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Romero Pisonero E, Mora-Fernández J, Queipo Matas R, González Montalvo JI, Neira Álvarez M, Ojeda Thies C, Sáez López P, Malafarina V. Demographic, functional and clinical characteristics in hip fracture patients according to mental status of the Spanish National Hip Fracture Registry. Rev Esp Geriatr Gerontol 2024; 59:101450. [PMID: 38159499 DOI: 10.1016/j.regg.2023.101450] [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: 09/27/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To describe the differences according to mental status at admission on the care process and 30-day outcomes in hip fracture patients, mainly regarding the use of rehabilitation resources and anti-osteoporotic medication, by analysing data from the Spanish National Hip Fracture Registry (RNFC, "Registro Nacional de Fracturas de Cadera" in Spanish). METHODS We analysed prospectively collected data from a cohort of patients admitted participating in the Spanish National Hip Fracture Registry (RNFC) in 76 Spanish hospitals between 2017 and 2019. We classified participants using Short Portable Mental Status Questionnaire (SPMSQ), defining two groups: patients with ≤2 SPMSQ score and patients with >2 SPMSQ score. RESULTS Of 21,254 patients was recorded SPMSQ in 17,242 patients, 9052 were >2 SPMSQ score (52.6%). These were older (87.7 vs. 85.3 years; p<0.001), had worse mobility (no-independent walking ability 26.0% vs. 4.5%; p<0.001) and were more likely to be living in nursing homes (35.3% vs. 9.6%; p<0.001). They were more likely to be treated nonoperatively (3.8% vs. 1.5%; p>0.001), less early mobilisation (57.5% vs. 68.9%; p<0.001) and suffered higher in-hospital mortality (5.2% vs. 2.7%; p<0.001). At discharge, they received less anti-osteoporotic medication (37.9% vs. 48.9%; p<0.001) and returned home less often (29.8%% vs. 51.2%; p<0.001). One month after fracture, patients with >2 SPMSQ score had poorer mobility (no-independent walking ability 44.4% vs. 24.9%; p<0.001) and were newly institutionalised in a nursing home more (12.6% vs. 12.0%; p<0.001) and were more likely to die by one-month post-fracture (9.5% vs. 4.6%; p<0.001). CONCLUSION RNFC patients with >2 SPMSQ score were more vulnerable and had poorer outcomes than patients with ≤2 SPMSQ score, suggesting that they need specialised care in-hospital and in the recovery phase.
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Affiliation(s)
| | - Jesús Mora-Fernández
- Department of Geriatrics, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University, Madrid, Spain
| | - Rocío Queipo Matas
- Europea University, Madrid, Spain; La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Juan Ignacio González Montalvo
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain; Department of Geriatrics, La Paz University Hospital, Madrid, Spain; Department of Medicine, Faculty of Medicine, Autonoma University, Madrid, Spain
| | | | - Cristina Ojeda Thies
- Department of Traumatology and Orthopaedic Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Pilar Sáez López
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain; Geriatrics Unit, Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain
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Schroeder HS, Israeli A, Liebergall M(I, Or O, Abu Ahmed W, Paltiel O, Justo D, Zimlichman E. Home Versus Hospital Rehabilitation of Older Adults Following Hip Fracture Yields Similar Patient-Reported Outcome Measures. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241230293. [PMID: 38491840 PMCID: PMC10943717 DOI: 10.1177/00469580241230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/18/2024]
Abstract
The increase in hip fractures (HF) due to aging of the population and the rise in attractiveness of services provided at home following the COVID-19 pandemic, emphasize the need to compare outcomes of home versus hospital HF rehabilitation. To date, studies comparing the 2 services have focused primarily on clinical outcomes rather than patient-reported outcomes (PROs). This longitudinal observational study evaluated PROs of older adults with HF in the 2 settings. The SF36 questionnaire was used to measure PROs 3 times after surgery. The first PRO was retrospective and reflected pre-fracture health status. Descriptive statistics and mixed-effect logistic regression were used. Of 86 patients participating in the study, 41 had home rehabilitation and 45 had hospital rehabilitation. In both groups, the mental and physical scores plummeted 2 weeks after the HF, compared to pre-fracture status. The difference in improvement from pre-fracture status to recovery in both groups, were not significantly (P < .05) different, except for the pain domain. PROs of home versus hospital rehabilitation were similar, suggesting that rehabilitation at home can be as effective as hospital rehabilitation for suitable patients. This knowledge can improve quality of care in an aging global population.
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Affiliation(s)
- Hanna S. Schroeder
- Hebrew University of Jerusalem, Jerusalem, Israel
- Israeli Ministry of Health, Israel
| | - Avi Israeli
- Israeli Ministry of Health, Israel
- Dr. Julien Rozan Professor of Healthcare, Hebrew University – Hadassah Medical School
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Omer Or
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Ora Paltiel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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Schroeder H, Israeli A, Liebergall M, Or O, Abu Ahmad W, Paltiel O, Justo D, Zimlichman E. Utilising patient-reported outcomes for goal-directed therapy of hip fracture patients: a sequential controlled trial. BMJ Open Qual 2023; 12:e002402. [PMID: 38154820 PMCID: PMC10759100 DOI: 10.1136/bmjoq-2023-002402] [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: 05/03/2023] [Accepted: 12/02/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Hip fracture patients (HFPs) frequently have multiple underlying conditions, necessitating that agreed-upon goals take these complications into consideration. Communication regarding goals between medical-personnel and patients is not always effective. Patient-reported outcomes (PROs) can outline personal goals and help promote quality health care in HFPs. Few studies have been published on this topic. The study's aim was to outline the process of using PROs for goal-directed therapy among HFPs. METHODS This sequential controlled trial was conducted among HFPs from two medical centres. The control and the intervention group received integrative rehabilitation. PROs were measured in both groups using the SF36 questionnaire three times postsurgery: 24-48 hours, 2 weeks and 3 months. During the first round of questioning, only the intervention group was asked 'what matters most to you?' during the rehabilitative process. Accordingly, agreed-upon goals that were determined by the SF36's eight topics and were incorporated into the HFP's rehabilitative process. A Likert scale of 1-5, '1' indicating no-achievement and '5' full-achievement, was used to assess the goal achievement 4-6 months post-fracture. RESULTS 84 HFPs participated in the study: 40 and 44 in the intervention and control group, respectively. In both groups, PROs declined after the HF, then improved somewhat 3 months later, but did not return to prefracture scores. Among the intervention group, 39% reached their specific goals (Likert level 5). Patients who achieved their goals had better PROs in comparison to others. The intervention group indicated PROs helped them articulate their desires and introduced them to new areas of care. CONCLUSIONS Shifting from asking 'what's the matter?' to 'what matters most to you?' can improve the understanding of HFPs' own priorities, promote quality outcomes and enhance patient-centred care. Using PROs as a guide for goal-directed therapy can create a more inclusive process that includes the patients' most important health determinants and needs.
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Affiliation(s)
- Hanna Schroeder
- School of Nursing in the Faculty of Medicine, Henrietta Szold Hadassah, Hebrew University of Jerusalem, Jerusalem, Israel
- Strategic and Economic Planning Administration, Israel Ministry of Health, Jerusalem, Israel
| | - Avi Israeli
- Dr. Julien Rozan Professor of Healthcare, Hebrew University - Hadassah Medical School, Jerusalem, Israel
- Office of the Chief Scientist, Israel Ministry of Health, Jerusalem, Israel
- Hadassah University Medical Center, Jerusalem, Israel
| | - Meir Liebergall
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Or
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Geriatrics Division, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
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Garcia-Barreiro G, Huespe I, Llano L, Dozo M, Benchimol JA, Rebecchi P, Taype D, Barla J, Sancineto C, Carabelli G. Patients with trochanteric hip fractures and pre-existing osteoarthritis can be treated with nailing osteosynthesis without significant decrease in functional status. Injury 2023; 54 Suppl 6:110735. [PMID: 38143114 DOI: 10.1016/j.injury.2023.04.022] [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: 01/29/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Functional outcome in patients after trochanteric fracture fixation with pre-existing radiographic osteoarthritis (OA) is unclear. Analyzing their function and independence, before and after fracture, could optimize their treatment and decrease the socioeconomic burden in this particular group. METHODS The influence of pre-existing radiographic hip OA on functional outcome was retrospectively analyzed with a cohort of patients undergoing proximal femoral nailing for trochanteric fracture. OA was graded according to the Tonnis classification. Functional outcome was assessed preoperatively and 12 months after surgery by the Parker Mobility Score (PMS). We consider a meaningful reduction a difference between preoperatively PMS and 12 months after surgery ≥ 2. In order to evaluate if OA is related to PMS reduction ≥ 2, we calculate the SubHazard ratio (SHR) performing a competing risk regression model considering death as a competing risk event, adjusting by confounders. Death, reoperations, readmissions, surgical time, and fracture reduction quality in patients with and without osteoarthritis were recorded. RESULTS 375 trochanteric hip fractures treated with cephalomedullary nails were included, from which 80 (21% CI95% 17%-21%) were classified as Tonnis 2 or 3. This group of patients with pre-existing OA was significantly older (mean age of 88.6 [SD 5.65] vs 85.5 years [SD 6.95]) than the group without OA. The preoperatively PMS score was 6.28 (2.71) in non-OA patients and 5.69 (2.67) in OA patients. The mean PMS reduction 12 months after surgery was 1.3 (SD 2.05) in OA patients and 1.07 (SD 2.2) in non-OA patients (p = 0.43). Competing risks analysis, adjusted by confounders had an SHR of 1.15 (IC95% 0.77 - 1.69). Death, readmission, reoperations, surgical time, and fracture reduction quality did not differ in both groups. CONCLUSIONS Patients with pre-existing radiographic OA treated with femoral nailing have a similar reduction in functional outcomes compared to the non-OA group at one-year follow-up. Further studies will be needed to compare the results of the functional outcome in arthroplasty with those of femoral nailing for the treatment of trochanteric femur fractures in patients with OA.
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Affiliation(s)
- Gonzalo Garcia-Barreiro
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Ivan Huespe
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Lionel Llano
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Marcelo Dozo
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Javier Alberto Benchimol
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Pilar Rebecchi
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Danilo Taype
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Jorge Barla
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Carlos Sancineto
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
| | - Guido Carabelli
- Orthopaedic Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina.
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Bardesono F, Trombetta S, Gullone L, Bonardo A, Gindri P, Castiglioni C, Milano E, Massazza G, Di Monaco M. A screening test is not enough to define the prognostic role of cognitive impairment after hip fracture: a short-term prospective study. Aging Clin Exp Res 2022; 34:2977-2984. [PMID: 36057082 DOI: 10.1007/s40520-022-02233-6] [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: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment assessed by easy-to-administer tests successfully predicts function after hip fracture, whereas the prognostic role of additional cognitive evaluations is largely unknown. AIMS To investigate the capability of further assessments to discriminate cognitive impairment with prognostic relevance in hip-fracture women defined cognitively intact or mildly impaired on the Short Portable Mental Status Questionnaire (SPMSQ). METHODS We prospectively investigated women with subacute hip fracture admitted to our rehabilitation facility. The women who made ≤4 errors on the SPMSQ were further assessed by 4 tests: Montreal Cognitive Assessment, Rey Auditory Verbal Learning Test (immediate and delayed recall) and Frontal Assessment Battery. Activities of daily living (ADL) were measured by the Barthel index. Successful rehabilitation was defined with a Barthel index score ≥85. RESULTS Data from 127 women were available. Each of the 4 cognitive tests assessed at admission significantly predicted the Barthel index scores measured at discharge. The predictive role persisted after multiple adjustments. For a change in cognitive scores corresponding to the difference between 25° and 75° percentiles in their distribution in the sample, the adjusted odds ratio to achieve successful rehabilitation roughly ranged from 2 to 4, depending on which cognitive test was adopted. DISCUSSION The women with subacute hip fracture defined cognitively intact or mildly impaired on the SPMSQ could have cognitive impairment revealed by further examination, with prognostic disadvantages in ADL. CONCLUSIONS Assessing cognition by the SPMSQ seems not enough to exclude the presence of cognitive impairment with relevant prognostic disadvantage in hip-fracture women.
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Affiliation(s)
- Francesca Bardesono
- Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Fondazione Opera San Camillo, Presidio di Torino, strada Santa Margherita 136, 10131, Turin, Italy
| | - Silvia Trombetta
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Laura Gullone
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Alessandra Bonardo
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Patrizia Gindri
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Carlotta Castiglioni
- Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Fondazione Opera San Camillo, Presidio di Torino, strada Santa Margherita 136, 10131, Turin, Italy
| | - Edoardo Milano
- Neuropsychology Service, Fondazione Opera San Camillo, Presidio di Torino, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Di Monaco
- Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Fondazione Opera San Camillo, Presidio di Torino, strada Santa Margherita 136, 10131, Turin, Italy.
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