1
|
Pratt J, Dalla Via J, Sale C, Gebre AK, Stephan BCM, Laws S, Zhu K, Lim WH, Prince RL, Lewis JR, Sim M. Apolipoprotein ɛ4 Is Associated With Increased Risk of Fall- and Fracture-Related Hospitalization: The Perth Longitudinal Study of Ageing Women. J Gerontol A Biol Sci Med Sci 2024; 79:glae134. [PMID: 38766839 PMCID: PMC11212482 DOI: 10.1093/gerona/glae134] [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: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
Apolipoprotein ɛ4 (APOE ɛ4) may be a genetic risk factor for reduced bone mineral density (BMD) and muscle function, which could have implications for fall and fracture risk. We examined the association between APOE ɛ4 status and long-term fall- and fracture-related hospitalization risk in older women. A total of 1 276 community-dwelling women from the Perth Longitudinal Study of Aging Women (mean age ± SD = 75.2 ± 2.7 years) were included. At baseline, women underwent APOE genotyping and detailed phenotyping for covariates including prevalent falls and fractures, as well as health and lifestyle factors. The association between APOE ɛ4 and fall-, any fracture-, and hip fracture-related hospitalizations, obtained over 14.5 years from linked health records, was examined using multivariable-adjusted Cox-proportional hazard models. Over 14.5 years, 507 (39.7%) women experienced a fall-related hospitalization and 360 (28.2%) women experienced a fracture-related hospitalization, including 143 (11.2%) attributed to a hip fracture. In multivariable-adjusted models, compared to noncarriers, APOE ɛ4 carriers (n = 297, 23.3%) had greater risk for a fall- (hazard ratio [HR] 1.48, 95% CI: 1.22-1.81), fracture- (HR 1.28, 95% CI: 1.01-1.63), or hip fracture-related hospitalization (HR 1.83, 95% CI: 1.29-2.61). The estimates remained similar when specific fall and fracture risk factors (fear of falling, plasma 25-hydroxyvitamin D, grip strength, timed up-and-go, hip BMD, vitamin K status, prevalent diabetes, HbA1c, cholesterol, and abbreviated mental test score) were added to the multivariable model. In conclusion, APOE ɛ4 is a potential risk factor for fall- and fracture-related hospitalization in community-dwelling older women. Screening for APOE ɛ4 could provide clinicians an opportunity to direct higher-risk individuals to appropriate intervention strategies.
Collapse
Affiliation(s)
- Jedd Pratt
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Jack Dalla Via
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Craig Sale
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Abadi K Gebre
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Blossom C M Stephan
- Institute of Mental Health, The University of Nottingham Medical School, Nottingham, UK
- Dementia Centre of Excellence, enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Simon Laws
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Wai H Lim
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Richard L Prince
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Joshua R Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
2
|
Zhang F, Zhu S, Di Y, Pan M, Xie W, Li X, Zhu W. Ambient PM 2.5 components might exacerbate bone loss among middle-aged and elderly women: evidence from a population-based cross-sectional study. Int Arch Occup Environ Health 2024:10.1007/s00420-024-02090-y. [PMID: 39060505 DOI: 10.1007/s00420-024-02090-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Previous studies have primarily focused on the links between fine particulate matter (PM2.5) and bone health among the general population instead of PM2.5 components and the specific population. We aimed to investigate the associations between PM2.5 components and bone health among middle-aged and elderly women. METHODS A total of 748 middle-aged and elderly women were randomly sampled from 32 streets/villages in Hubei Province. The concentrations of ambient PM2.5 and its components were extracted across various residential areas from the Tracking Air Pollution in China (TAP) dataset. Bone mineral density measurements were obtained from dual-energy X-ray absorptiometry scans of study participants. Multivariable logistic and linear models were employed to assess the relationship between PM2.5 and its components and bone loss. RESULTS Per interquartile range (IQR) increase in nitrate (NO3-) and ammonium (NH4+) concentrations were associated with 1.65 [95% confidence intervals (CI): 1.13, 2.30] and 1.77 (95% CI: 1.26, 2.49) times higher odds of osteoporosis, respectively. Long-term exposure to sulfate (SO42-), NO3-, and NH4+ was negatively associated with T-scores and bone mineral density in L1-L4 lumbar vertebrae. In addition, the elderly, women who have experienced menarche after the age of 14, and postmenopausal women were more susceptible to the water-soluble inorganic salts of PM2.5. CONCLUSION The study emphasizes the need for comprehensive policies addressing air quality, with a specific focus on vulnerable populations such as middle-aged and elderly women. Public health interventions aimed at reducing ambient PM2.5 concentrations and minimizing exposure to its harmful components are crucial in mitigating the adverse impact on skeletal health and improving the overall well-being of communities.
Collapse
Affiliation(s)
- Faxue Zhang
- Wuhan Orthopaedics Hospital of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Wuhan Sports University, Wuhan, 430079, China
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Yanfeng Di
- Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi, 830011, China
| | - Minghao Pan
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Wei Xie
- Wuhan Orthopaedics Hospital of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Wuhan Sports University, Wuhan, 430079, China
| | - Xugui Li
- Wuhan Orthopaedics Hospital of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Wuhan Sports University, Wuhan, 430079, China.
| | - Wei Zhu
- Wuhan Orthopaedics Hospital of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Wuhan Sports University, Wuhan, 430079, China.
| |
Collapse
|
3
|
Sanchez-Garcia E, Cruz-Jentoft AJ, Ravasco P, Suominen M, Pitkälä PK. Nutritional care in older adults: are we doing everything? An expert opinion review. Curr Med Res Opin 2024:1-22. [PMID: 39044672 DOI: 10.1080/03007995.2024.2380007] [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: 05/28/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
Malnutrition is a prevalent, yet often underdiagnosed and undertreated, condition in older adults. It is characterized by weight loss and/or reduced muscle mass due to diminished caloric intake, inflammation, and/or disease burden. In return, malnutrition can lead to diminished skeletal muscle functionality and disability, among others. Malnutrition plays a crucial role in the pathogenesis of two prevalent geriatric syndromes, namely sarcopenia and frailty. The complex interplay between malnutrition, sarcopenia, and frailty significantly impacts the older population, leading to increased morbidity, mortality, hospitalization rates, quality of life, and healthcare costs. Given the prognostic significance of malnutrition in geriatric care, recent guidelines emphasized the role of nutritional support in vulnerable populations. A group of vulnerable populations to malnutrition, sarcopenia, and frailty are older patients with hip fractures, cancer patients, and those with sarcopenic dysphagia. This article highlights the importance of individualized nutritional assessment and treatment in the management of vulnerable populations such as older patients with hip fractures, cancer, and those suffering from sarcopenic dysphagia. It presents practical protocols and guidelines that can be instrumental in enhancing the nutritional care of these groups, thereby improving their overall health outcomes.
Collapse
Affiliation(s)
- Elisabet Sanchez-Garcia
- Consultant in Geriatric Medicine, Mater Private Network, Cork, T12 K199, Ireland
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paula Ravasco
- Universidade Católica Portuguesa, Faculty of Medicine and Centre for Interdisciplinary Research in Health; Centre for Interdisciplinary Research Egas Moniz (CiiEM), Lisbon, Portugal
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Prof Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Gonzalez CA, Van Rysselberghe NL, Whittaker MJ, Ngo D, Michaud JB, Gardner MJ. Integrated Dual Lag Screws Have Higher Reoperation Rates for Fixation Failure Than Single Lag Component Cephalomedullary Nails: A Retrospective Study of 2,130 Patients with Intertrochanteric Femoral Fractures. J Bone Joint Surg Am 2024:00004623-990000000-01157. [PMID: 39042721 DOI: 10.2106/jbjs.23.01152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Previous studies comparing reoperation risk between integrated dual lag screw (IDL) and single lag component (SL) cephalomedullary nails (CMNs) in the treatment of intertrochanteric femoral fractures have demonstrated mixed results. The purpose of this study was to assess the rates of reoperation for fixation failure and all-cause reoperation in a large, multi-institutional cohort of patients with an intertrochanteric fracture treated with an IDL or SL CMN. We hypothesized that there would be no difference between the groups with respect to either of the reoperation rates. METHODS Adults (≥18 years old) who sustained an intertrochanteric fracture (AO/OTA 31A1 to 31A3) treated with an IDL or SL CMN between January 2014 and May 2021 at 1 of 13 Level-I trauma centers were included. Patients with <3 months of follow-up or pathologic fractures were excluded. Rates of reoperation were compared with use of the chi-square test and multivariable regression, controlling for age, gender, injury mechanism, fracture pattern, and postoperative neck-shaft angle. RESULTS A total of 2,130 patients met the inclusion criteria. The median age was 78 years, and 62.5% of patients were female. The cohort consisted of 287 patients (13.5%) with an IDL CMN and 1,843 patients (86.5%) with an SL CMN. A total of 99 patients (4.6%) had a reoperation of any type, of whom 29 (1.4% of all patients) had a reoperation for fixation failure. Compared with patients with an SL CMN, those with an IDL CMN had higher rates (4.2% versus 0.9%; p < 0.001) and odds (odds ratio [OR], 4.95 [95% confidence interval (CI), 2.29 to 10.69]; p < 0.001) of reoperation for fixation failure as well as higher rates (7.3% versus 4.2%; p = 0.021) and odds (OR, 1.83 [95% CI, 1.10 to 3.06]; p = 0.021) of all-cause reoperation. CONCLUSIONS Intertrochanteric femoral fractures treated with an IDL CMN were associated with low but significantly higher rates and significantly higher odds of reoperation for fixation failure and all-cause reoperation compared with those treated with an SL CMN. We suggest caution to surgeons in the use of IDL CMNs for high-risk patients and recommend using SL CMNs for most patients with intertrochanteric femoral fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | | | - Mathew J Whittaker
- Stanford Health Care, Stanford University Medical Center, Stanford, California
| | - Daniel Ngo
- University of Texas Health Science Center at Houston, Houston, Texas
| | - John B Michaud
- Stanford Health Care, Stanford University Medical Center, Stanford, California
| | - Michael J Gardner
- Stanford Health Care, Stanford University Medical Center, Stanford, California
| |
Collapse
|
6
|
Moon SH, Doshi KB, Lockhart T. Assessing fall risk in osteoporosis patients: a comparative study of age-matched fallers and nonfallers. Front Digit Health 2024; 6:1387193. [PMID: 39049820 PMCID: PMC11266042 DOI: 10.3389/fdgth.2024.1387193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/20/2024] [Indexed: 07/27/2024] Open
Abstract
This study aimed to investigate sway parameters and physical activity level of the age/gender-matched older adults with osteoporosis faller and nonfaller patients. By examining these factors, our objective was to understand how these faller and nonfaller groups with osteoporosis differed particularly in terms of balance capabilities and their impact on physical activity levels. We recruited 24 patients with osteoporosis: 12 who reported a fall within a year before recruitment (fallers) and 12 without falls (nonfallers). Given the close association between biochemical markers of musculoskeletal health such as serum calcium, parathyroid hormone (PTH), Vitamin D, and renal function, we compared these markers in both groups. As a result, elderly individuals with osteoporosis and with a history of falls within the preceding year indicated significantly higher sway velocity (P = 0.012*), sway area (P < 0.001*), and sway path length (P = 0.012*). Furthermore, fallers had significantly lower calcium (P = 0.02*) and Parathyroid hormone (PTH) (P = 0.02*), as well as higher Alkaline Phosphatase (ALP) (P = 0.02*) as compared to nonfallers despite similar vitamin D and creatinine levels. In conclusion, diminished biochemical factors in the osteoporosis faller group could possibly cause postural instability resulting in lower physical activity levels in the osteoporosis fall group and increasing the risk of falls.
Collapse
Affiliation(s)
- Seong Hyun Moon
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Krupa B. Doshi
- Division of Endocrinology, Mayo Clinic, Scottsdale, AZ, United States
| | - Thurmon Lockhart
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| |
Collapse
|
7
|
Prieto-Moreno R, Mora-Traverso M, Estévez-López F, Molina-Garcia P, Ortiz-Piña M, Salazar-Graván S, Cruz-Guisado V, Gago ML, Martín-Matillas M, Ariza-Vega P. Effects of the ActiveHip+ mHealth intervention on the recovery of older adults with hip fracture and their family caregivers: a multicentre open-label randomised controlled trial. EClinicalMedicine 2024; 73:102677. [PMID: 38911836 PMCID: PMC11192790 DOI: 10.1016/j.eclinm.2024.102677] [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: 10/27/2023] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Background Mobile health (mHealth) systems are a promising alternative for rehabilitation of hip fracture, addressing constrained healthcare resources. Half of older adults fails to recover their pre-fracture routines, which imposes a burden on caregivers. We aimed to test the effectiveness of the 3-month ActiveHip + mHealth intervention on physical and psychological outcomes of older adults with hip fracture and their family caregivers. Methods In a multicentre open-label randomised controlled trial conducted across 3 hospitals in Andalusia (Spain), patients older than 65 with a hip fracture, who were previously independent and lacked cognitive impairment were recruited alongside with their caregivers. Participants were randomly allocated (1:1) to the intervention group (ActiveHip+) or control (usual care) group. The intervention group underwent a 12-week health education and tele-rehabilitation programme through the ActiveHip + mHealth intervention. The primary outcome, physical performance, was assessed using the Short Physical Performance Battery at three time points: at hospital discharge (baseline), 3-month after surgery (post intervention) and 1-year after surgery follow-up. Primary analyses of primary outcomes and safety data followed an intention-to-treat approach. This study is registered at ClinicalTrials.gov, NCT04859309. Findings Between June 1st, 2021 and June 30th, 2022 data from 105 patients and their caregivers were analysed. Patients engaged in the ActiveHip + mHealth intervention (mean 7.11 points, SE 0.33) showed higher physical performance compared with patients allocated in the control group (mean 5.71 points, SE 0.32) at 3 months after surgery (mean difference in change from baseline 1.40 points, SE 0.36; puncorrected = 0.00011). These benefits were not maintained at 1-year after surgery follow-up (mean difference in change from baseline 0.19 points, SE 0.47; puncorrected = 0.68). No adverse events, including falls and refractures, were reported during the tele-rehabilitation sessions. At 3-months, the intervention group had 2 falls, compared to 4 in the control group, with no observed refractures. At the 1-year follow-up, the intervention group experienced 7 falls and 1 refracture, while the control group had 13 falls and 2 refractures. Interpretation This study suggests that the ActiveHip + mHealth intervention may be effective for recovering physical performance in older adults with hip fracture. Importantly, the implementation of ActiveHip + into daily clinical practice may be feasible and has already been adopted in 18 hospitals, mostly in Spain but also in Belgium and Portugal. Thus, ActiveHip + could offer a promising solution when rehabilitation resources are limited. However, its dependence on caregiver support and the exclusion of participants with cognitive impairment makes it necessary to be cautious about its applicability. In addition, the non-maintenance of the effectiveness at 1-year follow-up highlights the need of refinement the ActiveHip + intervention to promote long-lasting behavioural changes. Funding EIT Health and the Ramón y Cajal 2021 Excellence Research Grant action from the Spanish Ministry of Science and Innovation.
Collapse
Affiliation(s)
- Rafael Prieto-Moreno
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
- SPORT Research Group (CTS-1024), CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, 04009, Almería, Spain
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
| | - Marta Mora-Traverso
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sport Science, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Fernando Estévez-López
- SPORT Research Group (CTS-1024), CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, 04009, Almería, Spain
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Mariana Ortiz-Piña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Susana Salazar-Graván
- Orthopaedic Surgery and Traumatology Service, University Hospital Virgen de las Nieves, Granada, Spain
| | - Víctor Cruz-Guisado
- Department of Physical Medicine and Rehabilitation, University Hospital Jerez de la Frontera, Cadiz, Spain
| | - Marta Linares Gago
- Department of Physical Medicine and Rehabilitation, University Hospital Puerto Real, Cadiz, Spain
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health Through Physical Activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sport Science, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| |
Collapse
|
8
|
Danazumi MS, Lightbody N, Dermody G. Effectiveness of fracture liaison service in reducing the risk of secondary fragility fractures in adults aged 50 and older: a systematic review and meta-analysis. Osteoporos Int 2024; 35:1133-1151. [PMID: 38536447 PMCID: PMC11211169 DOI: 10.1007/s00198-024-07052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/01/2024] [Indexed: 06/28/2024]
Abstract
To determine and appraise the certainty of fracture liaison service (FLS) in reducing the risk of secondary fragility fractures in older adults aged ≥ 50 years and to examine the nature of the FLS and the roles of various disciplines involved in the delivery of the FLS. Medline, EMBASE, PubMed, CINAHL, SCOPUS, and The Cochrane Library were searched from January 1st, 2010, to May 31st, 2022. Two reviewers independently extracted data. The risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the PEDro scale for randomized trials, while the GRADE approach established the certainty of the evidence. Thirty-seven studies were identified of which 34 (91.9%) were rated as having a low risk of bias and 22 (59.5%) were meta-analyzed. Clinically important low certainty evidence at 1 year (RR 0.26, CI 0.13 to 0.52, 6 pooled studies) and moderate certainty evidence at ≥ 2 years (RR 0.68, CI 0.55 to 0.83, 13 pooled studies) indicate that the risk of secondary fragility fracture was lower in the FLS intervention compared to the non-FLS intervention. Sensitivity analyses with no observed heterogeneity confirmed these findings. This review found clinically important moderate certainty evidence showing that the risk of secondary fragility fracture was lower in the FLS intervention at ≥ 2 years. More high-quality studies in this field could improve the certainty of the evidence. Review registration: PROSPERO-CRD42021266408.
Collapse
Affiliation(s)
- Musa Sani Danazumi
- Discipline of Physiotherapy, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
- Department of Physiotherapy, Federal Medical Centre Nguru, 02 Machina Road, Nguru, 630101, Yobe, Nigeria
| | - Nicol Lightbody
- Queensland Government Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Gordana Dermody
- School of Health, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, 4556, Australia.
| |
Collapse
|
9
|
Khan AA, Slart RHJA, Ali DS, Bock O, Carey JJ, Camacho P, Engelke K, Erba PA, Harvey NC, Lems WF, Morgan S, Moseley KF, O'Brien C, Probyn L, Punda M, Richmond B, Schousboe JT, Shuhart C, Ward KA, Lewiecki EM. Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices. Mayo Clin Proc 2024; 99:1127-1141. [PMID: 38960497 DOI: 10.1016/j.mayocp.2024.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 07/05/2024]
Abstract
Osteoporotic fractures, also known as fragility fractures, are reflective of compromised bone strength and are associated with significant morbidity and mortality. Such fractures may be clinically silent, and others may present clinically with pain and deformity at the time of the injury. Unfortunately, and even at the time of detection, most individuals sustaining fragility fractures are not identified as having underlying metabolic bone disease and are not evaluated or treated to reduce the incidence of future fractures. A multidisciplinary international working group with representation from international societies dedicated to advancing the care of patients with metabolic bone disease has developed best practice recommendations for the diagnosis and evaluation of individuals with fragility fractures. A comprehensive narrative review was conducted to identify key articles on fragility fractures and their impact on the incidence of further fractures, morbidity, and mortality. This document represents consensus among the supporting societies and harmonizes best practice recommendations consistent with advances in research. A fragility fracture in an adult is an important predictor of future fractures and requires further evaluation and treatment of the underlying osteoporosis. It is important to recognize that most fragility fractures occur in patients with bone mineral density T scores higher than -2.5, and these fractures confirm the presence of skeletal fragility even in the presence of a well-maintained bone mineral density. Fragility fractures require further evaluation with exclusion of contributing factors for osteoporosis and assessment of clinical risk factors for fracture followed by appropriate pharmacological intervention designed to reduce the risk of future fracture. Because most low-trauma vertebral fractures do not present with pain, dedicated vertebral imaging and review of past imaging is useful in identifying fractures in patients at high risk for vertebral fractures. Given the importance of fractures in confirming skeletal fragility and predicting future events, it is recommended that an established classification system be used for fracture identification and reporting.
Collapse
Affiliation(s)
- Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada.
| | - Riemer H J A Slart
- University Medical Center Groningen, Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, Groningen, The Netherlands
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Oliver Bock
- Department of Osteoporosis, Inselspital, Bern University Hospital, Switzerland, IG Osteoporose, Bern, Switzerland
| | - John J Carey
- Department of Rheumatology, University of Galway, Galway, Ireland
| | | | - Klaus Engelke
- Department of Medicine 3 and Institute of Medical Physics, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Germany
| | - Paola A Erba
- Department of Medicine and Surgery, Nuclear Medicine UnitASST, Ospedale Papa Giovanni, University of Milan-Bicocca, Piazza, Bergamo, Italy
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust, Southampton, UK
| | - Willem F Lems
- Department of Rheumatology, Amsterdam University Medical Center, The Netherlands
| | - Sarah Morgan
- Osteoporosis Prevention and Treatment Center and DXA Facility, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Linda Probyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marija Punda
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - John T Schousboe
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | | | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust, Southampton, UK
| | | |
Collapse
|
10
|
Walsh ME, Kristensen PK, Hjelholt TJ, Hurson C, Walsh C, Ferris H, Crozier-Shaw G, Keohane D, Geary E, O'Halloran A, Merriman NA, Blake C. Systematic review of multivariable prognostic models for outcomes at least 30 days after hip fracture finds 18 mortality models but no nonmortality models warranting validation. J Clin Epidemiol 2024; 173:111439. [PMID: 38925343 DOI: 10.1016/j.jclinepi.2024.111439] [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: 04/05/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Prognostic models have the potential to aid clinical decision-making after hip fracture. This systematic review aimed to identify, critically appraise, and summarize multivariable prediction models for mortality or other long-term recovery outcomes occurring at least 30 days after hip fracture. STUDY DESIGN AND SETTING MEDLINE, Embase, Scopus, Web of Science, and CINAHL databases were searched up to May 2023. Studies were included that aimed to develop multivariable models to make predictions for individuals at least 30 days after hip fracture. Risk of bias (ROB) was dual-assessed using the Prediction model Risk Of Bias ASsessment Tool. Study and model details were extracted and summarized. RESULTS From 5571 records, 80 eligible studies were identified. They predicted mortality in n = 55 studies/81 models and nonmortality outcomes (mobility, function, residence, medical, and surgical complications) in n = 30 studies/45 models. Most (n = 46; 58%) studies were published since 2020. A quarter of studies (n = 19; 24%) reported using 'machine-learning methods', while the remainder used logistic regression (n = 54; 68%) and other statistical methods (n = 11; 14%) to build models. Overall, 15 studies (19%) presented 18 low ROB models, all predicting mortality. Common concerns were sample size, missing data handling, inadequate internal validation, and calibration assessment. Many studies with nonmortality outcomes (n = 11; 37%) had clear data complexities that were not correctly modeled. CONCLUSION This review has comprehensively summarized and appraised multivariable prediction models for long-term outcomes after hip fracture. Only 15 studies of 55 predicting mortality were rated as low ROB, warranting further development of their models. All studies predicting nonmortality outcomes were high or unclear ROB. Careful consideration is required for both the methods used and justification for developing further nonmortality prediction models for this clinical population.
Collapse
Affiliation(s)
- Mary E Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, D04 C7X2, Ireland.
| | - Pia Kjær Kristensen
- The Department of Clinical Medicine, Orthopaedic, Aarhus University, DK-8200, Aarhus, Denmark
| | - Thomas J Hjelholt
- Department of Geriatrics, Aarhus University Hospital, DK-8200, Aarhus, Denmark
| | - Conor Hurson
- Department of Trauma and Orthopaedics, St Vincent's University Hospital, Dublin D04 T6F4, Ireland
| | - Cathal Walsh
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Helena Ferris
- Department of Public Health, Health Service Executive - South West, St. Finbarr's Hospital, Cork, T12 XH60, Ireland
| | - Geoff Crozier-Shaw
- Department of Trauma and Orthopaedics, Mater Misercordiae University Hospital, Eccles Street, Dublin, Ireland
| | - David Keohane
- Department of Orthopaedics, St. James' Hospital, Dublin, Ireland
| | - Ellen Geary
- Department of Trauma and Orthopaedics, St Vincent's University Hospital, Dublin D04 T6F4, Ireland
| | | | - Niamh A Merriman
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, D04 C7X2, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, D04 C7X2, Ireland
| |
Collapse
|
11
|
Hallberg S, Söreskog E, Borgström F, Cederholm T, Hedström M. Association between institutionalization by 4 months post-discharge walking capacity and lean body mass in elderly hip fracture patients: Evidence from a Swedish Registry Based Study. SAGE Open Med 2024; 12:20503121241258409. [PMID: 38881593 PMCID: PMC11179511 DOI: 10.1177/20503121241258409] [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: 09/19/2023] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Background and purpose Losing independence is a main concern for hip fracture patients, and particularly not being able to return home. Given the large impact on quality of life by loss of independence and the high risk for institutionalization after hip fracture, it is of importance to identify modifiable risk factors for such negative outcomes. This study aimed to investigate the association between two such factors, that is, lean body mass and 4 months post-discharge walking capacity, and the risk of institutionalization in previously independent living older people who suffer a hip fracture. Patients and methods A retrospective cohort study was conducted using Swedish national-based population registers. Patients ⩾60 years with a hip fracture during 2008-2017 were included from the Swedish National Registry for Hip Fractures. Risk of institutionalization over the 1-year period following a hip fracture was analyzed using logistic regression analyses adjusted for potential predictors and characteristics. Results In total, 11,265 patients were included. Over the first year, 8% (95% CI: 8-9) of the patients with a hip fracture had lost independence, increasing to 15% (95% CI: 14-16) after 5 years. Poor recovery of post-discharge walking ability was associated with a higher odds ratio of losing independence compared with good recovery (OR 12.0; 95% CI: 7.8-18.4; p < 0.001). Having higher estimated lean body mass than 45 kg at index was associated with lower odds of losing independence. Conclusion Maintaining lean body mass and mobility after a hip fracture is likely important from an individual as well as public health perspective.
Collapse
Affiliation(s)
| | - Emma Söreskog
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | | | - Tommy Cederholm
- Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Hedström
- Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
12
|
Kjærvik C, Gjertsen JE, Stensland E, Uleberg B, Taraldsen K, Søreide O. Impact of physiotherapy access on health-related quality of life following hip fracture: an observational study on 30 752 hip fractures from the Norwegian Hip Fracture Register 2014-2018. BMJ Open 2024; 14:e086428. [PMID: 38844395 PMCID: PMC11163825 DOI: 10.1136/bmjopen-2024-086428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES The main objective of this study was to investigate the characteristics of patients receiving private community physiotherapy (PT) the first year after a hip fracture. Second, to determine whether utilisation of PT could improve health-related quality of life (HRQoL). METHODS In an observational cohort study, 30 752 hip fractures from the Norwegian Hip Fracture Register were linked with data from Statistics Norway and the Norwegian Control and Payment of Health Reimbursements Database. Association between covariates and utilisation of PT in the first year after fracture, the association between covariates and EQ-5D index score and the probability of experiencing 'no problems' in the five dimensions of the EQ-5D were assessed with multiple logistic regression models. RESULTS Median age was 81 years, and 68.4% were females. Most patients with hip fracture (57.7%) were classified as American Society of Anesthesiologists classes 3-5, lived alone (52.4%), and had a low or medium level of education (85.7%). In the first year after injury, 10 838 of 30 752 patients with hip fracture (35.2%) received PT. Lower socioeconomic status (measured by income and level of education), male sex, increasing comorbidity, presence of cognitive impairment and increasing age led to a lower probability of receiving postoperative PT. Among those who used PT, EQ-5D index score was 0.061 points (p<0.001) higher than those who did not. Correspondingly, the probability of having 'no problems' in three of the five dimensions of EQ-5D was greater. CONCLUSIONS A minority of the patients with hip fracture had access to private PT the first year after injury. This may indicate a shortcoming in the provision of beneficial post-surgery rehabilitative care reducing post-treatment HRQoL. The findings underscore the need for healthcare policies that address disparities in PT access, particularly for elderly patients, those with comorbidities and reduced health, and those with lower socioeconomic status.
Collapse
Affiliation(s)
- Cato Kjærvik
- Nordlands Hospital, Bodo, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Jan-Erik Gjertsen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eva Stensland
- Centre of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Bodo, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Bård Uleberg
- Centre of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Bodo, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | | | - Odd Søreide
- Centre of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Bodo, Norway
| |
Collapse
|
13
|
Hinchliffe C, Rehman RZU, Pinaud C, Branco D, Jackson D, Ahmaniemi T, Guerreiro T, Chatterjee M, Manyakov NV, Pandis I, Davies K, Macrae V, Aufenberg S, Paulides E, Hildesheim H, Kudelka J, Emmert K, Van Gassen G, Rochester L, van der Woude CJ, Reilmann R, Maetzler W, Ng WF, Del Din S. Evaluation of walking activity and gait to identify physical and mental fatigue in neurodegenerative and immune disorders: preliminary insights from the IDEA-FAST feasibility study. J Neuroeng Rehabil 2024; 21:94. [PMID: 38840208 PMCID: PMC11151484 DOI: 10.1186/s12984-024-01390-1] [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: 09/25/2023] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Many individuals with neurodegenerative (NDD) and immune-mediated inflammatory disorders (IMID) experience debilitating fatigue. Currently, assessments of fatigue rely on patient reported outcomes (PROs), which are subjective and prone to recall biases. Wearable devices, however, provide objective and reliable estimates of gait, an essential component of health, and may present objective evidence of fatigue. This study explored the relationships between gait characteristics derived from an inertial measurement unit (IMU) and patient-reported fatigue in the IDEA-FAST feasibility study. METHODS Participants with IMIDs and NDDs (Parkinson's disease (PD), Huntington's disease (HD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjogren's syndrome (PSS), and inflammatory bowel disease (IBD)) wore a lower-back IMU continuously for up to 10 days at home. Concurrently, participants completed PROs (physical fatigue (PF) and mental fatigue (MF)) up to four times a day. Macro (volume, variability, pattern, and acceleration vector magnitude) and micro (pace, rhythm, variability, asymmetry, and postural control) gait characteristics were extracted from the accelerometer data. The associations of these measures with the PROs were evaluated using a generalised linear mixed-effects model (GLMM) and binary classification with machine learning. RESULTS Data were recorded from 72 participants: PD = 13, HD = 9, RA = 12, SLE = 9, PSS = 14, IBD = 15. For the GLMM, the variability of the non-walking bouts length (in seconds) with PF returned the highest conditional R2, 0.165, and with MF the highest marginal R2, 0.0018. For the machine learning classifiers, the highest accuracy of the current analysis was returned by the micro gait characteristics with an intrasubject cross validation method and MF as 56.90% (precision = 43.9%, recall = 51.4%). Overall, the acceleration vector magnitude, bout length variation, postural control, and gait rhythm were the most interesting characteristics for future analysis. CONCLUSIONS Counterintuitively, the outcomes indicate that there is a weak relationship between typical gait measures and abnormal fatigue. However, factors such as the COVID-19 pandemic may have impacted gait behaviours. Therefore, further investigations with a larger cohort are required to fully understand the relationship between gait and abnormal fatigue.
Collapse
Affiliation(s)
- Chloe Hinchliffe
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK
| | | | | | - Diogo Branco
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Dan Jackson
- Open Lab, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | | | | | | | - Kristen Davies
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK
| | - Victoria Macrae
- NIHR Newcastle Clinical Research Facility, Newcastle Upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Emma Paulides
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Hanna Hildesheim
- Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Kirsten Emmert
- Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | | | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK
- NIHR Newcastle Clinical Research Facility, Newcastle Upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK.
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
| |
Collapse
|
14
|
Charatcharoenwitthaya N, Nimitphong H, Wattanachanya L, Songpatanasilp T, Ongphiphadhanakul B, Deerochanawong C, Karaketklang K. Epidemiology of hip fractures in Thailand. Osteoporos Int 2024:10.1007/s00198-024-07140-2. [PMID: 38832991 DOI: 10.1007/s00198-024-07140-2] [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: 11/16/2023] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
This retrospective study examining hip fracture incidence, hip fracture trends, and the annual hospitalization costs for hip fractures in a population aged 50 years and older within the Universal Health Coverage System revealed that the incidence of hip fractures and the annual hospitalization costs for hip fractures increased significantly from 2013 to 2022. PURPOSE To examine the annual incidence of hip fractures over 10 years (2013-2022), hip fracture trends, and the annual hospitalization costs for hip fractures in a population aged 50 years and older within the Universal Health Coverage System. METHODS A retrospective study was conducted. Hip fracture hospitalizations were identified using ICD-10. Data on the number of hip fracture hospitalizations, population aged ≥ 50 years, and hospitalization costs were obtained. The primary outcome was the annual incidence of hip fractures. The secondary outcomes were hip fracture incidence by 5-year age group, the annual hospitalization costs for hip fractures, and the number of hip fractures in 6 regions of Thailand. RESULTS The hip fracture incidence increased annually from 2013-2019 and then plateaued from 2019-2022, with the crude incidence (per 100,000 population) increasing from 112.7 in 2013 to 146.7 in 2019 and 146.9 in 2022. The age-standardized incidence (per 100,000 population) increased from 116.3 in 2013 to 145.1 in 2019 and remained at 140.7 in 2022. Increases in the crude incidence were observed in both sexes (34% in females and 21% in males; p < 0.05). The annual hospitalization costs for hip fractures increased 2.5-fold, from 17.3 million USD in 2013 to 42.8 million USD in 2022 (p < 0.001). The number of hip fractures increased in all six regions of Thailand across the 10-year study period. CONCLUSION Osteoporotic hip fractures are a significant health concern in Thailand. The incidence and the annual hospitalization costs for hip fractures increased significantly from 2013 to 2022.
Collapse
Affiliation(s)
- Natthinee Charatcharoenwitthaya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Thammasat University, 99/209 Pahonyothin Road, Pathumthani, 12120, Thailand.
| | - Hataikarn Nimitphong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Bangkok, 10400, Ratchathewi, Thailand
| | - Lalita Wattanachanya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Bangkok, 10330, Thailand
| | - Thawee Songpatanasilp
- Department Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Thung Phaya Thai, Bangkok, 10400, Ratchathewi, Thailand
| | - Boonsong Ongphiphadhanakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Bangkok, 10400, Ratchathewi, Thailand
| | - Chaicharn Deerochanawong
- College of Medicine, Ministry of Public Health, Rajavithi Hospital, Rangsit University, Bangkok, 10400, Thailand
| | - Khemajira Karaketklang
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Bangkok-Noi, Thailand
| |
Collapse
|
15
|
Ensrud KE, Schousboe JT, Crandall CJ, Leslie WD, Fink HA, Cawthon PM, Kado DM, Lane NE, Cauley JA, Langsetmo L. Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older. JAMA Netw Open 2024; 7:e2418612. [PMID: 38941095 PMCID: PMC11214124 DOI: 10.1001/jamanetworkopen.2024.18612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/23/2024] [Indexed: 06/29/2024] Open
Abstract
Importance While adults aged 80 years and older account for 70% of hip fractures in the US, performance of fracture risk assessment tools in this population is uncertain. Objective To compare performance of the Fracture Risk Assessment Tool (FRAX), Garvan Fracture Risk Calculator, and femoral neck bone mineral density (FNBMD) alone in 5-year hip fracture prediction. Design, Setting and Participants Prognostic analysis of 3 prospective cohort studies including participants attending an index examination (1997 to 2016) at age 80 years or older. Data were analyzed from March 2023 to April 2024. Main Outcomes and Measures Participants contacted every 4 or 6 months after index examination to ascertain incident hip fractures and vital status. Predicted 5-year hip fracture probabilities calculated using FRAX and Garvan models incorporating FNBMD and FNBMD alone. Model discrimination assessed by area under receiver operating characteristic curve (AUC). Model calibration assessed by comparing observed vs predicted hip fracture probabilities within predicted risk quintiles. Results A total of 8890 participants were included, with a mean (SD) age at index examination of 82.6 (2.7) years; 4906 participants (55.2%) were women, 866 (9.7%) were Black, 7836 (88.1%) were White, and 188 (2.1%) were other races and ethnicities. During 5-year follow-up, 321 women (6.5%) and 123 men (3.1%) experienced a hip fracture; 818 women (16.7%) and 921 men (23.1%) died before hip fracture. Among women, AUC was 0.69 (95% CI, 0.67-0.72) for FRAX, 0.69 (95% CI, 0.66-0.72) for Garvan, and 0.72 (95% CI, 0.69-0.75) for FNBMD alone (FNBMD superior to FRAX, P = .01; and Garvan, P = .01). Among men, AUC was 0.71 (95% CI, 0.66-0.75) for FRAX, 0.76 (95% CI, 0.72-0.81) for Garvan, and 0.77 (95% CI, 0.72-0.81) for FNBMD alone (P < .001 Garvan and FNBMD alone superior to FRAX). Among both sexes, Garvan greatly overestimated hip fracture risk among individuals in upper quintiles of predicted risk, while FRAX modestly underestimated risk among those in intermediate quintiles of predicted risk. Conclusions and Relevance In this prognostic study of adults aged 80 years and older, FRAX and Garvan tools incorporating FNBMD compared with FNBMD alone did not improve 5-year hip fracture discrimination. FRAX modestly underpredicted observed hip fracture probability in intermediate-risk individuals. Garvan markedly overpredicted observed hip fracture probability in high-risk individuals. Until better prediction tools are available, clinicians should prioritize consideration of hip BMD, life expectancy, and patient preferences in decision-making regarding drug treatment initiation for hip fracture prevention in late-life adults.
Collapse
Affiliation(s)
- Kristine E. Ensrud
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
- Department of Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - John T. Schousboe
- HealthPartners Institute, Bloomington, Minnesota
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | | | - William D. Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Howard A. Fink
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
- Department of Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Peggy M. Cawthon
- California Pacific Medical Center Research Institute, San Francisco
| | - Deborah M. Kado
- Department of Medicine, Stanford University, California
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Palo Alto, California
| | - Nancy E. Lane
- Department of Internal Medicine, University of California, Davis, Sacramento
| | - Jane A. Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Langsetmo
- Department of Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| |
Collapse
|
16
|
Oh J, Kim B, Oh G, Hwangbo Y, Ye JC. End-to-End Semi-Supervised Opportunistic Osteoporosis Screening Using Computed Tomography. Endocrinol Metab (Seoul) 2024; 39:500-510. [PMID: 38721637 PMCID: PMC11220219 DOI: 10.3803/enm.2023.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGRUOUND Osteoporosis is the most common metabolic bone disease and can cause fragility fractures. Despite this, screening utilization rates for osteoporosis remain low among populations at risk. Automated bone mineral density (BMD) estimation using computed tomography (CT) can help bridge this gap and serve as an alternative screening method to dual-energy X-ray absorptiometry (DXA). METHODS The feasibility of an opportunistic and population agnostic screening method for osteoporosis using abdominal CT scans without bone densitometry phantom-based calibration was investigated in this retrospective study. A total of 268 abdominal CT-DXA pairs and 99 abdominal CT studies without DXA scores were obtained from an oncology specialty clinic in the Republic of Korea. The center axial CT slices from the L1, L2, L3, and L4 lumbar vertebrae were annotated with the CT slice level and spine segmentation labels for each subject. Deep learning models were trained to localize the center axial slice from the CT scan of the torso, segment the vertebral bone, and estimate BMD for the top four lumbar vertebrae. RESULTS Automated vertebra-level DXA measurements showed a mean absolute error (MAE) of 0.079, Pearson's r of 0.852 (P<0.001), and R2 of 0.714. Subject-level predictions on the held-out test set had a MAE of 0.066, Pearson's r of 0.907 (P<0.001), and R2 of 0.781. CONCLUSION CT scans collected during routine examinations without bone densitometry calibration can be used to generate DXA BMD predictions.
Collapse
Affiliation(s)
- Jieun Oh
- Healthcare AI Team, National Cancer Center, Goyang, Korea
| | - Boah Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Gyutaek Oh
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, Goyang, Korea
| | - Jong Chul Ye
- Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| |
Collapse
|
17
|
Mitchell RJ, Wijekulasuriya S, Mayor A, Borges FK, Tonelli AC, Ahn J, Seymour H. Principles for management of hip fracture for older adults taking direct oral anticoagulants: an international consensus statement. Anaesthesia 2024; 79:627-637. [PMID: 38319797 DOI: 10.1111/anae.16226] [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] [Accepted: 12/04/2023] [Indexed: 02/08/2024]
Abstract
Hip fracture is a common serious injury among older adults, yet the management of hip fractures for patients taking direct oral anticoagulants remains inconsistent worldwide. Drawing from a synthesis of available evidence and expert opinion, best practice approaches for managing patients with a hip fracture and who are taking direct oral anticoagulants pre-operatively were considered by a working group of the Fragility Fracture Network Hip Fracture Audit Special Interest Group. The literature and related clinical guidelines were reviewed and a two-round modified Delphi study was conducted with a panel of experts from 16 countries and involved seven clinical specialities. Four consensus statements were achieved: peripheral nerve blocks can reasonably be performed on presentation for patients with hip fracture who are receiving direct oral anticoagulants; hip fracture surgery can reasonably be performed for patients taking direct oral anticoagulants < 36 h from last dose; general anaesthesia could reasonably be administered for patients with hip fracture and who are taking direct oral anticoagulants < 36 h from last dose (assuming eGFR > 60 ml.min-1.1.73 m-2); and it is generally reasonable to consider recommencing direct oral anticoagulants (considering blood loss and haemoglobin) < 48 h after hip fracture surgery. No consensus was achieved regarding timing of spinal anaesthesia. The consensus statements were developed to aid clinicians in their decision-making and to reduce practice variations in the management of patients with hip fracture and who are taking direct oral anticoagulants. Each statement will need to be considered specific to each individual patient's treatment.
Collapse
Affiliation(s)
- R J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - S Wijekulasuriya
- Department of Anaesthesia, Huddersfield Royal Infirmary, Huddersfield, UK
| | - A Mayor
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - F K Borges
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - A C Tonelli
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Michigan, Ann Arbour, MI, USA
| | - J Ahn
- Department of Geriatric Medicine, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| | - H Seymour
- Department of Geriatric Medicine, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| |
Collapse
|
18
|
Kraaijkamp JJM, Stijntjes M, De Groot JH, Chavannes NH, Achterberg WP, van Dam van Isselt EF. Movement Patterns in Older Adults Recovering From Hip Fracture. J Aging Phys Act 2024; 32:312-320. [PMID: 38215728 DOI: 10.1123/japa.2023-0090] [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: 03/27/2023] [Revised: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 01/14/2024]
Abstract
The aim of this study was to quantify physical activity and sedentary behavior in older adults recovering from hip fracture and to identify groups based on movement patterns. In this cross-sectional cohort study, older adults (≥70 years) were included 3 months after surgery for proximal femoral fracture. Patients received an accelerometer for 7 days. Demographics and outcomes related to physical function, mobility, cognitive functions, quality of life, and hip fracture were assessed. In total, 43 patients with sufficient accelerometer wear time were included. Across all groups, participants engaged in very low levels of physical activity, spending an average of 11 hr/day in prolonged sedentary behavior. Based on the extracted components from a principal component analysis, three groups with substantial differences in levels of physical activity and sedentary behavior could be distinguished.
Collapse
Affiliation(s)
- Jules J M Kraaijkamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- ZZG Zorggroep, Nijmegen, the Netherlands
| | - Marjon Stijntjes
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
- BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Jurriaan H De Groot
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | | |
Collapse
|
19
|
Ishida S, Kitaji Y, Yasuda K, Yamashita H, Harashima H, Miyano S. Association of comorbidities with postoperative walking independence in patients with hip fractures: a single-center, retrospective, observational study. Int J Rehabil Res 2024; 47:110-115. [PMID: 38517124 DOI: 10.1097/mrr.0000000000000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Hip fractures (HFs) are common in the elderly and lead to decreased walking independence. Although comorbidities may be associated with gaining walking independence, few studies have comprehensively examined baseline and preoperative clinical factors. We aimed to evaluate the effects of comorbidities on the postoperative walking independence of patients with HFs. This single-center, retrospective, observational study included patients with HFs admitted to an acute care hospital between 1 May 2022 and 1 March 2023, who before the incident were able to walk independently [functional independence measure (FIM) walk score ≥6 points]. Postoperative walking independence was evaluated using the walk item of the FIM. The Charlson comorbidity index (CCI) was used to evaluate comorbidities at admission, and the patients were divided into two categories with CCI scores of 0 points and ≥1 point. The effect of comorbidities, assessed using the CCI, on postoperative walking independence was evaluated using Cox proportional hazards analysis. Ninety-four participants were included in the analysis. The Cox proportional hazards model adjusted for potential confounders (age, operative delay and nutritional status) revealed that the CCI was significantly associated with postoperative walking independence ( P < 0.05). The hazard ratio and 95% confidence interval (CI) for the CCI for postoperative walking independence were 0.40 (95% CI, 0.189-0.865). Preoperative assessment of comorbidities using the CCI may aid in predicting the postoperative walking independence of patients with HFs.
Collapse
Affiliation(s)
- Shinnosuke Ishida
- Department of Rehabilitation, Tokyo General Hospital, Nakano-ku, Japan
| | | | | | | | | | | |
Collapse
|
20
|
Alejo AL, Rascoe AS, Kim CY, Ren BO, Hoffa MT, Heimke IM, Vallier HA. Factors associated with a prolonged time to return to safe driving following lower extremity injuries. Ann Phys Rehabil Med 2024; 67:101850. [PMID: 38824871 DOI: 10.1016/j.rehab.2024.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Andrew L Alejo
- Department of Orthopaedic Surgery, Case Western Reserve Univeristy, Cleveland, OH, USA
| | - Alexander S Rascoe
- Department of Orthopaedic Surgery, Case Western Reserve Univeristy, Cleveland, OH, USA
| | - Chang-Yeon Kim
- Department of Orthopaedic Surgery, Case Western Reserve Univeristy, Cleveland, OH, USA
| | - Bryan O Ren
- Department of Orthopaedic Surgery, Case Western Reserve Univeristy, Cleveland, OH, USA
| | - Matthew T Hoffa
- Department of Orthopaedic Surgery, Case Western Reserve Univeristy, Cleveland, OH, USA
| | - Isabella M Heimke
- Department of Orthopaedic Surgery, Case Western Reserve Univeristy, Cleveland, OH, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve Univeristy, Cleveland, OH, USA.
| |
Collapse
|
21
|
McKenna RE. Can fracture liaison services prevent second fractures in patients with osteoporosis? JAAPA 2024; 37:1-5. [PMID: 38985120 DOI: 10.1097/01.jaa.0000000000000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
ABSTRACT Patients who have had fractures are at increased risk for a second or fragility fracture. A fracture liaison service (FLS), often staffed or led by physician associates/assistants or NPs, may help reduce second fractures and patient mortality. This article reviews FLSs and their effectiveness.
Collapse
Affiliation(s)
- Robert E McKenna
- Robert E. McKenna is director of accreditation and an assistant professor in the PA program at Marshall B. Ketchum University in Fullerton, Calif. The author has disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|
22
|
Ponds NHM, Raats JH, Brameier DT, Schuijt HJ, Cooper L, Sagona A, Javedan H, Weaver MJ. Beyond Mortality: Severely Frail Femur Fracture Patients Can Regain Independence after Surgery. J Clin Med 2024; 13:3197. [PMID: 38892908 PMCID: PMC11172540 DOI: 10.3390/jcm13113197] [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: 04/15/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: Little is known about the post-operative functional outcomes of severely frail femur fracture patients, with previous studies focusing on complications and mortality. This study investigated patient- or proxy-reported outcomes after femur fracture surgery in older adult patients with severe frailty. Methods: This was a retrospective cross-sectional study of older adult (>70 years) patients with severe frailty (defined by a Comprehensive Geriatric Assessment-based Frailty Index (FI-CGA) ≥ 0.40), who underwent femur fracture surgery at a Level 1 Trauma Center. Patients or their proxy (i.e., close relative) reported mobility, psychosocial, and functional outcomes at least 1-year after surgery. Results: Thirty-seven predominantly female (76%) patients with a median age of 85 years (IQR 79-92), and a median FI-CGA of 0.48 (IQR 0.43-0.54) were included. Eleven patients (30%) regained pre-fracture levels of ambulation, with twenty-six patients (70%) able to walk with or without assistance. The majority of patients (76%) were able to have meaningful conversations. Of the patients, 54% of them experienced no to minimal pain, while 8% still experienced a lot of pain. Functional independence varied, as follows: five patients (14%) could bathe themselves; nine patients (25%) could dress themselves; fourteen patients (39%) could toilet independently; and seventeen patients (47%) transferred out of a (wheel)chair independently. Conclusions: Despite the high risk of mortality and perioperative complications, many of the most severely frail patients with surgically treated femur fractures regain the ability to ambulate and live with a moderate degree of independence. This information can help healthcare providers to better inform these patients and their families of the role of surgical treatment during goals of care discussions.
Collapse
Affiliation(s)
- Noa H. M. Ponds
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
- Department of Surgery, St. Antonius Hospital, 3543 AZ Utrecht, The Netherlands
| | - Jochem H. Raats
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
- Department of Surgery, St. Antonius Hospital, 3543 AZ Utrecht, The Netherlands
| | - Devon T. Brameier
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Henk Jan Schuijt
- Center for Geriatric Trauma, St. Antonius Hospital, 3543 AZ Utrecht, The Netherlands
| | - Lisa Cooper
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
- Department of Geriatric Medicine, Rabin Medical Center, Tel Aviv 4941492, Israel
| | - Abigail Sagona
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Houman Javedan
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Michael J. Weaver
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
| |
Collapse
|
23
|
Ní Chróinín D, Ghimire R, McEvoy L, Lieu D, Jennings M, Gallagher K, Katyal A, Mahmood D, Boey J, Tcharkhedian E. Introduction of enhanced weekend physiotherapy for patients with hip fracture is associated with improved early mobility outcomes. Australas J Ageing 2024. [PMID: 38773849 DOI: 10.1111/ajag.13317] [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: 12/27/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVE To assess whether enhanced daily weekend physiotherapy (EWP) for patients with hip fracture was associated with improved clinical outcomes. METHODS We retrospectively analysed all previously ambulatory adults admitted with hip fracture to our tertiary hospital, comparing 'usual' ('control') care (09/19-03/20) to EWP (09/20-03/21). Outcomes included Day-7 mobility ≥20 m (primary), additional mobility measures, specified postoperative complications, new residential facility placement, acute length-of-stay (LOS) and 30-day death. RESULTS Amongst 235 eligible patients (128 control, 107 EWP), 66% were female, mean age was 80.4 years (SD 10.5), 20% from residential care and 49% (114/235) were mobilising without aid at baseline (no between-group differences; all p ≥ .20). Median acute LOS was 10 days (IQR 6-15), total hospital LOS was 21 days (IQR 12-37) and 3% (n = 6) died by Day 30. Median Day-7 distance mobilised was 25 m (IQR 7-50) with EWP versus 10 m (3-40) (p = .06). No EWP patients developed pressure injury (0 vs. 6, p = .02); other outcomes were similar between groups. Adjusting for age, residence, baseline cognitive impairment, American Society of Anesthesiologist score and preadmission mobilisation without aids, EWP was independently associated with increased likelihood of mobilising ≥20 m at Day 7 (aOR 1.83, 95% CI 1.04-3.23, p = .03). CONCLUSIONS Enhanced daily weekend physiotherapy was associated with improvement in early mobility, but not other outcomes assessed. These data would be strengthened by randomised controlled trial data exploring more intense physiotherapy, cost-benefit analysis and patient experience measures.
Collapse
Affiliation(s)
- Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia
| | - Ram Ghimire
- Department of Geriatric Medicine, Campbelltown, New South Wales, Australia
| | - Lynette McEvoy
- Department of Orthopaedic Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - David Lieu
- Department of Orthopaedic Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matt Jennings
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kristen Gallagher
- Department of Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Anubhav Katyal
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Daniel Mahmood
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Jonathan Boey
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Elise Tcharkhedian
- Department of Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
| |
Collapse
|
24
|
Ipsen JA, Viberg B, Pedersen LT, Draborg E, Bruun IH. Informal care after hip fracture: prospective cohort. BMC Geriatr 2024; 24:436. [PMID: 38760708 PMCID: PMC11100116 DOI: 10.1186/s12877-024-05040-y] [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: 09/20/2023] [Accepted: 05/02/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Hip fracture is very common and it has life-shattering consequences for older persons. After discharge the older persons need help with even basic everyday activities from formal and informal caregivers. In Scandinavia formal care are well-developed however the presence of informal caregivers likely reflect on the amount of formal care and wears on the informal caregivers. This study explore how often and how much informal care (IC) older persons receive after hip fracture. METHOD We contacted 244 community-dwelling older persons every two weeks the first twelve weeks after discharge after hip fracture and asked them if they received care from family and/or friends and how much. We used non-parametric statistics and level of significance was 95%. RESULTS The proportion of older persons receiving IC was 90% and the median amount of IC was 32 hours (IQR 14-66). The number of older persons who received IC was highest the first four weeks after discharge and so was the amount of hours of IC. The older persons that were high-dependence on IC received a median of 66 (IQR 46-107) hours compared to the low-dependent of 11 hours (IQR 2-20). CONCLUSION IC is very frequent, especially the first two to four weeks after discharge. The median IC was 32 hours from discharge to the 12-week follow-up. However, this figure tended to rise for persons with, among other, reduced functionality and those residing with a partner. IMPLICATIONS With respect to local differences, the findings in this study are likely applicable to other Scandinavian countries. We strongly suggest that the variation in older person need for informal caregiver be given consideration in the prioritisation of resources. TRIAL REGISTRATION This prospective cohort study of informal care, was part of a cluster-randomised stepped-wedge clinical controlled trial. Written consent was obtained required by regional ethics committee S-20200070. Data was collected in accordance with the Danish Data Protection Agency (20-21854).
Collapse
Affiliation(s)
- Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars T Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Health Education, University College South Denmark, Esbjerg, Denmark
| | - Eva Draborg
- Department of Public Health, DaCHE - Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Inge Hansen Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
25
|
Xu P, Zhao N, Wang J. Knowledge, attitude, and practice toward osteoporosis among patients with chronic kidney disease in Zhejiang. Medicine (Baltimore) 2024; 103:e38153. [PMID: 38758880 PMCID: PMC11098230 DOI: 10.1097/md.0000000000038153] [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: 12/25/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
Patients with chronic kidney disease (CKD) are considered high-risk group for osteoporosis. However, the current understanding of their knowledge, attitude, and practice toward osteoporosis remains unclear. CKD patients were recruited from Li Huili Hospital, Ningbo Medical Center between March 2023 and June 2023. A self-designed questionnaire was used to collect the participant's demographic characteristics and knowledge, attitude, and practice toward osteoporosis. A total of 500 valid questionnaires were included in the analysis, with participants aged 51.08 ± 14.76 years. The mean scores for knowledge, attitude, and practice were 6.67 ± 3.04 (range: 0-11), 33.99 ± 3.37 (range: 10-50), and 35.29 ± 5.54 (range: 9-45), respectively. Pearson correlation analysis revealed significant positive associations between knowledge and attitude scores (r = 0.440, P < .001), knowledge and practice scores (r = 0.376, P < .001), as well as attitude and practice scores (r = 0.403, P < .001). Structural equation modeling revealed direct associations between knowledge and attitude (path coefficient = 0.488, P < .001), and between attitude and practice (path coefficient = 0.485, P < .001). The knowledge also exhibited a directly positive effect on practice (path coefficient = 0.449, P < .001). Undergoing glucocorticoid therapy (odd ratio [OR] = 2.353, 95% confidence interval [CI]: 1.022-5.418, P = .044) and osteoporosis osteoporosis (OR = 1.565, 95% CI: 1.011-2.421, P = .044) were positively associated with knowledge. Moreover, disease duration >1 year was positively associated with practice (OR = 3.643, 95% CI: 1.754-7.565, P < .001). CKD patients demonstrated moderate knowledge, neutral attitude, and moderate practice toward osteoporosis. To address the practice gaps of CKD patients toward osteoporosis, targeted educational interventions and attitude support programs can be developed.
Collapse
Affiliation(s)
- Pengjie Xu
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Nadan Zhao
- Department of Radiology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Jiangdong Wang
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| |
Collapse
|
26
|
Costa V, Rojo A, López-López S, Pareja-Galeano H, Velásquez A, Perea L, Raya R. Evaluating the Usability and Safety of Virtual Reality Application Combined with the SWalker for Functional Gait Rehabilitation. Games Health J 2024. [PMID: 38757664 DOI: 10.1089/g4h.2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Objective: This research evaluates from a usability point of view the combination of a developed fully immersive virtual reality (VR) solution with the SWalker robotic device. It aims to contribute to research in the exploration of immersive experiences overground with a functional gait recovery device. Materials and Methods: We evaluated the system in a pilot study with 20 healthy participants aged 85.1 (SD: 6.29). Participants used the SWalker-VR platform while testing one VR application focused on walking and the other on balance practice. Afterward, the participants answered three usability questionnaires. Results: The platform was validated in terms of safety using the Simulator Sickness Questionnaire, obtaining less than 20 points for all subscales: nausea (4.29 ± 14.47), oculomotor (0.38 ± 14.18), and disorientation (1.39 ± 14.52). For usability evaluation, the System Usability Scale provided an overall score of 70.63 ± 11.64, and the Post-Study System Usability Questionnaire (PSSUQ) rated 1.61 ± 0.54. The usability scores reported by both questionnaires were moderate and good, respectively. These results were similar in overall scores for both groups: participants with low cognitive level and participants with high cognitive level. Finally, the possible causes for the "no answered" responses on the PSSUQ were discussed. Conclusion: It is concluded that the SWalker-VR platform is reported to have adequate usability and high security by older adults. The potential interest of studying the effects of the long-term use of this platform by older adults with gait impairment is expressed. Clinical Trials reference: NCT06025981.
Collapse
Affiliation(s)
- Vanina Costa
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Ana Rojo
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Sergio López-López
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
| | - Helios Pareja-Galeano
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Rafael Raya
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| |
Collapse
|
27
|
Selaković I, Mandić-Rajčević S, Milovanović A, Tomanović-Vujadinović S, Dimitrijević S, Aleksić M, Dubljanin-Raspopović E. Pre-Fracture Functional Status and Early Functional Recovery are Significant Predictors of Instrumental Activities of Daily Living After Hip Fracture: A Prospective Cohort Study. Geriatr Orthop Surg Rehabil 2024; 15:21514593241255627. [PMID: 38766275 PMCID: PMC11102673 DOI: 10.1177/21514593241255627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Although the overall quality of medicine has improved in recent decades, the functional capacity in many hip fracture patients remains insufficient. The goal of the present study was to identify significant predictors of Instrumental Activities of Daily Living (IADL) measured by the Lawton-Brody scale at 3- and 6-month follow-up in patients with hip fractures admitted to a hospital. Methods This observational cohort study included 191 patients with acute hip fractures. IADL was measured at baseline and after 3 and 6 months using the Lawton-Brody scale. Multivariable logistic regression analysis was carried out using pre-fracture functional status, sociodemographic variables, hand grip strength (HGS), surgical procedure, complications, and length of hospital stay, Short Physical Performance Battery, and Barthel Index (BI) on the fifth postoperative day as potential predictors for IADL after a hip fracture surgery. Results The mean age of the participants was 80.3 ± 6.8 years, and 77.0% of our cohort were women. Multivariate regression analysis revealed that pre-fracture functional status and early functional recovery were independent predictors of IADL after hip fracture surgery. Conclusions Clinicians should take steps to improve functional outcomes by changing how patients are rehabilitated in the first days after hip fracture surgery, especially for the group of patients with a lower functional status before the fracture.
Collapse
Affiliation(s)
- Ivan Selaković
- Centre for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- Institute of Social medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anđela Milovanović
- Centre for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Tomanović-Vujadinović
- Centre for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Dimitrijević
- Special Hospital for Cerebral Palsy and Developmental Neurology, Belgrade, Serbia
| | - Milica Aleksić
- Centre for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Emilija Dubljanin-Raspopović
- Centre for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
28
|
Katz D, Geftler A, Abu-Ajaj A, Makulin E, Star E, Zikrin E, Shacham D, Velikiy N, Freud T, Press Y. Intensive rehabilitation after pelvic and hip fractures: a comparative retrospective study. Front Med (Lausanne) 2024; 11:1346354. [PMID: 38818387 PMCID: PMC11137187 DOI: 10.3389/fmed.2024.1346354] [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: 11/29/2023] [Accepted: 04/25/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose Pelvic fracture (PF) is common, especially among older patients, and its prevalence increases over time. In contrast to hip fracture (HF), the literature on rehabilitation after PF is scant, mandating a study of the outcomes of rehabilitation in patients with PF. The present study compared patients who underwent intensive rehabilitation following HF or PF. Methods A retrospective study of patients 65 years of age and older who underwent intensive rehabilitation in the Geriatrics Department. Data were collected on patients with PF, while data on patients with HF were taken from an earlier study. All patients in both groups suffered from low-energy trauma. Rehabilitation outcomes were measured using the Montebello Rehabilitation Factor Score-revised (MRSF-R). Results 144 PF patients were compared with 138 HF patients. The mean age of the patients in the HF group was 82.5 ± 7.1 compared to 81.5 ± 6.9 in the PF group (p = 0.230). Females comprised 77.5% of the patients in the HF group and 90.3% in the PF group (p = 0.04). All patients in the HF group underwent surgical repair of their fracture, while all patients in the PF group had non-surgical treatment. More patients in the HF sample had a nursing caregiver prior to the fracture (92.0% vs. 60.4%, p < 0.001), had a higher Charlson Co-morbidity Index total score (2.1 ± 1.9 vs. 1.6 ± 1.7, p = 0.13), developed more delirium (21.7% vs. 8.3%, p = 0.16), more infections (29.0% vs. 11.1%, p < 0.002), and more cardiovascular complications (23.9% vs. 5.6%, p < 0.001) during hospitalization. They had longer hospital stays (20.9 ± 7.5 vs. 18.2 ± 7.7 days, p = 0.0007), and had a higher mortality rate (13.8% vs. 6.3%, p = 0.037) over the first year following the fracture than the PF group. A similar rate of patients in both groups (64.5% vs. 60.4%, p = 0.483) had successful intensive rehabilitation. In the PF group only cognitive state was an independent predictor of successful rehabilitation, with each additional point in the Mini Mental State Examination (MMSE) increasing the patient's chance of reaching an MRFS-R score ≥ 50 by 20.5%. Conclusion Despite slightly different characteristics in the two groups, the results of intensive rehabilitation were similar. Cognitive state was the only independent factor that affected achievement of a better rehabilitation outcome. With the increasing rate of PF, more studies should focus on rehabilitation in this patient population.
Collapse
Affiliation(s)
- Dori Katz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Alex Geftler
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Orthopedics, Soroka Medical Center, Be'er Sheva, Israel
| | - Ahmed Abu-Ajaj
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Evgeni Makulin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Eva Star
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Evgeniya Zikrin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - David Shacham
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Natalia Velikiy
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yan Press
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| |
Collapse
|
29
|
Ogawa T, Onuma R, Sagae H, Schermann H, Kristensen MT, Fushimi K, Yoshii T, Jinno T. Association between additional weekend rehabilitation and functional outcomes in patients with hip fractures: does age affect the effectiveness of weekend rehabilitation? Eur Geriatr Med 2024:10.1007/s41999-024-00980-5. [PMID: 38703245 DOI: 10.1007/s41999-024-00980-5] [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: 10/01/2023] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Rehabilitation after hip fracture surgery is crucial for improving physical function. Additional rehabilitation over the weekend or after working hours is reportedly associated with improved physical function; however, this may not apply to an aging population, including patients aged > 90 years. This study aimed to investigate the association between additional weekend rehabilitation and functional outcomes in different age groups. METHODS This study analyzed a cohort of patients aged ≥ 60 years who had hip fractures and were operated on from 2010 to 2018. Data were extracted from a nationwide multicentre database. Functional outcomes at discharge were compared between patients who underwent rehabilitation on weekdays only and those who underwent rehabilitation on both weekdays and weekends. The patient groups were selected using propensity score matching analysis. Furthermore, a subgroup-analysis was conducted on patients in their 60 s, 70 s, 80 s, and 90 s. RESULTS A total of 390,713 patients underwent surgery during the study period. After matching, each group comprised 129,583 pairs of patients. Patients who underwent weekend rehabilitation exhibited improved physical function in transferring, walking, and stair climbing at discharge, as compared with patients who did not (odds ratio [95% confidence interval]: 1.17 [1.15-1.19], 1.17 [1.15-1.2], and 1.06 [1.03-1.08], respectively). In subgroup analysis, except for stair climbing, the positive association between weekend rehabilitation and patient function was observed across all age groups. CONCLUSION Weekend rehabilitation was significantly associated with improved physical function. Given the limited healthcare resources, high-demand activities such as stair climbing may be reserved for younger age groups to optimise rehabilitation therapy.
Collapse
Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Ryo Onuma
- Department of Rehabilitation, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Hiromori Sagae
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Haggai Schermann
- Division of Orthopaedic Surgery, Laniado Hospital, Sanz Medical Center, Affiliated with Ariel University, Netanya, Israel
- Laniado Hospital, Sanz Medical Center, Affiliated with Ariel University, Ariel, Israel, Divrei Khayim St 16, 4244916, Netanya, Israel
| | - Morten Tange Kristensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, University of Copenhagen, Nielsine Nielsens Vej 10, 2400, Copenhagen NV, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan.
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
| |
Collapse
|
30
|
Robert W, Piotr A, Michał S, Bogdan K, Pluskiewicz W. Hip Fracture Incidence Over Twenty Years in Poland: The HiPoL Study. J Clin Densitom 2024; 27:101500. [PMID: 38761417 DOI: 10.1016/j.jocd.2024.101500] [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: 11/06/2023] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION In the previous report, we noted a significant increase in hip fracture incidence in the local study area. The aim of the study was the continuous observation of hip fracture incidence in the local community over the last 20 years and to estimate their projection for the next 30 years. METHODS Medical records of the patients aged 50 years and older in the period 2002 - 2021 (local data - area of the district Tarnowskie Góry and the city of Piekary Śląskie) with diagnosis ICD-10: S72.0; S72.1; and S72.2 (only the fragility fractures) were taken into analysis. RESULTS 2,723 fragility hip fractures in the local area were registered (72 % in women). The increase in the rate was constantly observed, even during the COVID - 19 pandemic. The incidence rate ratio for the local population increased to 1.41. The incidence rate in 2021 was for the total population 230.2 (men 151.3; women 294.2). For comparison in 2002, it was 129.0 (men 48.8; women 192.4). In 2050 the number of fractures according to our new estimation will increase. CONCLUSIONS The number of fragility hip fractures in Polish men and women aged over 50 years in the local population increased. The epidemiological situation is still worsening. Therefore, especially due to the reduction of orthopedic beds and the aging population phenomenon the situation will be tragic to our patients.
Collapse
Affiliation(s)
- Wilk Robert
- Municipal Hospital, Department of Orthopedic and Trauma Surgery, Sosnowiec, Poland.
| | - Adamczyk Piotr
- Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Skrzypek Michał
- Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
| | - Koczy Bogdan
- Department of Trauma and Orthopedics, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland
| | - Wojciech Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
31
|
Kay RS, Ho L, Clement ND, Duckworth AD, Hall AJ. The incidence of subsequent contralateral hip fracture and factors associated with increased risk: the IMPACT Contralateral Fracture Study. Osteoporos Int 2024; 35:903-909. [PMID: 38448782 DOI: 10.1007/s00198-024-07039-y] [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: 10/02/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
Patients who sustain a contralateral hip fracture experience significantly inferior outcomes; however, the incidence and predictors of contralateral hip fracture remain poorly understood. In the present study, 2.5% of patients sustained a contralateral hip fracture within 12 months, and socioeconomic deprivation was associated with reduced risk of contralateral hip fracture. INTRODUCTION Hip fractures are associated with high morbidity and mortality, and patients that sustain a subsequent contralateral fracture experience inferior outcomes. The risk of contralateral fracture is highest within the first year; however, the incidence and associated factors remain poorly understood. The aims were to investigate (i) the incidence of a subsequent contralateral hip fracture within the first year, (ii) identify factors associated with an increased risk of contralateral fracture and (iii) compare early mortality risk after index versus contralateral hip fracture. METHODS This study included all patients aged over 50 years admitted to NHS hospitals in Scotland between 1st March 2020 and 31st December 2020 (n = 5566) as routine activity of the Scottish Hip Fracture Audit (SHFA). Multivariate logistic regression was used to examine factors associated with 30-day mortality, and cox regression was used to identify factors associated with a contralateral fracture. RESULTS During the study period 2.5% (138/5566) of patients sustained a contralateral hip fracture within 12 months of the index hip fracture. Socioeconomic deprivation was inversely associated with increased risk of contralateral fracture (odds ratio 2.64, p < 0.001), whilst advancing age (p = 0.427) and sex (p = 0.265) were not. After adjusting for significant cofounders, there was no significant difference in 30-day mortality following contralateral fracture compared to index fracture (OR 1.22, p = 0.433). CONCLUSION One in 40 (2.5%) hip fracture patients sustained a contralateral fracture within 12 months of their index fracture, and deprivation was associated with a reduced risk of contralateral fracture. No difference in 30-day mortality was found.
Collapse
Affiliation(s)
- Robert S Kay
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Lucas Ho
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Scottish Hip Fracture Audit, Edinburgh, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew J Hall
- Scottish Hip Fracture Audit, Edinburgh, UK
- School of Medicine, University of St Andrews, St Andrews, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
| |
Collapse
|
32
|
Paradis BE, Klein BJ, Bartlett LE, Cohn RM, Bitterman AD. Goals of Care Discussions in Orthopaedic Surgery: Geriatric Hip Fractures. J Arthroplasty 2024; 39:1144-1148. [PMID: 38462140 DOI: 10.1016/j.arth.2024.03.001] [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: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Due to the severity of hip fracture complications in the geriatric population, including major morbidity and mortality, it is crucial to establish treatment goals and manage expectations as a patient-centered multidisciplinary team. Goals of care (GOC) are personalized treatment programs designed to align with the individual patient's values and preferences. There is a paucity of literature on the topic of GOC discussions, especially regarding orthopaedic injuries. Therefore, this narrative review aims to provide an account of GOC discussions related to geriatric hip fractures. METHODS We reviewed articles published on GOC between 1978 and 2024. The articles were identified by searching PubMed and Google Scholar. We utilized the search terms GOC discussions and hip fracture, with additional descriptors including arthroplasty and geriatric. RESULTS There were 11 articles that met the selection criteria and were published between 1978 and 2024. Five articles were published on GOC discussions in orthopaedic surgery, while the remaining 6 articles were published in non-orthopaedic fields. There was one systematic review, 2 narrative reviews, 6 observational studies, and 2 descriptive studies. Supplemental commentary from non-orthopaedic specialties and the fields of law and medical ethics was included to assist in highlighting barriers to GOC discussions and to explore potential strategies to enhance GOC discussions. CONCLUSIONS Goals of care discussions provide a framework for treatment decisions based on an individual patient's values and cultural beliefs; however, these conversations may be limited by perceived time constraints, patient health care literacy, and physicians' misconceptions of what is most important to discuss. While no clear consensus was identified regarding strategies for improving GOC discussions in geriatric patients who have hip fractures, the authors recommend standardized training programs, expedited family meetings, multidisciplinary team involvement, assistive technology such as Outcome Prioritization Tool, and the incorporation of GOC discussions into institutional hip fracture pathways.
Collapse
Affiliation(s)
- Brienne E Paradis
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Brandon J Klein
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Lucas E Bartlett
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Randy M Cohn
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Adam D Bitterman
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| |
Collapse
|
33
|
van Bremen HE, Seppala LJ, Hegeman JH, van der Velde N, Willems HC. Characteristics and Outcomes of Nonoperatively Managed Patients With Hip Fracture Using the Dutch Hip Fracture Audit. J Orthop Trauma 2024; 38:265-272. [PMID: 38259058 PMCID: PMC11017835 DOI: 10.1097/bot.0000000000002778] [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] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To identify and compare characteristics of patients with hip fracture treated nonoperatively versus those treated operatively. METHODS DESIGN Retrospective cohort study. SETTING Hip fracture population-based study. PATIENT SELECTION CRITERIA All adult patients with hip fractures (OTA/AO 31A and 31B) were included. Patients with pathological or periprosthetic hip fractures were excluded. OUTCOME MEASURES AND COMPARISONS Patients were categorized according to the type of management (operative vs. nonoperative) and type of fracture (nondisplaced vs. other). Patient and fracture characteristics associated with nonoperative management (NOM) were analyzed. RESULTS A total of 94,930 patients with hip fracture were included. Of these, 3.2% were treated nonoperatively. Patients receiving NOM were older [86 years (interquartile range, 79-91 years) vs. 81 years (interquartile range, 72-87 years); P < 0.001], more frequently institutionalized (42.4% vs. 17.6%), and were more dependent in activities of daily living (22.2% vs. 55.0%). Various clinical characteristics, including dementia [odds ratio (OR) 1.31 (95% confidence interval, CI, 1.18-1.45) P < 0.001], no functional mobility [OR 4.39 (95% CI, 3.14-3.68) P < 0.001], and activities of daily living (ADL) measured as KATZ-6-ADL [OR 1.17 (95% CI, 1.14-1.20) P < 0.001] were independently associated with NOM. Seven-day mortality was 37.6%, and 30-day mortality was 57.1% in patients treated nonoperatively. CONCLUSIONS The first step in understanding patients who potentially benefit from NOM is evaluating the current standard of care. This study provides insight into the current hip fracture population treated nonoperatively. These patients are older, have higher percentage of dementia, more dependent, and show higher short-term mortality rates. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Hanne-Eva van Bremen
- Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam, the Netherlands;
- Dutch Institute for Clinical Auditing, Leiden, the Netherlands
- Amsterdam University Medical Centers, location Academic Medical Center, Internal Medicine and Geriatrics, University of Amsterdam, Amsterdam, the Netherlands;
| | - Lotta J. Seppala
- Amsterdam University Medical Centers, location Academic Medical Center, Internal Medicine and Geriatrics, University of Amsterdam, Amsterdam, the Netherlands;
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; and
| | - Johannes H. Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, the Netherlands
| | - Nathalie van der Velde
- Amsterdam University Medical Centers, location Academic Medical Center, Internal Medicine and Geriatrics, University of Amsterdam, Amsterdam, the Netherlands;
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; and
| | - Hanna C. Willems
- Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam, the Netherlands;
- Amsterdam University Medical Centers, location Academic Medical Center, Internal Medicine and Geriatrics, University of Amsterdam, Amsterdam, the Netherlands;
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; and
| |
Collapse
|
34
|
Terré JA, Torrado J, George I, Harari R, Cox-Alomar PR, Villablanca PA, Faillace RT, Granada JF, Dangas G, Garcia MJ, Latib A, Wiley J. Aortic Stenosis Management in Patients With Acute Hip Fracture. JACC. ADVANCES 2024; 3:100912. [PMID: 38939644 PMCID: PMC11198465 DOI: 10.1016/j.jacadv.2024.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 06/29/2024]
Abstract
The treatment of severe aortic stenosis (SAS) has evolved rapidly with the advent of minimally invasive structural heart interventions. Transcatheter aortic valve replacement has allowed patients to undergo definitive SAS treatment achieving faster recovery rates compared to valve surgery. Not infrequently, patients are admitted/diagnosed with SAS after a fall associated with a hip fracture (HFx). While urgent orthopedic surgery is key to reduce disability and mortality, untreated SAS increases the perioperative risk and precludes physical recovery. There is no consensus on what the best strategy is either hip correction under hemodynamic monitoring followed by valve replacement or preoperative balloon aortic valvuloplasty to allow HFx surgery followed by valve replacement. However, preoperative minimalist transcatheter aortic valve replacement may represent an attractive strategy for selected patients. We provide a management pathway that emphasizes an early multidisciplinary approach to optimize time for hip surgery to improve orthopedic and cardiovascular outcomes in patients presenting with HFx-SAS.
Collapse
Affiliation(s)
- Juan A. Terré
- Section of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Juan Torrado
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isaac George
- Structural Heart and Valve Center, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Rafael Harari
- Department of Cardiology, Bellevue Hospital, New York, New York, USA
| | - Pedro R. Cox-Alomar
- Department of Cardiology, Louisiana State University, New Orleans, Louisiana, USA
| | | | - Robert T. Faillace
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Bronx, New York, USA
| | | | - George Dangas
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mario J. Garcia
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - José Wiley
- Section of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| |
Collapse
|
35
|
Jehu DA, Langston R, Sams R, Young L, Hamrick M, Zhu H, Dong Y. The Impact of Dual-Tasks and Disease Severity on Posture, Gait, and Functional Mobility among People Living with Dementia in Residential Care Facilities: A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2691. [PMID: 38732796 PMCID: PMC11086138 DOI: 10.3390/s24092691] [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: 03/25/2024] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
Gait speed and timed-up-and-go (TUG) predict cognitive decline, falls, and mortality. Dual-tasks may be useful in cognitive screening among people living with dementia (PWD), but more evidence is needed. This cross-sectional study aimed to compare single- and dual-task performance and determine the influence of dementia severity on dual-task performance and interference. Thirty PWD in two residential care facilities (Age: 81.3 ± 7.1 years; Montreal Cognitive Assessment: 10.4 ± 6.0 points) completed two trials of single- (feet apart) and dual-task posture (feet apart while counting backward), single- (walk 4 m) and dual-task gait (walk 4m while naming words), and single- (timed-up-and-go (TUG)), and dual-task functional mobility (TUG while completing a category task) with APDM inertial sensors. Dual-tasks resulted in greater sway frequency, jerk, and sway area; slower gait speed; greater double limb support; shorter stride length; reduced mid-swing elevation; longer TUG duration; reduced turn angle; and slower turn velocity than single-tasks (ps < 0.05). Dual-task performance was impacted (reduced double limb support, greater mid-swing elevation), and dual-task interference (greater jerk, faster gait speed) was related to moderate-to-severe compared to mild PWD. Moderate-to-severe PWD had poorer dynamic stability and a reduced ability to appropriately select a cautious gait during dual-tasks than those with mild PWD, indicating the usefulness of dual-tasks for cognitive screening.
Collapse
Affiliation(s)
- Deborah A Jehu
- Department of Community & Behavioral Health Sciences, Institute of Public and Preventative Health, Augusta University, Augusta, GA 30912, USA
| | - Ryan Langston
- Department of Community & Behavioral Health Sciences, Institute of Public and Preventative Health, Augusta University, Augusta, GA 30912, USA
| | - Richard Sams
- Georgia War Veterans Nursing Home, Augusta, GA 30901, USA;
| | - Lufei Young
- School of Nursing, University of North Carolina, Charlotte, NC 28081, USA;
| | - Mark Hamrick
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Haidong Zhu
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| |
Collapse
|
36
|
Heiberg KE, Beckmann M, Bruun-Olsen V. Prediction of walking speed one year following hip fracture based on pre-fracture assessments of mobility and physical activity. BMC Geriatr 2024; 24:358. [PMID: 38649830 PMCID: PMC11036605 DOI: 10.1186/s12877-024-04926-1] [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: 10/12/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Older people with hip fracture are often medically frail, and many do not regain their walking ability and level of physical activity. The aim of this study was to examine the relationship between pre-fracture recalled mobility, fear of falling, physical activity, walking habits and walking speed one year after hip fracture. METHODS The study had a longitudinal design. Measurements were performed 3-5 days postoperatively (baseline) and at one year after the hip fracture. The measurements at baseline were all subjective outcome measures recalled from pre-fracture: The New Mobility Scale (NMS), the 'Walking Habits' questionnaire, The University of California, Los Angeles (UCLA) Activity Scale, Fear of Falling International (FES-I) and demographic variables. At one year 4-meter walking speed, which was a part of the Short Physical Performance Battery (SPPB) was assessed. RESULTS At baseline 207 participants were included and 151 were assessed after one year. Their age was mean (SD) 82.7 (8.3) years (range 65-99 years). Those with the fastest walking speed at one year had a pre-fracture habit of regular walks with a duration of ≥ 30 min and/or a frequency of regular walks of 5-7 days a week. Age (p =.020), number of comorbidities (p <.001), recalled NMS (p <.001), and recalled UCLA Activity Scale (p =.007) were identified as predictors of walking speed at one year. The total model explained 54% of the variance in walking speed. CONCLUSIONS Duration and frequency of regular walks before the hip fracture play a role in walking speed recovery one year following the fracture. Subjective outcome measures of mobility and physical activity, recalled from pre-fracture can predict walking speed at one year. They are gentle on the old and medically frail patients in the acute phase after hip fracture, as well as clinically less time consuming.
Collapse
Affiliation(s)
- Kristi Elisabeth Heiberg
- ¹Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
- ²Department of Medical Research, Clinic of Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
| | - Monica Beckmann
- ²Department of Medical Research, Clinic of Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Vigdis Bruun-Olsen
- ²Department of Medical Research, Clinic of Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| |
Collapse
|
37
|
Szulc P, Lewis JR, Chapurlat R. Decline in muscle strength and physical function after fracture in men - the prospective STRAMBO study. J Bone Miner Res 2024; 39:252-259. [PMID: 38477746 DOI: 10.1093/jbmr/zjae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 03/14/2024]
Abstract
Studies on muscle strength and physical function after fracture are focused on short follow-ups and adjacent anatomical region. We compared loss of muscle strength and physical function in men after fracture with normal ageing-related decline. In 823 men aged 60-87, measurements of grip strength and clinical tests (chair stands, balance) were performed every 4 years for 12 years. In 155 men with incident fracture, we compared the status after vs. before the fracture. In men without fracture (controls), we compared the status on the first follow-up (4 years) vs. baseline. In men with fracture, grip strength decreased more than in the controls (41%, 0.28SD, P < .01). Men with fracture had higher risk of incident deterioration on the five chair-stand test vs. the controls (OR = 2.45, P < .001). They had higher risk of incident inability to stand for 10s with closed eyes vs. the controls (OR = 4.80, P < .01). They also had higher risk of deterioration on the tandem walk than the controls: forwards (OR = 2.04, P < .01), backwards (OR = 2.25, P < .005). The rapid physical decline was not limited to the region of the fracture site. In men who had incident non-upper limb fractures, grip strength decreased more (32%, P < .05) vs. the controls. In men who had incident non-lower limb fractures, the risk of decline in the tests of the lower limbs was higher vs. controls (chair stands, OR = 2.73, P < .001). The risk of decline was higher in men with clinical fractures which occurred >1 year before the next visit vs. controls (tandem walk forwards, OR = 2.98, P < .005). Overall, in older men, fractures were associated with greater loss of muscle strength and physical function vs. normal ageing. This accelerated decline was also found in the anatomical regions remote from the fracture site. Thus, programs to decrease or reverse the post-fracture decline could have beneficial effects on subsequent fracture risk.
Collapse
Affiliation(s)
- Paweł Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon, Place d'Arsonval, France
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth WA 6027, Australia
| | - Roland Chapurlat
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon, Place d'Arsonval, France
| |
Collapse
|
38
|
Noeske KE, Snowdon DA, Ekegren CL, Harding KE, Prendergast LA, Peiris CL, Shields N, O'Halloran PD, Porter J, Watts JJ, Taylor NF. Walking self-confidence and lower levels of anxiety are associated with meeting recommended levels of physical activity after hip fracture: a cross-sectional study. Disabil Rehabil 2024:1-7. [PMID: 38635302 DOI: 10.1080/09638288.2024.2338195] [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: 11/08/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture. MATERIALS AND METHODS Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis determined factors associated with meeting physical activity thresholds related to positive health outcomes: 4,400 and 7,100 daily steps. Explanatory variables were: walking self-confidence; falls self-efficacy; depression; anxiety; co-morbidities; previous gait aid use; nutritional status; age; and gender. RESULTS Forty-three participants (20%) met the lower threshold of ≥4,400 to <7,100 steps and thirty participants (14%) met the upper threshold of ≥7,100 steps. Walking self-confidence was positively associated with meeting higher physical activity thresholds (adjusted odds ratio [AOR] 1.32: 95% CI 1.11 to 1.57, p = 0.002). Age (AOR 0.93: 95% CI 0.89 to 0.98, p = 0.003), DASS-21 anxiety score (AOR 0.81: 95% CI 0.69 to 0.94, p = 0.008) and comorbidity index score (AOR 0.52: 95% CI 0.36 to 0.72, p < 0.001) were negatively associated with meeting higher physical activity thresholds. CONCLUSION Walking self-confidence and anxiety are potentially modifiable factors associated with meeting physical activity thresholds related to positive health outcomes after hip fracture.
Collapse
Affiliation(s)
- Kate E Noeske
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - David A Snowdon
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Academic Unit, Peninsula Health, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Luke A Prendergast
- School of Computing, Engineering and Mathematical Sciences, La Trobe University, Bundoora, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- The Royal Melbourne Hospital, Allied Health, Parkville, Australia
| | - Nora Shields
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Australia
| | - Paul D O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), Deakin University School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, 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
| |
Collapse
|
39
|
Iacovazzo C, Sara R, Buonanno P, Vargas M, Coviello A, Punzo R, Maffei V, Marra A. The Effects of the Pericapsular Nerve Group Block on Postoperative Pain in Patients with Hip Fracture: A Multicenter Study. Diagnostics (Basel) 2024; 14:827. [PMID: 38667473 PMCID: PMC11049482 DOI: 10.3390/diagnostics14080827] [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: 02/14/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND An adequate early mobilization followed by an effective and pain-free rehabilitation are critical for clinical and functional recovery after hip and proximal femur fracture. A multimodal approach is always recommended so as to reduce the administered dose of analgesics, drug interactions, and possible side effects. Peripheral nerve blocks should always be considered in addition to spinal or general anesthesia to prolong postoperative analgesia. The pericapsular nerve group (PENG) block appears to be a less invasive and more effective analgesia technique compared to other methods. METHODS We conducted multicenter retrospective clinical research, including 98 patients with proximal femur fracture undergoing osteosynthesis surgery within 48 h of occurrence of the fracture. Thirty minutes before performing spinal anesthesia, 49 patients underwent a femoral nerve (FN) block plus a lateral femoral cutaneous nerve (LCFN) block, and the other 49 patients received a PENG block. A non-parametric Wilcoxon-Mann-Whitney (α = 0.05) test was performed to evaluate the difference in resting and dynamic numerical rating scale (NRS) at 30 min, 6 h, 12 h, and 24 h. RESULTS the PENG block administration was more effective in reducing pain intensity compared to the FN block in association with the LFCN block, as seen in the resting and dynamic NRS at thirty minutes and 12 h follow-up. CONCLUSION the PENG block was more effective in reducing pain intensity than the femoral nerve block associated with the lateral femoral cutaneous nerve block in patients with proximal femur fracture undergoing to osteosynthesis.
Collapse
Affiliation(s)
- Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Rosario Sara
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Roberta Punzo
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Vincenzo Maffei
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| |
Collapse
|
40
|
Woodcroft-Brown V, Bell J, Pulle CR, Mitchell R, Close J, McDougall C, Hurring S, Sarkies M. Patient, surgical and hospital factors predicting actual first-day mobilisation after hip fracture surgery: An observational cohort study. Australas J Ageing 2024. [PMID: 38616338 DOI: 10.1111/ajag.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To examine patient, surgical and hospital factors associated with Day-1 postoperative mobility after hip fracture surgery in older adults. METHODS A cohort study using Australia and New Zealand Hip Fracture Registry was conducted. Participants were aged older than 50 years and underwent hip fracture surgery between 1 January 2020 and 31 December 2020 inclusive. The outcome was standing and step transferring out of bed onto a chair and/or walking Day-1 after hip fracture surgery. RESULTS Mean age was 82 years and 68% were women. Of 12,318 patients with hip fracture, 5981 (49%) actually mobilised Day-1. Odds of actual first-day mobilisation were lower for individuals usually walking with either stick or crutch (OR = 0.71, 95% CI 0.62-0.82) or two aids or frame (OR = 0.57, 95% CI 0.52-0.64) or wheelchair/bed bound (OR = 0.24, 95% CI 0.17-0.33); who had impaired cognition preadmission (OR = 0.57, 95% CI 0.51-0.64); from aged care facilities (OR = 0.59, 95% CI 0.52-0.67); had an American Society of Anaesthesiologists grade 2 (OR = 0.63, 95% CI 0.41-0.97), 3 (OR = 0.31, 95% CI 0.20-0.47) or 4 or 5 (OR = 0.21, 95% CI 0.14-0.32); surgery delay >48 h (OR = 0.81, 95% CI 0.71-0.91); and restricted/non-weight-bearing status immediately postoperatively (OR = 0.53, 95% CI 0.42-0.67). CONCLUSIONS Both non-modifiable and modifiable patient and surgical factors influence first-day mobilisation after hip fracture surgery. Reducing time to surgery might assist future quality improvement efforts to increase Day-1 postoperative mobility.
Collapse
Affiliation(s)
- Victoria Woodcroft-Brown
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jack Bell
- The Prince Charles Hospital Allied Health Research Collaborative (AHRC), The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Chrysanth Ranjeev Pulle
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine McDougall
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Hurring
- Older Person's Health Specialist Service, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Sydney School of Health Services, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Implementation Science Academy, Sydney Health Partners, Sydney, New South Wales, Australia
| |
Collapse
|
41
|
Dissaneewate K, Dissaneewate P, Orapiriyakul W, Kritsaneephaiboon A, Chewakidakarn C. Development and Validation of Two-Step Prediction Models for Postoperative Bedridden Status in Geriatric Intertrochanteric Hip Fractures. Diagnostics (Basel) 2024; 14:804. [PMID: 38667450 PMCID: PMC11049116 DOI: 10.3390/diagnostics14080804] [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: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Patients with intertrochanteric hip fractures are at an elevated risk of becoming bedridden compared with those with intraarticular hip fractures. Accurate risk assessments can help clinicians select postoperative rehabilitation strategies to mitigate the risk of bedridden status. This study aimed to develop a two-step prediction model to predict bedridden status at 3 months postoperatively: one model (first step) for prediction at the time of admission to help dictate postoperative rehabilitation plans; and another (second step) for prediction at the time before discharge to determine appropriate discharge destinations and home rehabilitation programs. Three-hundred and eighty-four patients were retrospectively reviewed and divided into a development group (n = 291) and external validation group (n = 93). We developed a two-step prediction model to predict the three-month bedridden status of patients with intertrochanteric fractures from the development group. The first (preoperative) model incorporated four simple predictors: age, dementia, American Society of Anesthesiologists physical status classification (ASA), and pre-fracture ambulatory status. The second (predischarge) model used an additional predictor, ambulation status before discharge. Model performances were evaluated using the external validation group. The preoperative model performances were area under ROC curve (AUC) = 0.72 (95%CI 0.61-0.83) and calibration slope = 1.22 (0.40-2.23). The predischarge model performances were AUC = 0.83 (0.74-0.92) and calibration slope = 0.89 (0.51-1.35). A decision curve analysis (DCA) showed a positive net benefit across a threshold probability between 10% and 35%, with a higher positive net benefit for the predischarge model. Our prediction models demonstrated good discrimination, calibration, and net benefit gains. Using readily available predictors for prognostic prediction can assist clinicians in planning individualized postoperative rehabilitation programs, home-based rehabilitation programs, and determining appropriate discharge destinations, especially in environments with limited resources.
Collapse
Affiliation(s)
- Kantapon Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
- Department of Clinical Research and Medical Data Science, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Pornpanit Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Wich Orapiriyakul
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Apipop Kritsaneephaiboon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Chulin Chewakidakarn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| |
Collapse
|
42
|
Maegele M. Management of patients with proximal femur fractures under DOACs. Eur J Trauma Emerg Surg 2024; 50:359-366. [PMID: 38400927 PMCID: PMC11035399 DOI: 10.1007/s00068-024-02472-4] [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: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE In the past, preinjury direct oral anticoagulant (DOAC) intake has led to delays in time to surgery (TTS) in patients with proximal femur fractures and delays in surgery have been associated with impaired outcomes. Although healthcare institutions/federal committees have set rules for treatment within 24 h of injury, comprehensive guidelines for the perioperative management of these patients, in particular when on preinjury DOACs, are still lacking. This contribution aims to summarize the current evidence on the safe time window for surgery in patients with proximal femur fractures on preinjury DOACs and to outline therapeutic options if emergency DOAC reversal becomes necessary. METHODS Narrative review based upon selective review of the pertinent literature. RESULTS For the majority of patients with proximal femur fractures and on preinjury DOACs, early surgery appears safe as soon as medical clearance has been obtained. There may be an increase in the need for blood products but with data not yet conclusive. Work-up including assessment of remaining anticoagulant activity and potential reversal should be restricted to patients at risk for bleeding complications, in particular in the presence of renal/hepatic impairment. Methodology for rapid assessment of DOACs including quantitative/qualitative concentration levels is work in progress. In the case of bleeding, rapidly acting reversal agents are available. CONCLUSION Preinjury DOAC use should not routinely delay surgery in patients with proximal femur fractures.
Collapse
Affiliation(s)
- Marc Maegele
- Department for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany.
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| |
Collapse
|
43
|
Ariza-Vega P, Prieto-Moreno R, Mora-Traverso M, Molina-García P, Ashe MC, Martín-Matillas M. Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study. Disabil Rehabil Assist Technol 2024; 19:1009-1018. [PMID: 36308295 DOI: 10.1080/17483107.2022.2138999] [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: 04/06/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Hip fracture results in an older person's loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. MATERIALS AND METHODS Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n = 2), caregivers (n = 3), and health providers (n = 2)] with 45 participants (14 older adults, 21 caregivers and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording sessions, transcription and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. RESULTS Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. CONCLUSIONS Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture.
Collapse
Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Molina-García
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| |
Collapse
|
44
|
Mora-Traverso M, Prieto-Moreno R, Molina-Garcia P, Salas-Fariña Z, Martín-Martín L, Martín-Matillas M, Ariza-Vega P. Effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients with hip fracture. J Telemed Telecare 2024; 30:549-558. [PMID: 35060784 DOI: 10.1177/1357633x211073256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Telerehabilitation has emerged in the last decade as a promising alternative to conduct the rehabilitation process at home. However, there are no studies testing the effects of telerehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. Thus, the aim of this study is to test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. METHODS The present study is a non-randomized clinical trial that includes patients older than 65 years old with a hip fracture and their family caregivers (ClinicalTrials.gov; Identifier: NCT02968589). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, the first being the main analysis. The intervention group received a home-based multidisciplinary telerehabilitation intervention, called @ctivehip, that lasted 12 weeks. The control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients' quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS) and the fitness level, assessed with the International Fitness Scale. RESULTS The quality of life of the telerehabilitation group increased, while the control group scored worsened at the 3-month follow-up (medium effect size: 0.66 SDs; p = 0.006). The telerehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: -0.50 SDs; p = 0.015). Lastly, the telerehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p = 0.022). DISCUSSION The @ctivehip telerehabilitation program seems to be a promising treatment to improve the quality of life and psychological factors (i.e. anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level.
Collapse
Affiliation(s)
- Marta Mora-Traverso
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Rafael Prieto-Moreno
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Pablo Molina-Garcia
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Zeus Salas-Fariña
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
- Sport and Health University Research Institute (iMUDS), Universtity of Granada, Granada, Spain
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| |
Collapse
|
45
|
Turabi RY, Sheehan KJ, Guerra S, O'Connell MDL, Wyatt D. Barriers and facilitators to early mobilisation and weight-bearing as tolerated after hip fracture surgery among older adults in Saudi Arabia: a qualitative study. Age Ageing 2024; 53:afae075. [PMID: 38619122 PMCID: PMC11017516 DOI: 10.1093/ageing/afae075] [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: 10/20/2023] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE To explore the practice of prescribing and implementing early mobilisation and weight-bearing as tolerated after hip fracture surgery in older adults and identify barriers and facilitators to their implementation. METHODS Semi-structured interviews were conducted with 20 healthcare providers (10 orthopaedic surgeons and 10 physiotherapists) from Saudi Arabian government hospitals. Data were analysed using inductive thematic analysis. RESULTS While early mobilisation and weight-bearing as tolerated were viewed as important by most participants, they highlighted barriers to the implementation of these practices. Most participants advocated for mobility within 48 h of surgery, aligning with international guidance; however, the implementation of weight-bearing as tolerated was varied. Some participants stressed the type of surgery undertaken as a key factor in weight-bearing prescription. For others, local protocols or clinician preference was seen as most important, the latter partially influenced by where they were trained. Interdisciplinary collaboration between orthopaedic surgeons and physiotherapists was seen as a crucial part of postoperative care and weight-bearing. Patient and family member buy-in was also noted as a key factor, as fear of further injury can impact a patient's adherence to weight-bearing prescriptions. Participants noted a lack of standardised postoperative protocols and the need for routine patient audits to better understand current practices and outcomes. CONCLUSION This study contributes to national and global discussions on the prescription of early mobilisation and weight-bearing as tolerated. It highlights the necessity for a harmonised approach, incorporating standardised, evidence-based protocols with patient-specific care, robust healthcare governance and routine audits and monitoring for quality assurance and better patient outcomes.
Collapse
Affiliation(s)
- Ruqayyah 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
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - David Wyatt
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| |
Collapse
|
46
|
Zare Z, Ghane G, Shahsavari H, Ahmadnia S, Ghiyasvandian S. Social Life After Hip Fracture: A Qualitative Study. J Patient Exp 2024; 11:23743735241241174. [PMID: 38559664 PMCID: PMC10981218 DOI: 10.1177/23743735241241174] [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] [Indexed: 04/04/2024] Open
Abstract
The return to social life after a hip fracture is a major concern for patients and a determinant factor in their recovery. However, patients' perceptions of social life after hip fracture are variable and context-dependent. By identifying these perceptions and strategies of patients, interventions can be strengthened and modified. The aim of this study was to identify patients' perceptions of their social life after hip fracture. This qualitative study used inductive content analysis. Twenty patients with hip fractures who were referred to Tehran University of Medical Sciences hospitals were purposefully selected and included in the study. Data were collected through individual, face-to-face, in-depth, semi-structured interviews conducted by a researcher experienced in carrying out such interviews. The interviews were recorded, immediately transcribed verbatim, and analyzed in MAXQDA-10. The interviewing process continued until data saturation was reached. The data analysis led to the extraction of three categories: Disruption of normal social life, Minimal social life, and Social isolation. The results indicated that the social life of these patients is influenced by physical conditions and contextual factors and progresses over time. All patients experienced meaningful disruption of their social life after experiencing hip fractures and movement limitations. The interdisciplinary perspectives provided by these findings can increase awareness of patients' post-fracture social life perceptions and conditions. These findings can also be used to design future programs for interdisciplinary interventions (involving sociology and medical sciences) to improve social life and increase the ability to return to a normal social life. Recovery management for patients with hip fractures should be preventive and organized by an all-around team (involving medicine, psychology, and sociology) based on patient-centered, community-based, and modern care strategies.
Collapse
Affiliation(s)
- Zahra Zare
- Department of Operating Room, School of Allied Medical Science, Tehran University of Medical Sciences, Tehran, Iran
| | - Golnar Ghane
- Department of Medical Surgical Nursing; School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- Department of Medical Surgical Nursing; School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Ahmadnia
- Department of Sociology, School of Social Sciences, University of Allameh Tabataba'i, Tehran, Iran
| | - Shahrzad Ghiyasvandian
- Department of Medical Surgical Nursing; School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
47
|
Aldieri A, Biondi R, La Mattina AA, Szyszko JA, Polizzi S, Dall'Olio D, Curti N, Castellani G, Viceconti M. Development and validation of a semi-automated and unsupervised method for femur segmentation from CT. Sci Rep 2024; 14:7403. [PMID: 38548805 PMCID: PMC10978861 DOI: 10.1038/s41598-024-57618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/20/2024] [Indexed: 04/01/2024] Open
Abstract
Quantitative computed tomography (QCT)-based in silico models have demonstrated improved accuracy in predicting hip fractures with respect to the current gold standard, the areal bone mineral density. These models require that the femur bone is segmented as a first step. This task can be challenging, and in fact, it is often almost fully manual, which is time-consuming, operator-dependent, and hard to reproduce. This work proposes a semi-automated procedure for femur bone segmentation from CT images. The proposed procedure is based on the bone and joint enhancement filter and graph-cut algorithms. The semi-automated procedure performances were assessed on 10 subjects through comparison with the standard manual segmentation. Metrics based on the femur geometries and the risk of fracture assessed in silico resulting from the two segmentation procedures were considered. The average Hausdorff distance (0.03 ± 0.01 mm) and the difference union ratio (0.06 ± 0.02) metrics computed between the manual and semi-automated segmentations were significantly higher than those computed within the manual segmentations (0.01 ± 0.01 mm and 0.03 ± 0.02). Besides, a blind qualitative evaluation revealed that the semi-automated procedure was significantly superior (p < 0.001) to the manual one in terms of fidelity to the CT. As for the hip fracture risk assessed in silico starting from both segmentations, no significant difference emerged between the two (R2 = 0.99). The proposed semi-automated segmentation procedure overcomes the manual one, shortening the segmentation time and providing a better segmentation. The method could be employed within CT-based in silico methodologies and to segment large volumes of images to train and test fully automated and supervised segmentation methods.
Collapse
Affiliation(s)
- Alessandra Aldieri
- PolitoBIOMedLab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Riccardo Biondi
- IRCCS Bologna - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Antonino A La Mattina
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Julia A Szyszko
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Stefano Polizzi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Daniele Dall'Olio
- IRCCS Bologna - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Nico Curti
- IRCCS Bologna - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Physics and Astronomy, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Gastone Castellani
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Marco Viceconti
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| |
Collapse
|
48
|
Forssten MP, Mohammad Ismail A, Ioannidis I, Ribeiro MAF, Cao Y, Sarani B, Mohseni S. Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk. Front Surg 2024; 11:1367457. [PMID: 38525320 PMCID: PMC10957751 DOI: 10.3389/fsurg.2024.1367457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction The number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h. Methods All patients registered in the 2013-2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality. Results A total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57-4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90-8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively. Conclusion Delaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk.
Collapse
Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Marcelo A. F. Ribeiro
- Pontifical Catholic University of São Paulo, São Paulo, Brazil
- Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Babak Sarani
- Division of Trauma and Acute Care Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
49
|
Singh A, Kotzur T, Vivancos-Koopman I, Emukah C, Brady C, Martin C. A component-based analysis of metabolic syndrome's impact on 30-day outcomes after hip fracture: reduced mortality in obese patients. OTA Int 2024; 7:e301. [PMID: 38292467 PMCID: PMC10827291 DOI: 10.1097/oi9.0000000000000301] [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] [Indexed: 02/01/2024]
Abstract
Introduction Hip fractures are a common injury associated with significant morbidity and mortality. In the United States, there has been a rapid increase in the prevalence of metabolic syndrome (MetS), a condition comprised several common comorbidities, including obesity, diabetes mellitus, and hypertension, that may worsen perioperative outcomes. This article assesses the impact of MetS and its components on outcomes after hip fracture surgery. Methods Patients who underwent nonelective operative treatment for traumatic hip fractures were identified in the 2015-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Baseline characteristics between groups were compared, and significant differences were included as covariates. Multivariate regression was performed to assess the impact of characteristics of interest on postoperative outcomes. Patients with MetS, or a single one of its constitutive components-hypertension, diabetes, and obesity-were compared with metabolically healthy cohorts. Results In total 95,338 patients were included. Patients with MetS had increased complications (OR 1.509; P < 0.001), but reduced mortality (OR 0.71; P < 0.001). Obesity alone was also associated with increased complications (OR 1.14; P < 0.001) and reduced mortality (OR 0.736; P < 0.001). Both hypertension and diabetes alone increased complications (P < 0.001) but had no impact on mortality. Patients with MetS did, however, have greater odds of adverse discharge (OR 1.516; P < 0.001), extended hospital stays (OR 1.18; P < 0.001), and reoperation (OR 1.297; P = 0.003), but no significant difference in readmission rate. Conclusion Patients with MetS had increased complications but decreased mortality. Our component-based analysis showed had obesity had a similar effect: increased complications but lower mortality. These results may help surgeons preoperatively counsel patients with hip fracture about their postoperative risks.
Collapse
Affiliation(s)
- Aaron Singh
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Travis Kotzur
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | | | - Chimobi Emukah
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Christina Brady
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Case Martin
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| |
Collapse
|
50
|
Bennett MJ, Center JR, Perry L. Establishing consensus recommendations for long-term osteoporosis care for patients who have attended an Australian fracture liaison service: a Delphi study. Osteoporos Int 2024; 35:373-389. [PMID: 38267665 PMCID: PMC10867051 DOI: 10.1007/s00198-024-07014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/01/2024] [Indexed: 01/26/2024]
Abstract
Coordinating healthcare activities between fracture liaison services (FLS) and primary care is challenging. Using a Delphi technique, we developed 34 consensus statements to support improved care coordination across this healthcare transition. PURPOSE Evidence supporting an optimal coordination strategy between fracture liaison services (FLS) and primary care is lacking. This study aimed to develop consensus statements to support consistency and benchmarking of clinical practice to improve coordination of care for patients transitioning from FLS to primary care following an osteoporotic fracture. METHODS A Delphi technique was used to develop consensus among a panel of experts, including FLS clinicians (medical and non-medical), general practitioners (GPs), and consumers. RESULTS Results of a preparatory questionnaire (n = 33) informed the development of 34 statements for review by expert panellists over two Delphi rounds (n = 25 and n = 19, respectively). The majority of participants were from New South Wales (82%), employed as FLS clinicians (78.8%) and working in metropolitan centres (60.6%). Consensus was achieved for 24/34 statements in round one and 8/10 statements in round two. All statements concerning patient education, communication, and the GP-patient relationship achieved consensus. Expert opinions diverged in some areas of clinician roles and responsibilities and long-term monitoring and management recommendations. CONCLUSION We found clear consensus among experts in many key areas of FLS integration with primary care. While experts agreed that primary care is the most appropriate setting for long-term osteoporosis care, overall confidence in primary care systems to achieve this was low. The role of (and responsibility for) adherence monitoring in a resource-limited setting remains to be defined.
Collapse
Affiliation(s)
- Michael J Bennett
- Department of Endocrinology, Prince of Wales Hospital, Randwick, NSW, Australia.
- Department of Endocrinology, The Sutherland Hospital, Caringbah, NSW, Australia.
- St George and Sutherland Clinical School, UNSW Medicine, Sydney, NSW, Australia.
- The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
| | - Jacqueline R Center
- The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- St Vincent's Healthcare Clinical School, School of Clinical Medicine, UNSW, Sydney, NSW, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Prince of Wales Hospital & Community Health Services, Randwick, NSW, Australia
| |
Collapse
|