Pita-Fernandez S, Seoane-Pillado T, López-Calviño B, Gonzalez-Zabaleta JL. Comorbidity as a predictor of mortality and mobility after hip fracture. Geriatr Gerontol Int 2015; 16:561-9. [PMID: 25981487 DOI: 10.1111/ggi.12510] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/14/2022]
Abstract
AIM To determine mortality and mobility rates after hip fracture. METHODS A prospective study (n = 199 patients) was carried out in the Health Care Center of A Coruña (Spain) during the period between January 2009 and December 2011. A descriptive study, and Cox and logistic regression analysis were carried out. Informed consent and ethical review board approval were obtained (code 2010/120 CEIC Galicia). RESULTS The patients' mean age was 82.5 ± 8.4 years and 76% were female. The average Charlson Comorbidity Index score was 6.1 ± 2.1. Creatinine clearance <60 mL/min/1.73 m(2) was 44%. The probability of survival 6 months after hip fracture was 89.2% and the survival rate at 12 months was 81.4%. Cox regression analysis showed that the indicator that most influenced mortality rate was comorbidity (HR = 1.133; P = 0.020) and age approaching borderline statistical significance (HR = 1.034; P = 0.064). The Parker Mobility Score decreased significantly (P < 0.001) after hip fracture. Before fracture, 19% of the patients were able to get about the house, 26% were able to get out of the house and 55% were able to go shopping. After hip fracture (90 days), the percentages changed to 56.2%, 19.1% and 24.7%, respectively (P < 0.001). After taking into account age, sex, type of fracture, surgical delay, previous fracture and comorbidity, the only indicator capable of predicting incapacity to walk was comorbidity. CONCLUSIONS Comorbidity is the best predictor of mortality and mobility after hip fracture. Geriatr Gerontol Int 2016; 16: 561-569.
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Affiliation(s)
| | - Salvador Pita-Fernandez
- Clinical Epidemiology and Biostatistics Research Group, Biomedical Research Institute of A Coruña (INIBIC), A Coruña Hospital (CHUAC), SERGAS, University of A Coruña, A Coruña, Spain
| | - Teresa Seoane-Pillado
- Clinical Epidemiology and Biostatistics Research Group, Biomedical Research Institute of A Coruña (INIBIC), A Coruña Hospital (CHUAC), SERGAS, University of A Coruña, A Coruña, Spain
| | - Beatriz López-Calviño
- Clinical Epidemiology and Biostatistics Research Group, Biomedical Research Institute of A Coruña (INIBIC), A Coruña Hospital (CHUAC), SERGAS, University of A Coruña, A Coruña, Spain
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Di Monaco M, Castiglioni C, Di Monaco R, Tappero R. Prevalence and burden of vertebral fractures in older men and women with hip fracture: A cross-sectional study. Geriatr Gerontol Int 2015; 16:352-7. [DOI: 10.1111/ggi.12479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Marco Di Monaco
- Osteoporosis Research Center; Division of Physical and Rehabilitation Medicine; Presidio Sanitario San Camillo; Fondazione Opera San Camillo; Torino Italy
| | - Carlotta Castiglioni
- Osteoporosis Research Center; Division of Physical and Rehabilitation Medicine; Presidio Sanitario San Camillo; Fondazione Opera San Camillo; Torino Italy
| | - Roberto Di Monaco
- Department of Culture, Politics, and Society; University; Torino Italy
| | - Rosa Tappero
- Osteoporosis Research Center; Division of Physical and Rehabilitation Medicine; Presidio Sanitario San Camillo; Fondazione Opera San Camillo; Torino Italy
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Dependence for basic and instrumental activities of daily living after hip fractures. Arch Gerontol Geriatr 2014; 60:66-70. [PMID: 25465506 DOI: 10.1016/j.archger.2014.10.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/03/2014] [Accepted: 10/30/2014] [Indexed: 11/23/2022]
Abstract
The objective of the study is to determine basic activities of daily living (Barthel Index) and instrumental activities of daily living (Lawton-Brody Index) before and after hip fracture. Follow-up study of patients (n=100) with hip fracture, operated at Complejo Hospitalario Universitario de A Coruña (Spain). Period January/2009-December/2011. Demographic characteristic of the patients, Charlson Index, Glomerular filtration rate, Barthel index, Lawton index, type of proximal femur fracture and surgical treatment delay were recorded. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained. Before fracture were independent for activities of daily living (ADL) a 38.0%, at 90 days were 15.4%. The Barthel index score decreased from 75.2±28.2 to 56.5±31.8) (p<0.0001). If we consider the age, gender, comorbidity (Charlson index), renal function, fracture type and surgical delay objectify the only independent variable to predict dependency effect is age. If we also consider the Barthel score objectify the variable that significantly modifies that score at 90 days is the baseline value of the index. The prevalence of independence for instrumental activities of daily living (IADL) at the baseline moment is 11% and at 90 days is decreased to 2.2%. There is a decrease in the independence effect in all activities. The variable predictor of independence for all activities after taking into consideration age, sex, comorbidity, fracture type, surgical delay and renal function is the baseline score of the Barthel and Lawton index.
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Radosavljevic N, Nikolic D, Lazovic M, Jeremic A. Hip fractures in a geriatric population - rehabilitation based on patients needs. Aging Dis 2014; 5:177-82. [PMID: 24900940 DOI: 10.14336/ad.2014.0500177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/10/2013] [Accepted: 10/14/2013] [Indexed: 01/05/2023] Open
Abstract
With an increased life expectancy in humans and thus an increase in the number of the elderly population, the frequency of hip fractures will rise as well. Aside from a higher incidence, hip fractures in a geriatric population is a significant problem due to the possible onset of severe and in some cases dramatic complications and consequences. The primary purpose of treatment and rehabilitation in the elderly after a hip fracture is to improve an individual's quality of life. It is important to underline that principles and methods of functional restoration after hip fracture should consider careful planning of a rehabilitation program individually for every patient and its implementation with respect to decisions made by the rehabilitation team.
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Affiliation(s)
| | - Dejan Nikolic
- Physical Medicine and Rehabilitation Department, University Children's Hospital, Belgrade, Serbia
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Bianco A, Patti A, Bellafiore M, Battaglia G, Sahin FN, Paoli A, Cataldo MC, Mammina C, Palma A. Group fitness activities for the elderly: an innovative approach to reduce falls and injuries. Aging Clin Exp Res 2014; 26:147-52. [PMID: 24057943 DOI: 10.1007/s40520-013-0144-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/05/2013] [Indexed: 11/25/2022]
Abstract
AIM The aim of this study was to examine the opportunity to adopt, for the elderly, already validated function ability tests to better understand how to prevent falls and injuries and to better plan group fitness activities like ballroom dance classes (e.g., Valzer, Polka, Mazurka). METHODS A cross-sectional study was conducted. The Berg Balance Scale (BBS) and the Barthel Index (BI) were administered and the occurrence of falls during the previous 2 years was evaluated by anamnesis. One hundred and twenty-two elderly subjects living in Palermo city participated to the study. According to the anamnesis, subjects were divided into two groups: experimental group (EG) and control group (CG). The EG consisted of 75 subjects attending classes of ballroom dancing (73.0 ± 5.6 years 26.1 ± 3.9 BMI), while the CG included 47 volunteers (74.3 ± 5.4 years, 26.8 ± 4.4 BMI). A threshold of 70 % for both scales (BBS-70 and BI-70 %) was set, according to the aims of the study. STATISTICA software was adopted to perform an unpaired t test. A P value lower than 0.05 was considered to be statistically relevant. RESULTS The BI and BBS of CG were 76.7 ± 33.08 and 30.9 ± 14.9, respectively, while the BI and BBS of EG were 98.1 ± 6.9 and 50.5 ± 54. In EG the BBS-70 % showed 96.0 % of cases compared to 27.6 % of the CG. The BI showed a similar trend to BBS. In EG the BI-70 % showed 98.6 % of cases, while the BI-70 % of CG showed 70.2 % of cases. Moreover, only 36.0 % of EG reported falls previously, while CG reported 53.2 % of falls during the same period of time. CONCLUSION The BBS seems to be a valid and reliable tool able to be adopted also by professionals of the ballroom dancing sector (e.g., Valzer, Polka and Mazurka classes). Instructors may evaluate the functional ability of their attendees through BBS to easily obtain more information and better plan ballroom dance classes. Moreover, we highlight that these conclusions need to be supported by other studies with different cohorts and a larger population scale.
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Affiliation(s)
- Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, Via Eleonora Duse 2, 90146, Palermo, Italy,
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Functional improvement of self-care in the elderly after hip fracture: is age a factor? Arch Orthop Trauma Surg 2014; 134:489-93. [PMID: 24464301 DOI: 10.1007/s00402-014-1924-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aging population is growing rapidly in Asia resulting in an increased number of hip fractures being managed surgically. Though there is evidence of improved quality of patient care and outcomes with well-established models of care, we do not know if the functional recovery in activities of daily living among this group of patients is also dependant on age. We hypothesize that there will be a difference in Modified Barthel Index (MBI) scores between the 'older old' (>85 years) and the 'younger old' (<85 years). PATIENT AND METHODS Hip fracture patients (>60 years) treated surgically were divided into Group A (below 85 years) and Group B (above 85 years). Demographic data, Charlson's Comorbidity Index (CCI) score, time to surgery and length of stay (LOS) were recorded. To assess the recovery in activities of daily living, the MBI scores were measured for the following intervals; pre-fall, at discharge, at 6-month and at 1-year follow-up. RESULTS The mean age for Group A (n = 120) was 77 years (60-85) and the mean age for Group B (n = 59) was 91.8 years (86-108). There was no significant difference in the mean CCI (A: 1.14, B: 1.24), mean time to surgery (A: 72.3 h, B: 79.9 h) and mean LOS (A: 10.8 days, B: 10.3 days). The MBI scores were significantly different (P < 0.05) for the pre-injury scores (A = 91.5, B = 84.4); however, there was no significant difference for scores measured at discharge (A = 57.5, B = 52.7), at 6 months (A = 74.6, B = 69.3) and at 1 year (A = 82.2, B = 73.2). Though there was a significant improvement, the scores at 1 year were significantly lower than the pre-injury score for both groups. CONCLUSION We conclude that age is not a factor in determining functional recovery with regard to activities of daily living in an integrated model of care for geriatric hip fracture patients.
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Radosavljevic N, Lazovic M, Nikolic D, Petronic I, Radosavljevic Z, Jeremic A. Influence of selective comorbidity predictors on functional recovery after hip fracture in an older population. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014. [PMID: 23202276 DOI: 10.5507/bp.2012.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The purpose of the study was to evaluate the influence of four comorbidities from the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and their severity on functional status outcome after a rehabilitation program measured by the Berg Balance Scale (BBS) in patients with hip fracture. METHODS The study included 203 patients whose functional status was evaluated by the BBS at admission (Group 1), at discharge (Group 2) and 3 months after discharge (Group 3). Further comorbidity parameters from the CIRS-G were assessed: musculoskeletal impairment, neurological, vascular and cognitive impairment. For the evaluation of CIRS-G severity degree we used the range 0-4. RESULTS At admission there were non-significant differences in mean values of BBS between parameters for the same CIRS-G severity degree. Significant differences between BBS values were noticed in the period after discharge (Group 2((musculoskeletal)); P<0.05, Group 2((neurological and cognitive)); P<0.01) and after 3 months of follow-up (Group 3((musculoskeletal, neurological and cognitive)); P<0.01). Higher effects of CIRS-G severity degree on BBS values in Group 2 and Group 3 for neurological impairment (η(2)(Group2)=29.76 and η(2)(Group3)=28.35) and even higher for cognitive impairment (η(2)(Group2)=34.35 and η(2)(Group3)=40.63) were noticed. CONCLUSION Increase in CIRS-G severity degree of cognitive and neurological impairment in patients after hip fracture that were included in the rehabilitation program correlates closely with functional status after discharge and after 3 months of follow-up. Rehabilitation of patients after hip fracture should be mandatory for functional recovery regardless of the comorbidity and functional status.
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Abstract
PURPOSE OF REVIEW Lifestyle factors play a role in both the genesis and recovery from fragility fracture. The purpose of this review is to summarize recent evidence for exercise and nutrition in the management of hip fracture. RECENT FINDINGS Recent randomized controlled trials of exercise have primarily consisted of isolated resistance training or multimodal home-based programs. More robust, long-term, or supervised training is generally associated with greater clinical benefits, including muscle strength, mobility, and function. Recent nutritional interventions have included multinutrient supplements, nutritional counseling and support, and vitamin D/calcium supplementation. Isolated nutritional interventions have not consistently shown significant impact on long-term outcomes after hip fracture, although improvements in body weight, biochemical indices, complication rates, and mobility have been reported. Overall, there is marked heterogeneity in the robustness of responses seen to hip fracture treatment studies. Few large, long-term, multicomponent interventions with clinically relevant outcomes of functional independence, need for residential care, mortality, and quality of life have been reported. SUMMARY Evidence-based approaches to hip fracture should include comprehensive risk-factor assessment and treatment for sarcopenia/dynapenia, balance impairment, undernutrition of protein, energy, vitamin D and calcium, depression, cognitive impairment, sensory impairment, social isolation, and comorbid illness with exercise, nutrition and other modalities.
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Affiliation(s)
- Maria A Fiatarone Singh
- aExercise and Sport Science, Faculty of Health Sciences bSydney Medical School cUniversity of Sydney, New South Wales, Australia
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Mizrahi EH, Arad M, Fleissig Y, Adunsky A. Gender differences in functional outcome of elderly hip fracture patients. Geriatr Gerontol Int 2013; 14:845-50. [DOI: 10.1111/ggi.12178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eliyahu-Hayim Mizrahi
- Department of Geriatric Medicine and Rehabilitation; Shmuel Harofe Hospital; Beer-Yaakov Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Marina Arad
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Geriatric Medicine and Rehabilitation; Sheba Medical Center; Ramat-Gan Israel
| | - Yehudit Fleissig
- Department of Geriatric Medicine and Rehabilitation; Shmuel Harofe Hospital; Beer-Yaakov Israel
| | - Abraham Adunsky
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Geriatric Medicine and Rehabilitation; Sheba Medical Center; Ramat-Gan Israel
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