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Pedersen LT, Ipsen JA, Bruun IH, Egebæk HK, Andersen PT, Viberg B. Association between patient activation level and functional outcomes in older adults with hip fractures. Arch Gerontol Geriatr 2024; 124:105472. [PMID: 38728823 DOI: 10.1016/j.archger.2024.105472] [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: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program. METHOD An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks. RESULTS The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds. CONCLUSION Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.
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Affiliation(s)
- Lars Tobiesen 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.
| | - 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
| | - Inge H 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
| | - Heidi Klakk Egebæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, The Capital Region, Denmark; Department of Exercise Epidemiology, Institute for Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion, University of Southern Denmark, Odense & Esbjerg, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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Magel JS, Beneciuk JM, Siantz E, Fritz J, Garland EL, Hanley A, Shen J, Blosser P, Matev T, Gordon AJ. PT-IN-MIND: study protocol for a multisite randomised feasibility trial investigating physical therapy with integrated mindfulness (PT-IN-MIND) for patients with chronic musculoskeletal pain and long-term opioid treatment who attend outpatient physical therapy. BMJ Open 2024; 14:e082611. [PMID: 39079926 DOI: 10.1136/bmjopen-2023-082611] [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] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Many individuals receiving outpatient physical therapy have musculoskeletal pain and up to one-third use prescription opioids. The impact of physical therapist-led mindfulness-based interventions integrated with evidence-based physical therapy (I-EPT) to manage patients with chronic musculoskeletal pain and long-term opioid treatment has not been elucidated. This project evaluates the feasibility of conducting a cluster randomised trial to test the effectiveness of I-EPT. METHODS AND ANALYSIS Study 1 aim: Refine and manualise the I-EPT treatment protocol. Our approach will use semistructured interviews of patients and physical therapists to refine an I-EPT training manual. Study 2 aim: Evaluate different intensities of physical therapist training programmes for the refined I-EPT treatment protocol. Physical therapists will be randomised 1:1:1 to high-intensity training (HighIT), low-IT (LowIT) training and no training arms. Following training, competency in the provision of I-EPT (LowIT and HighIT groups) will be assessed using standardised patient simulations. Study 3 aim: Evaluate the feasibility of the I-EPT intervention across domains of the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework. The refined I-EPT treatment protocol will be tested in two different health systems with 90 patients managed by the randomised physical therapists. The coprimary endpoints for study 3 are the proportions of the Pain, Enjoyment of Life and General Activity Scale and the Timeline Followback for opioid use/dose collected at 12 weeks. ETHICS AND DISSEMINATION Ethics approval for the study was obtained from the University of Utah, University of Florida and Florida State University Institutional Review Boards. Informed consent is required for participant enrolment in all phases of this project. On completion, study data will be made available in compliance with NIH data sharing policies. TRIAL REGISTRATION NUMBER NCT05875207.
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Affiliation(s)
- John S Magel
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Jason M Beneciuk
- Physical Therapy, University of Florida, Gainesville, Florida, USA
- Clinical Research, Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Elizabeth Siantz
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
| | - Julie Fritz
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Eric L Garland
- Sanford Institute for Empathy and Compassion, University of California, San Diego, California, USA
- Department of Psychiatry, School of Medicine, University of California, San Diego, California, USA
| | - Adam Hanley
- Florida State University, Tallahassee, Florida, USA
| | - Jincheng Shen
- Population Health Sciences, University of Utah Health, Salt Lake City, Utah, USA
| | - Priscilla Blosser
- Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Adam J Gordon
- School of Medicine, University of Utah Health, Salt Lake City, Utah, USA
- VA Health Care System, Salt Lake City, Utah, USA
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Chang H, Luan C, Li C. Effect of Comprehensive Rehabilitation Training Based on Balance Function on Postoperative Recovery and Function of Hip Fracture in the Elderly: A Systematic Review and Meta-Analysis. Geriatr Orthop Surg Rehabil 2024; 15:21514593241261506. [PMID: 39086843 PMCID: PMC11289819 DOI: 10.1177/21514593241261506] [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: 10/18/2023] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction In China, the proportion of the elderly population is gradually increasing, followed by the increasing medical demands of elderly patients. Hip fracture is a common fracture in the elderly. The elderly are prone to serious postoperative complications, resulting in failure to restore normal hip function, which seriously affects patients' quality of life and further increases their mortality rate. Thus, hip fracture represents a remarkable public health issue within the realm of geriatric medical care. Significance This study systematically evaluated the impact of comprehensive rehabilitation training, with a focus on balance function, on elderly individuals with hip fractures' postoperative recovery and functional outcomes. Result Results showed a significant difference in BBS scores favoring comprehensive rehabilitation training based on balance function over conventional intervention. Similarly, AM-PAC scores favored the balance-focused training. TUTG meta-analysis indicated its adoption in comprehensive rehabilitation training. FIM scores showed improvement with balance-focused training. Harris score meta-analysis also favored this approach. A funnel plot analysis revealed potential publication bias, likely due to study heterogeneity and limited publications. Conclusions In conclusion, comprehensive rehabilitation training centered around balance function displayed clinical efficacy in enhancing postoperative hip joint function in elderly hip fracture patients. This approach improved balance, coordination, and posture control, facilitating lower limb function recovery and overall prognosis. It holds promise as a valuable treatment approach.
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Affiliation(s)
- Hai Chang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chunliang Luan
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chen Li
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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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.
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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
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Kristensen MT, Turabi R, Sheehan KJ. The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery. Clin Rehabil 2024; 38:990-997. [PMID: 38347704 DOI: 10.1177/02692155241231225] [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] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To determine the association between the extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture. DESIGN Cohort study. SETTING Acute orthopaedic hospital ward. PARTICIPANTS Consecutive sample of 701 patients, 65 years of age or older, 80% from own home, 49% with a trochanteric fracture, and 61% with an American Society of Anesthesiology grade > 2. INTERVENTION n/a. MAIN MEASURES Cumulated ambulation score (CAS) (0-6 points) on the first postoperative day and 30-day postoperative mortality. A CAS = 0 reflects no functional mobility (bedridden), while a CAS = 6 reflects independent out-of-bed-transfer, chair-stand, and indoor walking status. RESULTS Overall, 86% of patients were mobilised to standing or seated in chair (CAS ≥ 1) on the first postoperative day. A CAS of 0, 1-3, and 4-6 was observed for 97 (14%), 519 (74%), and 85 (12%) patients, respectively. Overall, 61 (8.7%) patients died within 30 days with the highest mortality (23.7%, n = 23) seen for those not mobilised (CAS = 0). Only one patient (1.2%) with a CAS of 4-6 points died. Cox regression analysis adjusted for age, sex, residential status, pre-fracture CAS, fracture type, and American Society of Anesthesiology grade, showed that a one-unit increase in CAS was associated with a 38% lower risk of 30-day mortality (Hazard Ratio = 0.63, 95%Confidence Interval, 0.50-0.78). CONCLUSION Mobility on the first postoperative day was associated with 30-day postoperative mortality, with a lower risk observed for those completing greater mobility. National registries may consider extending collection of mobility on the first postoperative day from a binary indicator to the CAS which captures the extent of mobility achieved.
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Affiliation(s)
- Morten Tange Kristensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg-Frederiksberg, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Ruqayyah Turabi
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Department of Physical Therapy, Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Katie J Sheehan
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
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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.
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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
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Prieto-Moreno R, Molina-García P, Ortiz-Piña M, Mora-Traverso M, Estévez-López F, Martín-Matillas M, Ariza-Vega P. Association of the @ctivehip tele-rehabilitation with the fear of falling of older adults with hip fracture and their family caregivers: Secondary analysis of a non-randomised controlled trial. J Telemed Telecare 2024:1357633X241257972. [PMID: 38836335 DOI: 10.1177/1357633x241257972] [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: 06/06/2024]
Abstract
INTRODUCTION Osteoporotic hip fracture is a major health problem. Falls, the primary cause, might lead to a persistent fear of falling (FoF) among older adults, affecting their daily activities and rehabilitation. While in-person interventions exist, limited research is available on the effects of tele-rehabilitation on the FoF after a hip fracture. Thus, this study aims to test the association of the @ctivehip tele-rehabilitation programme on reducing the levels of FoF experienced by both older adults with hip fracture and their family caregivers. METHODS A non-randomised controlled trial (ClinicalTrials.gov; Identifier: NCT02968589) that compared a webpage-based tele-rehabilitation (@ctivehip) against usual care. Fear of falling was assessed using the Short Falls Efficacy Scale-International. Patients' functional status was evaluated using the Functional Independence Measure. Physical performance was assessed by the Timed Up and Go test and Short Physical Performance Battery. We conducted a per-protocol analysis as the primary outcome, and an intention-to-treat approach as secondary analysis. RESULTS A total of 71 patients with hip fracture (78.75 ± 6.12 years, 75% women) and their family caregivers participated. Participants in the intervention showed a higher decrease in FoF in comparison to those in the usual care (0.5 Cohen's d; p = 0.042). The reduction in FoF resulting from participation in the tele-rehabilitation programme was mediated by improvements in functional status by 79%. The @ctivehip programme did not decrease FoF of family caregivers. DISCUSSION @ctivehip is associated with a reduction of the FoF in older adults with hip fractures, but not in their family caregivers, with the reduction being mostly explained by improvements in the patients' functional status. Although the intervention seems promising, it should not be applied in clinical settings until confirmed by appropriate-designed randomised clinical trials.
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Affiliation(s)
- Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Mariana Ortiz-Piña
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Fernando Estévez-López
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Miguel Martín-Matillas
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Bullock GS, Duncan P, Chandler AM, Aguilar AA, Latham N, Storer T, Alexander N, McDonough CM. Development of an exercise therapy referral clinical support tool for patients with osteoporosis at risk for falls. J Am Geriatr Soc 2024; 72:1810-1816. [PMID: 38344943 DOI: 10.1111/jgs.18796] [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: 08/28/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND The purpose of this study was to develop a clinical support tool for osteoporosis clinic providers to support risk assessment and referrals for evidence-based exercise therapy programs. METHODS A sequential Delphi method was used with a multidisciplinary group of national falls experts, to provide consensus on referral to exercise therapy for patients at risk for falls. The Delphi study included a primary research team, expert panel, and clinical partners to answer the questions: (1) "What patient characteristics are needed to develop a clinical support tool?"; (2) "What are the recommended exercise referrals for patients with osteoporosis at risk for falls?" The consensus process consisted of two rounds with 8 weeks between meetings. Two qualitative researchers analyzed the data using a modified version of a matrix analysis approach. RESULTS The following were the most important variables to include when determining exercise therapy referrals for patients with osteoporosis: Patient history and demographics, falls history over the last year, current physical function and balance, caregiver and transportation status, socioeconomic and insurance status, and patient preference. Potential exercise therapy referrals included one-on-one physical therapy, group physical therapy, home health, community-based exercise programs, and not acceptable for exercise therapy. CONCLUSIONS Patient characteristics including patient history, physical function and balance performance, socioeconomic and insurance status, and patient preference for exercise therapy are important to inform both the medical provider and patient with osteoporosis to choose the most appropriate exercise therapy referral. Adoption of the algorithmic suggestions may have a significant impact on uptake and adherence to exercise therapy, ultimately improving patient physical function and reducing falls risk.
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Affiliation(s)
- Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Pamela Duncan
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alison M Chandler
- Qualitative and Patient Reported Outcomes Shared Resource, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Aylin A Aguilar
- Qualitative and Patient Reported Outcomes Shared Resource, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nancy Latham
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Storer
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Alexander
- Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christine M McDonough
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Arcolin I, Giardini M, Corna S, Sartorio F, Caligari M, Godi M. Construct validity, responsiveness and minimal important difference of the cumulated ambulation score in older adults with hip fracture in sub-acute rehabilitation facility. Clin Rehabil 2024:2692155241249351. [PMID: 38656174 DOI: 10.1177/02692155241249351] [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: 04/26/2024]
Abstract
OBJECTIVE To assess the construct validity, responsiveness and minimal important difference of the cumulated ambulation score in patients with hip fracture in sub-acute rehabilitation facility. DESIGN Observational, prospective, monocenter, cohort study. SETTING Rehabilitation Institute. PARTICIPANTS 456 older adults with hip fracture (≥65 years) admitted for inpatient rehabilitation. MAIN OUTCOME MEASURES Cumulated ambulation score, functional independence measure and functional ambulation category were collected at admission and discharge. Construct validity and responsiveness were assessed through hypothesis testing and minimal important difference was determined using the anchor-based method; floor and ceiling effects were also assessed. RESULTS The cumulated ambulation score showed strong correlations with the functional independence measure and functional ambulation category scores at both admission and discharge, satisfying all the hypotheses for construct validity. The effect size of cumulated ambulation score was 1.63. Changes in cumulated ambulation score had a moderate-to-strong correlation with changes of other instruments and were able to discriminate patients improved from those not-improved, and patients classified as independent ambulators from those dependent. A ceiling effect was found only at discharge. The estimated minimal important difference was 2 points. CONCLUSIONS The cumulated ambulation score showed high levels of construct validity and responsiveness according to the hypothesis testing. A two points improvement at the end of rehabilitation was found to be clinically important in people with hip fracture in the sub-acute phase. The ceiling effect found at discharge suggested the limitation of the scale in assessing people with a partially recovered autonomy in performing postural changes and gait.
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Affiliation(s)
- Ilaria Arcolin
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Marica Giardini
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Stefano Corna
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Francesco Sartorio
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
- Department of Scientific Research Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, Budapest, Hungary
| | - Marco Caligari
- Integrated Laboratory of Assistive Solutions and Translational Research (LISART), Istituti Clinici Scientifici Maugeri IRCCS, Institute of Pavia, Pavia, Italy
| | - Marco Godi
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
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Silişteanu SC, Antonescu E, Duică L, Totan M, Cucu AI, Costea AI. Lumbar Paravertebral Muscle Pain Management Using Kinesitherapy and Electrotherapeutic Modalities. Healthcare (Basel) 2024; 12:853. [PMID: 38667615 PMCID: PMC11050304 DOI: 10.3390/healthcare12080853] [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: 03/06/2024] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Low back pain is considered a public health problem internationally. Low back pain is a cause of disability that occurs in adolescents and causes negative effects in adults as well. The work environment and physical and psychosocial factors can influence the occurrence and evolution of low back pain. METHODS The purpose of this paper is to highlight the physiological and functional changes in young adults with painful conditions of the lumbar spine, after using exercise therapy. The study was of the longitudinal type and was carried out over a period 6 months in an outpatient setting. The rehabilitation treatment included electrotherapeutic modalities and kinesitherapy. RESULTS The results obtained when evaluating each parameter, for all moments, show statistically significant values in both groups. The results obtained regarding the relationship between the therapeutic modalities specific to rehabilitation medicine and low back pain are consistent with those reported in studies. CONCLUSIONS Depending on the clinical-functional status of each patient, kinesitherapy can accelerate the heart rate and increase the blood pressure and oxygen saturation of the arterial blood, values that can later return to their initial levels, especially through training.
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Affiliation(s)
- Sînziana Călina Silişteanu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania; (S.C.S.); (A.I.C.); (A.I.C.)
| | - Elisabeta Antonescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania;
| | - Lavinia Duică
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania;
| | - Maria Totan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania;
| | - Andrei Ionuţ Cucu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania; (S.C.S.); (A.I.C.); (A.I.C.)
| | - Andrei Ioan Costea
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania; (S.C.S.); (A.I.C.); (A.I.C.)
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11
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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.
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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
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12
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Ishigaki T, Kubo H, Yoshida K, Shimizu N, Ogawa T. Validity and reliability of the 2-min step test in individuals with stroke and lower-limb musculoskeletal disorders. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1384369. [PMID: 38690193 PMCID: PMC11058829 DOI: 10.3389/fresc.2024.1384369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024]
Abstract
Introduction We investigated the reliability and validity of the 2-min step test (2MST) for assessing the exercise endurance of individuals with stroke and lower-limb musculoskeletal disorders. Participants and methods The participants were 39 individuals with stroke and 42 with lower-limb musculoskeletal disorders (mainly hip fractures) from the convalescent rehabilitation wards of four hospitals. The concurrent validity and congruence between the 2MST and the 6-min walk test (6MWT) and construct validity by hypotheses testing, including mobility and lower limb muscle strength, were also confirmed. A subset of participants (stroke-group, n = 15; musculoskeletal-group, n = 19) underwent a retest 2MST for our evaluation of relative and absolute reliability using the intraclass correlation coefficient (ICC1,1) and Bland-Altman plot. Results Both groups showed a moderate correlation between the 2MST and 6MWT (ρ = 0.55-0.60), but the congruence was not sufficient. The 6MWT was correlated with mobility in both groups and with muscle strength in the stroke group, whereas the 2MST did not show a significant correlation with mobility. The relative reliability was excellent in both groups (ICC1,1 > 0.9). In terms of absolute reliability, the width of the limit of agreement was 18.8% for the stroke group and 15.4% for the musculoskeletal group, relative to their respective sample means of 2MST. A fixed bias was identified in the stroke group, in which step counts increased by 6.5 steps upon retesting. Discussion Our analyses revealed that the 2MST is a valid and reliable tool for assessing the exercise endurance of individuals with stroke or lower-limb musculoskeletal disorders. However, it is necessary to validate the absolute reliability observed herein by using a larger sample size. In addition, when assessing the exercise endurance of individuals with stroke, it may be necessary to consider the potential bias of an increased step count during retesting.
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Affiliation(s)
- Tomoya Ishigaki
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Aichi, Japan
| | - Hiroki Kubo
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Hyogo, Japan
| | - Keishi Yoshida
- Department of Rehabilitation, Senri-Chuo Hospital, Osaka, Japan
| | - Natsuki Shimizu
- Department of Physical Therapy, Faculty of Health and Medical Care, Saitama Medical University, Saitama, Japan
| | - Tatsuya Ogawa
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
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13
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Seijas V, Maritz R, Fernandes P, Bernard RM, Lugo LH, Bickenbach J, Sabariego C. Rehabilitation delivery models to foster healthy ageing-a scoping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1307536. [PMID: 38660395 PMCID: PMC11041397 DOI: 10.3389/fresc.2024.1307536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
Introduction Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing. Methods We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models. Results Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent. Conclusions Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.
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Affiliation(s)
- Vanessa Seijas
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Roxanne Maritz
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Patricia Fernandes
- Department of Clinical Medicine, Federal University of Parana, Parana, Brazil
| | | | - Luz Helena Lugo
- Rehabilitation in Health Research Group, University of Antioquia, Medellin, Colombia
| | - Jerome Bickenbach
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Carla Sabariego
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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14
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Wenger LE, Barrett DR, Rhon DI, Young JL. Evaluating and Characterizing the Scope of Care for Interventions Labeled as Manual Therapy in Low Back Pain Trials: A Scoping Review. Phys Ther 2024; 104:pzad178. [PMID: 38157290 DOI: 10.1093/ptj/pzad178] [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: 02/16/2023] [Revised: 07/07/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The purpose of this scoping review was to evaluate and characterize the scope of care for low back pain that falls under the specific label of manual therapy. METHODS PubMed database, Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and SPORTDiscus were searched from journal inception through May 2022 for randomized controlled trials that investigated the treatment of low back pain using manual therapy. Terminology used to define manual therapy was extracted and categorized by using only the words included in the description of the intervention. An expert consultation phase was undertaken to gather feedback. RESULTS One hundred seventy-six trials met final inclusion criteria, and 169 unique terms labeled as manual therapy for the treatment of low back pain were found. The most frequent terms were mobilization (29.0%), manipulation (16.0%), and thrust (6.4%). Eight percent of trials did not define or specify what type of manual therapy was used in the study. After removing duplicates, 169 unique terms emerged within 18 categories. CONCLUSIONS Manual therapy intervention labels used in low back pain trials are highly variable. With such variation, the heterogeneity of the intervention in trials is likely large, and the likelihood that different trials are comparing the same interventions is low. Researchers should consider being more judicious with the use of the term manual therapy and provide greater detail in titles, methods, and supplementary appendices in order to improve clarity, clinical applicability, and usefulness of future research. IMPACT The ability to interpret and apply findings from manual therapy-related research for low back pain is challenging due to the heterogeneity of interventions under this umbrella term. A clear use of terminology and description of interventions by researchers will allow for improved understanding for the role of manual therapy in managing back pain.
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Affiliation(s)
- Laura E Wenger
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Dustin R Barrett
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | - Daniel I Rhon
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA
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15
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Vella SP, Machado GC. Clinimetrics: The Cumulated Ambulation Score. J Physiother 2024; 70:154. [PMID: 38472056 DOI: 10.1016/j.jphys.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Simon P Vella
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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16
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Kaizu Y, Miyata K, Arii H. Post-hip-fracture knee pain in older adults prolongs their hospital stays: A retrospective analysis using propensity score matching. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2080. [PMID: 38426246 DOI: 10.1002/pri.2080] [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: 11/10/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND PURPOSE Post-hip-fracture knee pain (PHFKP) occurs in ∼28%-37% of patients and contributes to a prolonged length of hospital stay (LOS). Analyses of LOS prolongation due to PHFKP have been limited to univariate analyses that do not consider important confounding factors. After adjusting for important confounding factors, we investigated whether the presence or absence of PHFKP makes a difference in LOS in patients with hip fractures. METHODS We conducted a retrospective review of the medical records of patients who had undergone postoperative rehabilitation after surgery for a hip fracture. Demographic and clinical information, discharge parameters, and PHFKP development information were collected from the medical records. Using propensity score matching, we performed a two-group comparison of LOS, the functional independence measure (FIM) motor score (FIMm), FIMm gain, and FIMm effectiveness in patients with and without PHFKP. Six variables were included in the calculation of propensity scores: age, sex, body mass index, fracture type, American Society of Anesthesiologists physical status, and independence in activities of daily living at discharge. One-way analysis of variance was used to examine the details of the relationships between LOS and (i) the time of PHFKP development and (ii) pain intensity. RESULTS We analyzed the cases of 261 patients, of whom 87 (33.3%) developed PHFKP. In propensity score matching, 80 patients were each matched to a patient in the PHFKP or non-PHFKP group. After propensity score matching, a between-group comparison revealed that the PHFKP group had a longer LOS (+11 days) than the non-PHFKP group, and there were no differences in FIMm gain or FIMm effectiveness. The timing of PHFKP development and pain intensity were not related to the LOS. DISCUSSION Even after adjusting for confounders, the development of PHFKP was found to prolong LOS. Clinicians should be aware of possible LOS prolongation in hip fracture patients with PHFKP.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Hospital, Takasaki, Gunma, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
| | - Hironori Arii
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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17
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Molina-Garcia P, Mora-Traverso M, Prieto-Moreno R, Díaz-Vásquez A, Antony B, Ariza-Vega P. Effectiveness and cost-effectiveness of telerehabilitation for musculoskeletal disorders: A systematic review and meta-analysis. Ann Phys Rehabil Med 2024; 67:101791. [PMID: 38128150 DOI: 10.1016/j.rehab.2023.101791] [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: 01/23/2023] [Revised: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Internet-based telerehabilitation could be a valuable option for the treatment of musculoskeletal disorders, with the advantage of providing rehabilitation from anywhere. However, there is no solid and updated evidence demonstrating its effectiveness on relevant clinical and cost outcomes. OBJECTIVE This systematic review aims to determine the clinical and cost-effectiveness of internet-based telerehabilitation during the recovery of musculoskeletal disorders. METHODS Medline, Web of Science, Scopus and Cochrane databases were systematically searched from inception to June 2023. Trials investigating the effects of internet-based telerehabilitation in any musculoskeletal disorder were selected. Nonoriginal articles and grey literature were excluded. Two independent reviewers conducted the study selection and data extraction. Random effect meta-analyses (standardized mean difference) and further sensitivity analyses were performed. RESULTS We selected 37 clinical trials (33 randomized and 4 non-randomized) and 5 health economics studies, which included a total of 4,288 participants. Telerehabilitation was more favourable than control treatments in improving all studied clinical outcomes, although the effectiveness varied depending on the type of musculoskeletal disorder. The standard mean differences (SMD) ranged from 0.24 to 0.91. For physical function, the primary outcome, superior effectiveness was found only in people with hip fractures (SMD, 0.87; 95 % CI, 0.34 to 1.41). The effects for joint replacement, osteoarthritis, and spine pain were similar to those of control treatments. However, the favourable outcomes for telerehabilitation became insignificant when compared specifically to face-to-face rehabilitation. Some results displayed publication bias and a lack of robustness, necessitating cautious interpretation. In terms of health economics studies, telerehabilitation was 89.55$ (95 % CI 4.6 to 174.5) cheaper per individual than conventional treatments. CONCLUSIONS Telerehabilitation should be considered in the recovery process of musculoskeletal disorders when optimal face-to-face rehabilitation is not feasible. Moreover, telerehabilitation reduces costs and time. PROSPERO NUMBER CRD42022322425.
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Affiliation(s)
| | - Marta Mora-Traverso
- 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
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain; Biomedical Research Unit, Torrecárdenas University Hospital, 04009 Almería, Spain; Department of Education, Faculty of Education Sciences, SPORT Research Group (CTS-1024) and CERNEP Research Center, University of Almería, Almería, Spain
| | | | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania 7000, Australia
| | - Patrocinio Ariza-Vega
- Instituto de Investigación Biosanitaria ibs.GRANDA, 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
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18
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Wang JZ, Ren B, An JL, Zhou XZ. Ipsilateral femoral neck and intertrochanteric fracture caused by low energy injury: A rare case report. Asian J Surg 2024; 47:679-680. [PMID: 37865552 DOI: 10.1016/j.asjsur.2023.09.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023] Open
Affiliation(s)
- Jian-Zhong Wang
- Affiliated Hospital of Hebei University, Baoding, Hebei Province, China
| | - Bao Ren
- Affiliated Hospital of Hebei University, Baoding, Hebei Province, China
| | - Ji-Long An
- Affiliated Hospital of Hebei University, Baoding, Hebei Province, China
| | - Xiao-Zhe Zhou
- Affiliated Hospital of Hebei University, Baoding, Hebei Province, China.
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Bynum JPW, Montoya A, Lawton EJ, Gibbons JB, Banerjee M, Meddings J, Norton EC. Accountable Care Organization Attribution and Post-Acute Skilled Nursing Facility Outcomes for People Living With Dementia. J Am Med Dir Assoc 2024; 25:53-57.e2. [PMID: 38081322 DOI: 10.1016/j.jamda.2023.10.031] [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: 07/10/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES Under the Accountable Care Organization (ACO) model, reductions in healthcare spending have been achieved by targeting post-acute care, particularly in skilled nursing facilities (SNFs). People with Alzheimer disease and related dementias (ADRD) are frequently discharged to SNF for post-acute care and may be at particular risk for unintended consequences of SNF cost reduction efforts. We examined SNF length of stay (LOS) and outcomes among ACO-attributed and non-ACO-attributed ADRD patients. DESIGN Observational serial cross-sectional study. SETTING AND PARTICIPANTS Twenty percent national random sample of fee-for-service Medicare beneficiaries (2013-2017) to identify beneficiaries with a diagnosis of ADRD and with a hospitalization followed by SNF admission (n = 263,676). METHODS Our primary covariate of interest was ACO (n = 66,842) and non-ACO (n = 196,834) attribution. Hospital readmission and death were measured for 3 time periods (<30, 31-90, and 91-180 days) following hospital discharge. We used 2-stage least squares regression to predict LOS as a function of ACO attribution, and patient and facility characteristics. RESULTS ACO-attributed ADRD patients have shorter SNF LOS than their non-ACO counterparts (31.7 vs 32.8 days; P < .001). Hospital readmission rates for ACO vs non-ACO differed at ≤30 days (13.9% vs 14.6%; P < .001) but were similar at 31-90 days and 91-180 days. No significant difference was observed in mortality post-hospital discharge for ACO vs non-ACO at ≤30 days; however, slightly higher mortality was observed at 31-90 days (8.4% vs 8.8%; P = .002) and 91-180 days (7.6% vs 7.9%; P = .011). No significant association was found between LOS and readmission, with small effects on mortality favoring ACOs in fully adjusted models. CONCLUSIONS AND IMPLICATIONS Being an ACO-attributed patient is associated with shorter SNF LOS but is not associated with changes in readmission or mortality after controlling for other factors. Policies that shorten LOS may not have adverse effects on outcomes for people living with dementia.
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Affiliation(s)
- Julie P W Bynum
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Ana Montoya
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Emily J Lawton
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jason B Gibbons
- Department of Health Policy and Managing, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mousumi Banerjee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jennifer Meddings
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, MI, USA; Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Edward C Norton
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
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20
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Miyata K, Igarashi T, Tamura S, Iizuka T, Otani T, Usuda S. Rasch analysis of the Short Physical Performance Battery in older inpatients with heart failure. Disabil Rehabil 2024; 46:401-406. [PMID: 36597920 DOI: 10.1080/09638288.2022.2162610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The physical function of older patients with heart failure (HF) is likely to decline, and the Short Physical Performance Battery (SPPB) is widely used for its evaluation. No study has analyzed the SPPB by using Rasch model in these patients. The aim of this study was to examine the structural validity and item response of the SPPB in older inpatients with HF. MATERIALS AND METHODS In this multicenter cross-sectional study, we investigated 106 older inpatients with HF. We evaluated the SPPB's rating scale structure, unidimensionality, and measurement accuracy (0 = poor performance to 4 = normal performance). RESULTS The SPPB rating scale fulfilled the category functioning criteria. All items fit the underlying scale construct. The SPPB demonstrated adequate reliability (person reliability = 0.81) and separated persons into four strata: those with very low, low, moderate, and high physical performance. Item-difficulty measures were -0.59 to 0.96 logits, and regarding the person ability-item difficulty matching for the SPPB, the item was somewhat easy (the mean of person ability = 0.89 logits; mean of item difficulty = 0.00). CONCLUSION The SPPB has strong measurement properties and is an appropriate scale for quantitatively evaluating physical function in older patients with HF.
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Affiliation(s)
- Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
| | - Tatsuya Igarashi
- Department of Rehabilitation, Numata Neurosurgery & Heart Disease Hospital, Gunma, Japan
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Gunma, Japan
| | - Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Gunma, Japan
| | - Takamitsu Iizuka
- Home-visit Nursing Station COCO-LO Maebashi, COCO-LO Co., Ltd., Gunma, Japan
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology, Gunma, Japan
| | - Shigeru Usuda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Gunma, Japan
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21
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Alito A, Fenga D, Portaro S, Leonardi G, Borzelli D, Sanzarello I, Calabrò RS, Milone D, Tisano A, Leonetti D. Early hip fracture surgery and rehabilitation. How to improve functional quality outcomes. A retrospective study. Folia Med (Plovdiv) 2023; 65:879-884. [PMID: 38351775 DOI: 10.3897/folmed.65.e99513] [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: 01/02/2023] [Accepted: 01/27/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Hip fractures are one of the major disability causes associated with a high morbidity and mortality rate. Early surgery and stable fixation could be associated with better pain control, possibly lower mortality rates, and early recovery of autonomy.
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22
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Prasad NK, Bajracharya R, Wijesinha M, Rathbun A, Orwig D, Magder L, Gruber-Baldini A, Mangione K, Craik RL, Magaziner J. Multicomponent Home-based Physical Therapy Versus Usual Care for Recovery After Hip Fracture. Arch Phys Med Rehabil 2023; 104:2011-2018. [PMID: 37610404 PMCID: PMC10840126 DOI: 10.1016/j.apmr.2023.05.001] [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: 12/14/2022] [Revised: 04/17/2023] [Accepted: 05/03/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE To quantify the effect of 2 home-based 16-week multi-component physical therapy interventions on functional recovery compared to usual care after hip fracture. DESIGN Cross-study comparison using participants from the Community Ambulation Project (CAP; a randomized controlled trial) were compared to the Baltimore Hip Studies-seventh cohort (BHS-7; an observational cohort study) at 3 different time points (CAP: 15, 31, 55 weeks; BHS-7: 8, 26, and 52 weeks). SETTING General community PARTICIPANTS: Combined convenience sample of hip-fracture patients 8-26 weeks post admission from a prospective cohort study and randomized controlled trial. (N=549) INTERVENTIONS: CAP participants were randomized to one of 2 interventions (PUSH: specific multi-component intervention; PULSE: non-specific multi-component intervention) after standard rehabilitation; BHS-7 participants received usual care. MAIN OUTCOME MEASURES Mean function (as measured by Short Physical Performance Battery (SPPB) and gait speed) was estimated in each cohort as quadratic functions of time using data from 3 post-fracture assessments in both studies (CAP: 15, 31, 55 weeks; BHS-7: 8, 26, and 52 weeks). RESULTS The harmonized samples included 101 PUSH, 100 PULSE, and 128 BHS-7 participants that had different demographic and clinical characteristics. Mean baseline SPPB scores (meters per second) were PUSH: 5.5 (SD=2.2), PULSE: 5.5 (SD=2.4), and BHS-7: 4.6 (SD=2.5); and mean gait speeds were 0.60 m/s (SD=0.20) for PUSH, 0.59 m/s (SD=0.17) for PULSE, and 0.46 m/s SD=(0.21) for BHS-7, respectively. Estimated between-group differences for SPPB improvement from 75 days to 1-year post admission were 0.7 (P=.04) in PUSH vs BHS-7; and 0.9 (P=.01) in PULSE vs BHS-7. Mean differences in change in gait speed were 0.08 (P=.002) for PUSH vs BHS-7; and 0.06 (P=.02) PULSE vs BHS-7 (P=.02). CONCLUSIONS Findings from this cross-study comparison that combined participants from 2 separate studies, with different designs and samples, suggest that home-based multi-component physical therapy programs were associated with greater functional improvement after hip fracture compared to usual care.
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Affiliation(s)
- Nikhil K Prasad
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Rashmita Bajracharya
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Marniker Wijesinha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Alan Rathbun
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Denise Orwig
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Laurence Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Kathleen Mangione
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, PA
| | - Rebecca L Craik
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, PA
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
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23
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Patil AR, Patil DS, Jagzape MV. Physiotherapy Rehabilitation in an Infected Non-union Shaft of Femur Repair Patient: A Case Report. Cureus 2023; 15:e50786. [PMID: 38239531 PMCID: PMC10795792 DOI: 10.7759/cureus.50786] [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: 07/21/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
While definitions may vary, infected non-union is generally described as a condition where a fracture fails to heal due to infection, typically persisting for a duration of six to eight months. Infected non-unions occurring in the shaft of the femur are infrequent and typically result from severe open fractures with deep fragmentation and segmental bone loss or following internal fixation of a severely fragmented closed fracture. Some associated factors contributing to non-union include positive bacterial cultures from deep wounds, histological evidence of bone necrosis, exposed bone without a vascularized periosteum for more than six weeks, and the presence of purulent discharge. Osteomyelitis, stiffness in adjacent joints, smoking, loss of soft tissue resulting in multiple sinus tracts, osteopenia, and deformities leading to limb length discrepancies are all complicating factors that impact treatment and prognosis. Infected non-union of bones, although rare, presents a significant challenge for physiotherapists striving to provide appropriate treatment. The level of stabilization at the fracture site is the most critical factor influencing whether a fracture progresses to non-union or successfully heals. Infection, such as osteomyelitis, also contributes to the development of non-union. Additionally, issues like tissue atrophy, joint stiffness, and muscle contractures can further complicate the non-union of a bone, posing a considerable challenge for physical therapists in helping patients achieve their recovery goals. Top of form this case report reviews the case of a 35-year-old male who was reported to Acharya Vinoba Bhave Rural Hospital (AVBRH) with an infective non-union of the shaft of the femur fracture after two months of repair. This case report highlights the recovery of patients from post-operative complications like non-union, stiffness, and reduced range of motion through tailored physiotherapy rehabilitation and improved quality of life.
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Affiliation(s)
- Anushri R Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepali S Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Medhavi V Jagzape
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zilmer CK, Kristensen MT, Magnusson SP, Bährentz IB, Jensen TG, Zoffmann SØ, Palm H, Bieler T. Intensified acute in-hospital physiotherapy for patients after hip fracture surgery: a pragmatic, randomized, controlled feasibility trial. Disabil Rehabil 2023:1-10. [PMID: 38037849 DOI: 10.1080/09638288.2023.2288672] [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: 05/30/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Intensified acute in-hospital physiotherapy (IP) after hip fracture (HF) may enhance patient's ability to regain basic mobility at discharge. The primary objective was to assess the feasibility of IP. Secondary to estimate the effect of IP on regained basic mobility at discharge. MATERIALS AND METHODS In a pragmatic, randomized, unblinded feasibility trial, 60 patients (mean age 79 years, 41 women) with HF and an independent pre-fracture basic mobility level were randomized (2:1) to IP with two daily sessions on weekdays focusing on functional training and weight-bearing activities (n = 40) versus usual care (UC) physiotherapy once daily (n = 20). Feasibility outcomes included physiotherapy completion rates, reasons for non-successful completion, and adverse events. The primary effect outcome was recovery of basic mobility (Cumulated Ambulation Score (CAS)). RESULTS Eighty-two percent of the sessions in the IP group were successfully- or partially completed versus 94% of the sessions in the UC group. No adverse events occurred. The main reason for not completing physiotherapy was fatigue. At discharge (median 7 days), 50% in the IP group had regained their pre-fracture basic mobility level (CAS = 6) versus 16% in the UC group; odds ratio = 5.33, 95%CI [1.3;21.5]. CONCLUSIONS IP seems feasible for patients after HF surgery, and it may enhance recovery. Fatigue was the primary obstacle to completing IP.
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Affiliation(s)
- Camilla Kampp Zilmer
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Orthopedic Surgery M, Institute of Sports Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Inger Birgitte Bährentz
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thomas Giver Jensen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Signe Østergaard Zoffmann
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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25
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Kamijikkoku S, Yoshimura Y. Concurrent Negative Impact of Undernutrition and Heart Failure on Functional and Cognitive Recovery in Hip Fracture Patients. Nutrients 2023; 15:4800. [PMID: 38004194 PMCID: PMC10674784 DOI: 10.3390/nu15224800] [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: 09/28/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Evidence on the effects of frailty, undernutrition, and heart failure (HF) on patients with hip fractures is scarce. This retrospective cohort study aimed to examine the effects of undernutrition and HF on outcomes in patients who underwent convalescent rehabilitation after hip fracture. Undernutrition was defined as body mass index (BMI) < 20.0 (Low BMI). Heart failure (HF) was defined as a B-type natriuretic peptide (BNP) > 100 (High BNP). The study outcomes included the Functional Independence Measure motor domain (FIM-motor) and cognitive domain (FIM-cognition) at discharge. To consider the effects of low BMI, high BNP, and the simultaneous presence of both ("low BMI and high BNP"), we used multivariate linear regression analyses to examine whether these were associated with the outcomes. A total of 110 (mean age 87.4 years, 24.8% male) were analyzed. As a result, low BMI (β = -0.088, p = 0.027) and high BNP (β = -0.053, p = 0.015), each alone, were significantly associated with the FIM motor at discharge, whereas the simultaneous presence of "low BMI and high BNP" was significantly associated with the FIM motor at discharge, while the strength of the association was greater than each association alone (β = -0.152, p = 0.010). Further, the simultaneous presence of "low BMI and high BNP" was significantly associated with FIM cognition at discharge (β = -0.109, p = 0.014). Comprehensive multidisciplinary management is needed, including preoperative or early postoperative nutritional support and rehabilitation, followed by rehabilitation nutrition care management, in patients with hip fracture.
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Affiliation(s)
- Shuichi Kamijikkoku
- Department of Cardiology Medicine, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan;
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
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26
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Milton-Cole R, O'Connell MDL, Sheehan KJ, Ayis S. The role of depression in the association between physiotherapy frequency and duration and outcomes after hip fracture surgery: secondary analysis of the physiotherapy hip fracture sprint audit. Eur Geriatr Med 2023; 14:999-1010. [PMID: 37329488 PMCID: PMC10587201 DOI: 10.1007/s41999-023-00808-8] [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: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE It is not known whether the association between the frequency and duration of physiotherapy and patient outcomes varies for those with and without depression. This study aims to evaluate whether the associations between the frequency and duration of physiotherapy after hip fracture surgery and discharge home, surviving at 30 days post-admission, and being readmitted 30 days post discharge vary by depression diagnosis. METHODS Data were from 5005 adults aged 60 and over included in the UK Physiotherapy Hip Fracture Sprint Audit who had undergone surgery for a nonpathological first hip fracture. Logistic regression models were used to estimate the unadjusted and adjusted odds ratios and their 95% confidence intervals for the associations between physiotherapy frequency and duration and outcomes. RESULTS Physiotherapy frequency and duration were comparable between patients with and without depression (42.1% and 44.6%). The average adjusted odds for a 30-min increase in physiotherapy duration for those with and without depression for discharge home were 1.05 (95% CI 0.85-1.29) vs 1.16 (95% CI 1.05-1.28, interaction p = 0.36), for 30-day survival were 1.26 (95% CI 1.06-1.50) vs 1.11 (95% CI 1.05-1.17, interaction p = 0.45) and for readmission were 0.89 (95% CI 0.81-0.98) vs 0.97 (95% CI 0.93-1.00, interaction p = 0.09). None of the interaction tests reached formal significance, but the readmission models were close (p = 0.09). CONCLUSION Results suggest physiotherapy duration may be negatively associated with readmission in those with depression but not those without depression, while no clear difference in the other outcomes was noted.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
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27
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Liu H, Gao E, Zhong Z, Wu W, Zhang Z. Clinical application of modified hip joint lateral position in femoral neck fracture. J Orthop Surg Res 2023; 18:698. [PMID: 37723505 PMCID: PMC10506282 DOI: 10.1186/s13018-023-04183-9] [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: 05/11/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND To show the femoral neck better in hip lateral view of X-ray, we design a modified hip lateral view and then investigate the value in femoral neck fractures. METHODS CT images of 10 normal hip joints for 3D reconstruction were selected, the Mimics Medical 21.0 was used, and rotating the proximal femur was to find the most suitable angle for showing the femoral neck well, designed the modified lateral view according to this angle. We collected 35 healthy cases and 35 femoral neck fractures as the normal and fracture group. And two groups were all taken hip anteroposterior view, cross-table lateral view and modified lateral view, which were analyzed by two radiologists to score the anatomical structures of the articular surface, femoral head, head neck junction, femoral neck, basal region and intertrochanteric region. Friedman test was used to analyze the score of femoral neck at different angles. T test and Wilcoxon signed-rank test were to compare inter-groups. RESULTS The modified lateral view was designed as follows: The subjects were supine, with the sagittal axis biased toward the healthy side at an angle of approximately 20° to the long axis of the examination table, the hip joint flexed at 45°, the lower extremity abducted at 40°, the centerline inclined 45° toward the head and the centerline aligned with the center of the groin. The modified lateral view showed the femoral head, head neck junction and femoral neck more clearly than the cross-table lateral view, but the cross-table lateral view showed the femoral neck basal and intertrochanteric region better. In addition, the time of taking the modified lateral view was significantly less than the cross-table lateral view (normal group: 0.789 min ± 0.223 vs 0.623 min ± 0.207, P < 0.001; fracture group: 1.131 min ± 0.362 vs 0.946 min ± 0.390, P < 0.001). CONCLUSIONS The modified lateral view can obtain a standard sagittal image of femoral neck, which can show the dislocation and angulation of the sagittal femoral neck fracture clearly, and improve the accuracy of diagnosis. And it is more convenient and easier for patients to cooperate, which is worthy promoting and applying in clinical work.
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Affiliation(s)
- Haitian Liu
- Department of CT/MR, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China
| | - Enpeng Gao
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China
| | - Zhiwei Zhong
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China
| | - Wenjuan Wu
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China
| | - Zuzhuo Zhang
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, China.
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28
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Hua Y, Yuan Y, Wang X, Liu L, Zhu J, Li D, Tu P. Risk prediction models for postoperative delirium in elderly patients with hip fracture: a systematic review. Front Med (Lausanne) 2023; 10:1226473. [PMID: 37780558 PMCID: PMC10540206 DOI: 10.3389/fmed.2023.1226473] [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: 06/08/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives To systematically evaluate the risk prediction models for postoperative delirium in older adult hip fracture patients. Methods Risk prediction models for postoperative delirium in older adult hip fracture patients were collected from the Cochrane Library, PubMed, Web of Science, and Ovid via the internet, covering studies from the establishment of the databases to March 15, 2023. Two researchers independently screened the literature, extracted data, and used Stata 13.0 for meta-analysis of predictive factors and the Prediction Model Risk of Bias Assessment Tool (PROBAST) to evaluate the risk prediction models for postoperative delirium in older adult hip fracture patients, evaluated the predictive performance. Results This analysis included eight studies. Six studies used internal validation to assess the predictive models, while one combined both internal and external validation. The Area Under Curve (AUC) for the models ranged from 0.67 to 0.79. The most common predictors were preoperative dementia or dementia history (OR = 3.123, 95% CI 2.108-4.626, p < 0.001), American Society of Anesthesiologists (ASA) classification (OR = 2.343, 95% CI 1.146-4.789, p < 0.05), and age (OR = 1.615, 95% CI 1.387-1.880, p < 0.001). This meta-analysis shows that these were independent risk factors for postoperative delirium in older adult patients with hip fracture. Conclusion Research on the risk prediction models for postoperative delirium in older adult hip fracture patients is still in the developmental stage. The predictive performance of some of the established models achieve expectation and the applicable risk of all models is low, but there are also problems such as high risk of bias and lack of external validation. Medical professionals should select existing models and validate and optimize them with large samples from multiple centers according to their actual situation. It is more recommended to carry out a large sample of prospective studies to build prediction models. Systematic review registration The protocol for this systematic review was published in the International Prospective Register of Systematic Reviews (PROSPERO) under the registered number CRD42022365258.
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Affiliation(s)
- Yaqi Hua
- Department of Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- School of Nursing, Nanchang University, Nanchang, Jiangxi, China
| | - Yi Yuan
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Xin Wang
- School of Nursing, Nanchang University, Nanchang, Jiangxi, China
| | - Liping Liu
- School of Nursing, Nanchang University, Nanchang, Jiangxi, China
| | - Jianting Zhu
- School of Nursing, Nanchang University, Nanchang, Jiangxi, China
| | - Dongying Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ping Tu
- Department of Postanesthesia Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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29
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Almilaji O, Ayis S, Goubar A, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ. Frequency, duration, and type of physiotherapy in the week after hip fracture surgery - analysis of implications for discharge home, readmission, survival, and recovery of mobility. Physiotherapy 2023; 120:47-59. [PMID: 37369161 DOI: 10.1016/j.physio.2023.03.002] [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: 03/03/2022] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery. METHODS A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence. RESULTS Overall, 73% were female and 40% had high frailty risk. Patients who received ≥2 hours of physiotherapy (versus less) had 3% (95% Confidence Interval: 0-6%), 4% (2-6%), and 6% (1-11%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 3% (0-6%) lower adjusted probability of readmission. Recipients of exercise (versus mobilisation alone) had 6% (1-12%), 3% (0-7%), and 11% (3-18%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 6% (2-10%) lower adjusted probability of readmission. Recipients of 6-7 days physiotherapy (versus 0-2 days) had 8% (5-11%) higher adjusted probability of survival. For patients with dementia, improved probability of survival, discharge home, readmission and indoor mobility recovery were observed with greater physiotherapy access. CONCLUSION Greater access to physiotherapy was associated with a higher probability of positive outcomes. For every 100 patients, greater access could equate to an additional eight patients surviving to 30-days and six avoiding 30-day readmission. The findings suggest a potential benefit in terms of home discharge and outdoor mobility recovery. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Orouba Almilaji
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK; Department of Health Service Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - Aicha Goubar
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine University of Alberta,Canada
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health,University of Sydney, Australia
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Antony Johansen
- Cardiff Trauma Unit, University Hospital of Wales, Cardiff, UK
| | - Morten Tange Kristensen
- Department of Physical & Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Finbarr C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK; Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, UK & Southern Health NHS Foundation Trust, UK
| | - Euan Sadler
- Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK.
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Walsh M, Ferris H, Brent L, Ahern E, Coughlan T, Romero-Ortuno R. Development of a Frailty Index in the Irish Hip Fracture Database. Arch Orthop Trauma Surg 2023; 143:4447-4454. [PMID: 36210379 PMCID: PMC10293399 DOI: 10.1007/s00402-022-04644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/01/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In older people, hip fracture can lead to adverse outcomes. Frailty, capturing biological age and vulnerability to stressors, can indicate those at higher risk. We derived a frailty index (FI) in the Irish Hip Fracture Database (IHFD) and explored associations with prolonged length of hospital stay (LOS ≥ 30 days), delirium, inpatient mortality and new nursing home admission. We assessed whether the FI predicted those outcomes independently of age, sex and pre-operative American Society of Anaesthesiology (ASA) score. MATERIALS AND METHODS A 21-item FI was constructed with 17 dichotomous co-morbidities, three 4-level ordinal pre-morbid functional variables (difficulty with indoor mobility, outdoor mobility, and shopping) and nursing home provenance (yes/no). The FI was computed as the proportion of items present and divided into tertiles (low, medium, high risk). Independent associations between FI and outcomes were explored with logistic regression, from which we extracted adjusted Odds Ratios (aOR) and Areas Under the Curve (AUC). RESULTS From 2017 to 2020, the IHFD included 14,615 hip fracture admissions, mean (SD) age 80.4 (8.8), 68.9% women. Complete FI data were available for 12,502 (85.5%). By FI tertile (low to high risk), prolonged LOS proportions were 5.9%, 16.1% and 23.1%; delirium 5.5%, 13.5% and 17.6%; inpatient mortality 0.6%, 3.3% and 10.1%; and new nursing home admission 2.2%, 5.9% and 11.3%. All associations were statistically significant (p < 0.001) independently of age and sex. AUC analyses showed that the FI score, added to age, sex, and ASA score, significantly improved the prediction of delirium and new nursing home admission (p < 0.05), and especially prolonged LOS and inpatient mortality (p < 0.001). CONCLUSIONS A 21-item FI in the IHFD was a significant predictor of outcomes and added value to traditional risk markers. The utility of a routinely derived FI to more effectively direct limited orthogeriatric resources requires prospective investigation.
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Affiliation(s)
- Mary Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
| | - Helena Ferris
- Department of Public Health, Health Service Executive-South, Killarney, Ireland
| | - Louise Brent
- National Office of Clinical Audit (NOCA) and Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Emer Ahern
- Cork University Hospital (CUH) and University College Cork (UCC), Cork, Ireland
| | - Tara Coughlan
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin (TCD), Dublin, Ireland
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin (TCD), Dublin, Ireland.
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Ben Natan M, Masarwa R, Yonai Y, Finkel B, Berkovich Y. Mortality, Survival, and Readmissions During a 12-Month Follow-Up After Hip Fracture: Inpatient Rehabilitation Versus Home Rehabilitation. Rehabil Nurs 2023; 48:140-144. [PMID: 37417864 DOI: 10.1097/rnj.0000000000000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
PURPOSE This study compared readmissions, survival, and mortality during a 12-month follow-up period of inpatient rehabilitation and home rehabilitation for older persons who had experienced a hip fracture. METHODS This work was retrospective cohort research. Between January 1 and December 30, 2019, the medical records of 280 elderly patients who were admitted to a hospital with a hip fracture were analyzed. Of these patients, 74.3% received inpatient rehabilitation, whereas 25.7% received home rehabilitation. RESULTS In terms of readmissions and death, there were no appreciable differences between the inpatient rehabilitation and home rehabilitation groups. The patients in the inpatient rehabilitation group were older; more likely to need assistance with activities of daily living; and were taking, on average, more prescription drugs on a daily basis than those in the home rehabilitation group. CONCLUSIONS AND CLINICAL RELEVANCE In conclusion, as better outcomes were expected for the home rehabilitation group, which on average included less complicated patients, our findings suggest that the home rehabilitation pathway may not be a good alternative to the inpatient rehabilitation pathway.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Rawan Masarwa
- Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaniv Yonai
- Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Binyamin Finkel
- Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel
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Skouras AZ, Antonakis-Karamintzas D, Tsolakis C, Tsantes AE, Kourlaba G, Zafeiris I, Soucacos F, Papagiannis G, Triantafyllou A, Houhoula D, Savvidou O, Koulouvaris P. Pre- and Postoperative Exercise Effectiveness in Mobility, Hemostatic Balance, and Prognostic Biomarkers in Hip Fracture Patients: A Study Protocol for a Randomized Controlled Trial. Biomedicines 2023; 11:biomedicines11051263. [PMID: 37238934 DOI: 10.3390/biomedicines11051263] [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: 03/15/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Hip fractures are a major health concern, particularly for older adults, as they can reduce life quality, mobility loss, and even death. Current evidence reveals that early intervention is recommended for endurance in patients with hip fractures. To our knowledge, preoperative exercise intervention in patients with hip fractures remains poorly researched, and no study has yet applied aerobic exercise preoperatively. This study aims to investigate the short-term benefits of a supervised preoperative aerobic moderate-intensity interval training (MIIT) program and the added effect of an 8-week postoperative MIIT aerobic exercise program with a portable upper extremity cycle ergometer. The work-to-recovery ratio will be 1-to-1, consisting of 120 s for each bout and four and eight rounds for the pre- and postoperative programs, respectively. The preoperative program will be delivered twice a day. A parallel group, single-blinded, randomized controlled trial (RCT) was planned to be conducted with 58 patients each in the intervention and control groups. This study has two primary purposes. First, to study the effect of a preoperative aerobic exercise program with a portable upper extremity cycle ergometer on immediate postoperative mobility. Second, to investigate the additional effect of an 8-week postoperative aerobic exercise program with a portable upper extremity cycle ergometer on the walking distance at eight weeks after surgery. This study also has several secondary objectives, such as ameliorating surgical and keeping hemostatic balance throughout exercise. This study may expand our knowledge of preoperative exercise effectiveness in hip fracture patients and enhance the current literature about early intervention benefits.
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Affiliation(s)
- Apostolos Z Skouras
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitrios Antonakis-Karamintzas
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Charilaos Tsolakis
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Sports Performance Laboratory, School of Physical Education & Sports Science, National and Kapodistrian University of Athens, 17237 Athens, Greece
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgia Kourlaba
- Faculty of Health, Department of Nursing, University of Peloponnese, 23100 Sparta, Greece
| | - Ioannis Zafeiris
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Fotini Soucacos
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgios Papagiannis
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece
| | - Athanasios Triantafyllou
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece
| | - Dimitra Houhoula
- Department of Food Science and Technology, University of West Attica, 12244 Egaleo, Greece
| | - Olga Savvidou
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panagiotis Koulouvaris
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Shen Y, Liu W, Zhu Z, Liu S, Cao Y, Yan L, Chen L. Application of a preoperative pain management mode based on instant messaging software in elderly hip fracture patients: a randomized controlled trial. BMC Geriatr 2023; 23:186. [PMID: 36991402 PMCID: PMC10061705 DOI: 10.1186/s12877-023-03905-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Preoperative analgesia of hip fracture in elderly patients is important, but it is also lacking. In particular, nerve block was not provided in time. In order to provide more effective analgesia, we designed a multimodal pain management mode based on instant messaging software.
Methods
From May to September 2022, a total of 100 patients with unilateral hip fracture aged over 65 were randomly divided into the test group and the control group. Finally, 44 patients in each group completed the result analysis. A new pain management mode was used in the test group. This mode focuses on the full information exchange between medical personnel in different departments, early fascia iliaca compartment block (FICB), and closed-loop pain management. Outcomes include the time when FICB is completed for the first time; The number of cases of FICB completed by emergency doctors; Patients' pain score, pain duration.
Results
The time for patients in the test group to complete FICB for the first time was 3.0 [1.925–3.475] h, which was less than the time for patients in the control group (4.0 [3.300–5.275] h). The difference was statistically significant (P < 0.001). Compared with 16 patients in the control group, 24 patients in the test group completed FICB by emergency doctors, and there was no statistical difference between the two groups (P = 0.087). The test group was superior to the control group in the highest NRS score (4.00 [3.00–4.00] vs 5.00 [4.00–5.75]), the duration of the highest NRS score (20.00 [20.00–25.00] mins vs 40.00 [30.00–48.75] mins), and the NRS > 3 time (35.00 [20.00–45.00] mins vs 72.50 [60.00–45.00] mins). The analgesic satisfaction of patients in the test group (5.00 [4.00–5.00]) was also significantly higher than that of the control group (3.00 [3.00–4.00]). The above four indexes were different between the two groups (P < 0.001).
Conclusions
Using instant messaging software, the new model of pain management can enable patients to receive FICB as soon as possible and improve the timeliness and effectiveness of analgesia.
Trial registration
Chinese Clinical Registry Center, ChiCTR2200059013, 23/04/2022.
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Zheng C, Liu F, Zheng Y, Chen P, Zhou M, Zhang H. Psychometric properties of the Chinese version of the self-care scale for older adults undergoing hip fracture surgery: A translation and validation study. Front Public Health 2023; 11:1119630. [PMID: 37006555 PMCID: PMC10050582 DOI: 10.3389/fpubh.2023.1119630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectiveThe purpose of this study was to translate and verify the reliability and validity of the Chinese version of the self-care scale for older adults undergoing hip fracture surgery.MethodsA total of 502 older adult/adults patients after hip fracture surgery were recruited from Liaoning, Shanxi, and Beijing, China. The reliability of the Chinese version of the scale was measured by internal consistency, split-half reliability, and retest reliability, and the validity was evaluated by the content validity index and structure validity index.ResultsThe Chinese version of the HFS-SC scale had a Cronbach's alpha coefficient of 0.848, and the Cronbach's alpha coefficients for the five dimensions ranged from 0.719 to 0.780. The split-half reliability of the scale was 0.739, and the retest reliability was 0.759. The content validity index (S-CVI) was 0.932. The five-factor structure, supported by the eigenvalues, total variance explained, and the scree plot accounted for 66.666% of the total variance. In confirmatory factor analysis, the model fit results were as follows, X2/df = 1.847, GFI = 0.914, AGFI = 0.878, PGFI = 0.640, IFI = 0.932, TLI = 0.912, CFI = 0.931, RMSEA = 0.058, PNFI = 0.679. The indicators of the model's fit were within reasonable bounds.ConclusionThe Chinese version of the self-care scale for older adults undergoing hip fracture surgery has suitable reliability and validity. The scale can be used to assess the level of older adult/adults self-care in China following hip replacement surgery and serves as a useful benchmark for identifying potential intervention targets to raise the level of older adult/adults self-care following hip replacement surgery.
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Affiliation(s)
- Chen Zheng
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - FangLin Liu
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Yan Zheng
- Operating Room of People's Hospital, Xinzhou, Shanxi, China
| | - Ping Chen
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - MingYue Zhou
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Huijun Zhang
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
- *Correspondence: Huijun Zhang
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Rehabilitation after Hip Fracture Surgery: A Survey on Italian Physiotherapists’ Knowledge and Adherence to Evidence-Based Practice. Healthcare (Basel) 2023; 11:healthcare11060799. [PMID: 36981456 PMCID: PMC10048225 DOI: 10.3390/healthcare11060799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
The average life expectancy of the Italian population has increased over the last decades, with a consequent increase in the demand for healthcare. Rehabilitation after hip fracture surgery is essential for autonomy, recovery, and reintegration into the social context. The aim of this study was to determine the level of knowledge and adherence to the recent treatment recommendations of the Italian physiotherapists. A web-based survey, composed of 21 items, was conducted and the frequencies and percentages of the responses were analyzed to evaluate if there was an integration and adherence to the recommendations of greater than 70%, with respect to the desired response. A total of 392 responses were collected and analyzed. Recommendations regarding the multidisciplinary approach, early mobilization, and progressive muscle strength training, achieved the desired value in the inpatient setting. Intensive rehabilitation and full weight bearing did not reach the threshold values. The results of this survey show a partial integration of the recommendations for rehabilitation after hip fracture surgery by Italian physiotherapists. Adherence seems to be better in the inpatient setting and with physiotherapists with higher levels of education.
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Walsh ME, Cunningham C, Brent L, Savin B, Fitzgerald M, Blake C. Long-term outcome collection after hip fracture in Ireland: a systematic review of traditional and grey literature. Osteoporos Int 2023:10.1007/s00198-023-06713-x. [PMID: 36869882 DOI: 10.1007/s00198-023-06713-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
UNLABELLED This review aimed to describe the methods and results from recent Irish research about post-acute hip fracture outcomes. Meta-analyses estimate the 30-day and 1-year mortality rate at 5% and 24% respectively. There is a need for standardised recommendations about which data should be recorded to aid national and international comparisons. PURPOSE Over 3700 older adults experience hip fracture in Ireland annually. The Irish Hip Fracture Database national audit records acute hospital data but lacks longer-term outcomes. This systematic review aimed to summarise and appraise recent Irish studies that collected long-term hip fracture outcomes and to generate pooled estimates where appropriate. METHODS Electronic databases and grey literature were searched in April 2022 for articles, abstracts, and theses published from 2005 to 2022. Eligible studies were appraised by two authors and outcome collection details summarised. Meta-analyses of studies with common outcomes were conducted where the sample was generalisable to the broad hip fracture population. RESULTS In total, 84 studies were identified from 20 clinical sites. Outcomes commonly recorded were mortality (n = 48 studies; 57%), function (n = 24; 29%), residence (n = 20; 24%), bone-related outcomes (n = 20; 24%), and mobility (n = 17; 20%). One year post-fracture was the most frequent time point, and patient telephone contact was the most common collection method used. Most studies did not report follow-up rates. Two meta-analyses were performed. The pooled estimate for one-year mortality was 24.2% (95% CI = 19.1-29.8%, I2 = 93.8%, n = 12 studies, n = 4220 patients), and for 30-day mortality was 4.7% (95% CI = 3.6-5.9%, I2 = 31.3%, n = 7 studies, n = 2092 patients). Reports of non-mortality outcomes were deemed inappropriate for meta-analysis. CONCLUSION Hip fracture long-term outcomes collected in Irish research are broadly in line with international recommendations. Heterogeneity of measures and poor reporting of methods and findings limits collation of results. Recommendations for standard outcome definitions nationally are warranted. Further research should explore the feasibility of recording long-term outcomes during routine hip fracture care in Ireland to enhance national audit.
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Affiliation(s)
- Mary E Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Louise Brent
- National Office of Clinical Audit, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | | | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
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Geriatric rehabilitation care after hip fracture. Eur Geriatr Med 2023; 14:295-305. [PMID: 36788193 PMCID: PMC10113343 DOI: 10.1007/s41999-023-00755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE After acute hospital admission, patients with a hip fracture are frequently discharged to skilled nursing homes providing geriatric rehabilitation (GR). There are few evidence-based studies regarding specific treatment times and assessments during GR. This study aims to provide a description of care for hip fracture patients during GR in the Netherlands. METHODS Descriptive study analyzing the care pathways from GR facilities, regarding healthcare professionals involved, allocated treatment time per profession, total length of rehabilitation stay, and assessment instruments. Based on the reimbursement algorithm (diagnostic treatment combination = DBCs), of 25 patients, the registered actual treatment time per profession was calculated. RESULTS The care pathways pivoted on three groups of health care professionals: medical team (MT), physiotherapy (PT), and occupational therapy (OT). There was some discrepancy between the allocated time in the care pathways and the calculated mean actual treatment time from the DBCs. First week: MT 120-180 min, DBC 120 (SD: 59) minutes; PT 120-230 min, DBC 129 (SD: 58) minutes; and OT 65-165 min, DBC 93 (SD: 61) minutes. From week two onwards, MT 15-36 min, DBC 49 (SD: 29) minutes; PT 74-179 min, DBC 125 (SD: 50) minutes; and OT 25-60 min, DBC 47 (SD: 44) minutes. Dieticians, psychologists, and social workers were sporadically mentioned. There was heterogeneity in the assessment and screening tools. CONCLUSIONS It is difficult to define current standard care in GR after hip fracture in the Netherlands due to the diversity in care pathways and large practice variation. This is a problem in conducting randomized effectiveness research with care provided as control. TRIAL REGISTER AND DATE OF REGISTRATION NL7491 04-02-2019.
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Howell DF, Malmgren Fänge A, Rogmark C, Ekvall Hansson E. Rehabilitation Outcomes Following Hip Fracture of Home-Based Exercise Interventions Using a Wearable Device-A Randomized Controlled Pilot and Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3107. [PMID: 36833801 PMCID: PMC9967499 DOI: 10.3390/ijerph20043107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Although hip fractures are common and severe, there is insufficient evidence concerning which type of rehabilitation is most beneficial. The primary aim of this three-armed pilot study was to investigate any difference in outcome after hip fractures between and within groups in terms of balance, everyday activities, and health-related quality of life (HRQoL) following different home rehabilitation interventions. Further aims were to study feasibility and to suggest, if necessary, adjustments to the protocol for a future full randomized controlled trial (RCT). In total, 32 persons were included in this study. The intervention groups underwent the HIFE program with or without an inertial measurement unit, while the control group underwent standard rehabilitation. Within- and between-groups differences in outcomes and feasibility outcomes in terms of recruitment and retention rates were analyzed, and the ability to collect primary and secondary outcomes was assessed. Balance, measured as postural sway, showed no significant improvement in any group. All three groups improved in functional balance (p = 0.011-0.028), activity of daily living (p = 0.012-0.027), and in HRQoL (p = 0.017-0.028). There were no other significant changes within or between the groups. The recruitment rate was 46%, the retention rate was 75%, and the ability to collect outcome measures was 80% at baseline and 64% at follow-up. Based on the results, it is possible to, after adjusting the protocol, conduct a full RCT.
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Affiliation(s)
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 22100 Lund, Sweden
| | - Cecilia Rogmark
- Department of Orthopedics, Skane University Hospital, Lund University, 21428 Malmö, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 22100 Lund, Sweden
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Chen L, Liu S, Cao Y, Yan L, Shen Y. Effect of perioperative ultrasound guided fascia iliaca compartment block in elderly adults with hip fractures undergoing arthroplasty in spinal anesthesia-a randomized controlled trial. BMC Geriatr 2023; 23:66. [PMID: 36732687 PMCID: PMC9893664 DOI: 10.1186/s12877-023-03786-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND For elderly adults undergoing hip arthroplasty, fascia iliaca compartment block (FICB) is often used before spinal anesthesia to reduce the pain of posture placement. However, the impact of FICB within 48 h needs further study. METHODS 89 elderly adults scheduled to undergo arthroplasty for hip fracture were enrolled and randomized into the FICB group (n = 45) and the control group (n = 44). The fascia iliaca on the operated side was located using ultrasound, and a puncture needle was placed under the fascia iliaca. The FICB group was injected with 40 ml of 0.5% ropivacaine, and the control group was injected with 40 ml of normal saline. Spinal anesthesia was performed after 20 min. Our primary outcome measures were: duration of analgesia, muscle strength, and Quality of Recovery (QoR). RESULTS The duration of analgesia in the FICB group was 403.5 ± 39.6 min, which was longer than that (357.5 ± 35.9 min) of the control group (P = 0.012). There were 19 (42.2%) patients with muscle strength of grade 4 in the FICB group and 36 (81.8%) patients with muscle strength of grade 4 in the control group. FICB group was lower (P < 0.001). QoR-15 at 24 h after surgery was 114.1 ± 8.3 in the FICB group and 104.6 ± 8.4 in the control group (P < 0.001). QoR-15 at 48 h after surgery was 122.7 ± 8.4 in the FICB group and 120.5 ± 9.5 in the control group (P = 0.232). CONCLUSIONS For elderly adults with hip fractures, FICB provided longer analgesia and improved 24-h QoR, but reduced postoperative muscle strength. TRAIL REGISTRATION Chinese Clinical Registry Center, ChiCTR2200056937, 23/02/2022.
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Affiliation(s)
- Liang Chen
- grid.412467.20000 0004 1806 3501Department of Anesthesiology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
| | - Shuangmei Liu
- grid.412467.20000 0004 1806 3501Department of Anesthesiology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
| | - Yanyan Cao
- grid.412467.20000 0004 1806 3501Department of Anesthesiology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
| | - Lei Yan
- grid.412467.20000 0004 1806 3501Department of Anesthesiology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
| | - Yang Shen
- grid.412467.20000 0004 1806 3501Department of Emergency Medicine, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
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Huang MZ, Rogers MW, Pizac D, Gruber-Baldini AL, Orwig D, Hochberg MC, Beamer BA, Creath RA, Savin DN, Conroy VM, Mangione KK, Craik R, Zhang LQ, Magaziner J. Effect of Multicomponent Home-Based Training on Gait and Muscle Strength in Older Adults After Hip Fracture Surgery: A Single Site Randomized Trial. Arch Phys Med Rehabil 2023; 104:169-178. [PMID: 36087806 PMCID: PMC10039715 DOI: 10.1016/j.apmr.2022.08.974] [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: 11/15/2021] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effect of 16-week home-based physical therapy interventions on gait and muscle strength. DESIGN A single-blinded randomized controlled trial. SETTING General community. PARTICIPANTS Thirty-four older adults (N=34) post hip fracture were randomly assigned to either experimental group (a specific multi-component intervention group [PUSH], n=17, 10 women, age=78.6±7.3 years, 112.1±39.8 days post-fracture) or active control (a non-specific multi-component intervention group [PULSE], n=17, 11 women, age=77.8±7.8 years, 118.2±37.5 days post-fracture). INTERVENTION PUSH and PULSE groups received 32-40 sessions of specific or non-specific multi-component home-based physical therapy, respectively. Training in the PUSH group focused on lower extremity strength, endurance, balance, and function for community ambulation, while the PULSE group received active movement and transcutaneous electrical nerve stimulation on extremities. MAIN OUTCOME MEASURES Gait characteristics, and ankle and knee muscle strength were measured at baseline and 16 weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B) was measured at baseline. RESULTS At 16 weeks, both groups demonstrated significant increases in usual (P<.05) and fast (P<.05) walking speed, while there was no significant difference in increases between the groups. There was only 1 significant change in lower limb muscle strength over time (non-fractured side) between the groups, such that PUSH did better (mean: 4.33%, 95% confidence interval:1.43%-7.23%). The increase in usual and fast walking speed correlated with the baseline Trail-making Test-B score (r=-0.371, P=.037) and improved muscle strength in the fractured limb (r=0.446, P=.001), respectively. CONCLUSION Gait speed improved in both home-based multicomponent physical therapy programs in older adults after hip fracture surgery. Muscle strength of the non-fractured limb improved in the group receiving specific physical therapy training. Specific interventions targeting modifiable factors such as muscle strength and cognitive performance may assist gait recovery after hip fracture surgery.
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Affiliation(s)
- Mei Zhen Huang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD
| | - Douglas Pizac
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD
| | - Denise Orwig
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD
| | - Marc C Hochberg
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD
| | - Brock A Beamer
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD; Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Exercise Science, Lebanon Valley College, Annville, PA
| | - Douglas N Savin
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD
| | - Vincent M Conroy
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD
| | - Kathleen K Mangione
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, PA
| | - Rebecca Craik
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, PA
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD; Department of Bioengineering, University of Maryland, College Park, MD
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD.
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Kawanishi K, Fukuda D, Miyashita T, Kitagawa T, Niwa H, Okuno T, Kinoshita T, Tsutsumi M, Kudo S. Effects of Compression Intervention on the Thigh Using Elastic Bandage on Lateral Femoral Pain After Trochanteric Fractures: A Multicenter Randomized Controlled Trial. Gerontol Geriatr Med 2023; 9:23337214231214405. [PMID: 38035263 PMCID: PMC10683377 DOI: 10.1177/23337214231214405] [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] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
A trochanteric fracture is one type of hip fracture. Management of postoperative pain after trochanteric fracture that is caused by decreased gliding between tissues in the lateral thigh is not established. The aim of this study was to examine the effect of compression of the thigh using an elastic bandage on trochanteric fracture after surgery. Multicenter randomized controlled trial was conducted in collaboration with the Comprehensive Rehabilitation Unit (sub-acute rehabilitation Unit) in two hospitals. Eligible volunteers (n = 34) with trochanteric fractures after surgery were randomly assigned to two groups. In the treatment group, participants practiced standing and walking under compression of the thigh with an elastic bandage. The control group was blinded to the intervention and practiced standing and walking under non-compression of the thigh with an elastic bandage. Both groups underwent a standard physical therapy program 2 times a day, daily. Two-way repeated measures of ANOVA showed significant main effect between the groups for gliding between tissue (p < .001), lateral femoral pain (p < .001), subcutaneous tissue thickness (p = .044). Compression of the thigh with an elastic bandage significantly improved subcutaneous tissue thickness, gliding between tissues, lateral thigh pain. Gait velocity improved with these functional improvements.
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Affiliation(s)
- Kengo Kawanishi
- Morinomiya University of Medical Sciences, Osaka, Japan
- Kano General Hospital, Osaka, Japan
| | | | | | - Takashi Kitagawa
- Morinomiya University of Medical Sciences, Osaka, Japan
- Higashi Osaka Hospital, Osaka, Japan
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Rix A, Lawrence D, Raper E, Calthorpe S, Holland AE, Kimmel LA. Measurement of Mobility and Physical Function in Patients Hospitalized With Hip Fracture: A Systematic Review of Instruments and Their Measurement Properties. Phys Ther 2022; 103:pzac142. [PMID: 36222144 DOI: 10.1093/ptj/pzac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/09/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting. METHODS Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. RESULTS Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed "Up & Go" Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness over time (effect sizes 0.63-2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] >0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%-60% of patients). The TUG, CAS, and BI all had good clinical utility. CONCLUSION Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting. IMPACT This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes.
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Affiliation(s)
- Alana Rix
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Drew Lawrence
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Eleanor Raper
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Sara Calthorpe
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Purcell K, Tiedemann A, Kristensen MT, Cunningham C, Hjermundrud V, Ariza-Vega P, Perracini M, Sherrington C. Mobilisation and physiotherapy intervention following hip fracture: snapshot survey across six countries from the Fragility Fracture Network Physiotherapy Group. Disabil Rehabil 2022; 44:6788-6795. [PMID: 34514916 DOI: 10.1080/09638288.2021.1974107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Hip fracture guidelines recommend early mobilisation, multidisciplinary care, physiotherapy and fall prevention interventions. This study documents mobilisation practices and physiotherapy interventions provided post-hip fracture in six countries. MATERIALS AND METHODS Physiotherapists from orthopaedic wards in Denmark, Australia, Spain, Brazil, Norway and Ireland provided information regarding mobilisation and physiotherapy for 10 consecutive hip fracture patients (>60 years), between 2014 and 2018. RESULTS Physiotherapists (n = 107) entered data on 426 patients. Two-thirds of patients (283, 66%) attempted standing 0-1 days after surgery (range: 0% of patients in Spain to 92% in Norway). Fewer patients (199, 47%) attempted walking on day 0-1 (range: 0% Spain/Brazil to 69% Norway). Physiotherapy to mobilise every weekday was provided to 356 patients (84%, range: 60% Ireland to 100% Spain). On weekends, physiotherapy to mobilise was limited (175, 40%, range: 0% Spain to 81% Brazil) but 298 patients (70%) mobilised with non-physiotherapy staff (range: 0% Spain to 96% Denmark/Ireland). Physiotherapy treatments included mobility, gait training, and range-of-motion exercises. Referral to fall prevention interventions was low (93, 22%, range: 0% Spain to 76% Ireland). CONCLUSION Stronger compliance with guideline recommendations on early mobilising, weekend mobilising and referral to fall prevention interventions post hip-fracture is needed in some countries.Implications for rehabilitation This study provides a snapshot of mobilisation and physiotherapy practice for hip fracture patients in six countries. The results suggest a need to improve systems and approaches in some countries to enhance compliance with recommendations specifically relating to: • early attempts at standing and walking post-surgery. • opportunities to mobilise on weekends (with physiotherapist and/or other staff). • broader range of multidisciplinary care e.g., geriatric review, occupational therapy and nutrition advice. • use of standardised tests by physiotherapists post-surgery. • referral to fall prevention interventions.
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Affiliation(s)
- Kate Purcell
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Morten Tange Kristensen
- Departments of Physical Therapy and Orthopedic Surgery, Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Amager - Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Vegar Hjermundrud
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain.,Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, Granada, Spain
| | - Monica Perracini
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
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Ratnasamy PP, Gouzoulis MJ, Kammien AJ, Oh I, Grauer JN. Home and Outpatient Physical Therapy Utilization Following Total Ankle Replacement. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221146175. [PMID: 36582653 PMCID: PMC9793015 DOI: 10.1177/24730114221146175] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Physical therapy (PT) following total ankle replacement (TAR) is often considered, but guidelines for its use are not standardized. Although patient factors may dictate recommendations, this retrospective cohort study aims to characterize baseline utilization practices to set the stage for establishing generalizable recommendations. Methods TAR patients were identified from the 2010-2019 M91 Ortho PearlDiver data set based on administrative coding. Patient factors were extracted, including age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients' surgery was performed (Midwest, Northeast, South, West), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of home or outpatient PT utilization in the 90 days following TAR were identified. Inpatient PT was not captured. Univariate and multivariate logistic regression analyses allowed identification of predictive factors for PT utilization. Results Of 5412 TAR patients identified, postoperative PT services were used by 2453 (45.3%). Most PT was outpatient (38.3% of the study population) compared to home (4.1% of the study population). Weekly utilization of PT was greatest in the first week following surgery (17.7% of PT visits) and thereafter followed a roughly bell-shaped curve, with utilization greatest at 7 weeks following surgery (14.9% of PT visits).Independent predictors of PT utilization following TAR included having surgery performed in the Midwest (relative to the South, OR 1.37, P < .0001), Northeast (OR 1.20, P = .0217), or West (OR 1.26, P < .0021) and having commercial (relative to Medicare, OR 1.87, P < .0001) or Medicaid insurance (OR 1.46, P = .0239). Conclusion Of 5412 TAR patients, 42.5% used PT within 90 days of surgery. PT utilization was highest in the first and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAR, PT care pathways may be better defined. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Philip P. Ratnasamy
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Michael J. Gouzoulis
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Alexander J. Kammien
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Irvin Oh
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N. Grauer
- Department of Orthopaedics &
Rehabilitation, Yale School of Medicine, New Haven, CT, USA
- Jonathan N. Grauer, MD, Department of
Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New
Haven, CT 06510, USA.
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Using TENS for Pain Control: Update on the State of the Evidence. Medicina (B Aires) 2022; 58:medicina58101332. [PMID: 36295493 PMCID: PMC9611192 DOI: 10.3390/medicina58101332] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022] Open
Abstract
Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention used in the treatment of acute and chronic pain conditions. The first clinical studies on TENS were published over 50 years ago, when effective parameters of stimulation were unclear and clinical trial design was in its infancy. Over the last two decades, a better understanding of the mechanisms underlying TENS efficacy has led to the development of an adequate dose and has improved outcome measure utilization. The continued uncertainty about the clinical efficacy of TENS to alleviate pain, despite years of research, is related to the quality of the clinical trials included in systematic reviews. This summary of the evidence includes only trials with pain as the primary outcome. The outcomes will be rated as positive (+), negative (−), undecided (U), or equivalent to other effective interventions (=). In comparison with our 2014 review, there appears to be improvement in adverse events and parameter reporting. Importantly, stimulation intensity has been documented as critical to therapeutic success. Examinations of the outcomes beyond resting pain, analgesic tolerance, and identification of TENS responders remain less studied areas of research. This literature review supports the conclusion that TENS may have efficacy for a variety of acute and chronic pain conditions, although the magnitude of the effect remains uncertain due to the low quality of existing literature. In order to provide information to individuals with pain and to clinicians treating those with pain, we suggest that resources for research should target larger, high-quality clinical trials including an adequate TENS dose and adequate timing of the outcome and should monitor risks of bias. Systematic reviews and meta-analyses should focus only on areas with sufficiently strong clinical trials that will result in adequate sample size.
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Fairhall NJ, Dyer SM, Mak JC, Diong J, Kwok WS, Sherrington C. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2022; 9:CD001704. [PMID: 36070134 PMCID: PMC9451000 DOI: 10.1002/14651858.cd001704.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Improving mobility outcomes after hip fracture is key to recovery. Possible strategies include gait training, exercise and muscle stimulation. This is an update of a Cochrane Review last published in 2011. OBJECTIVES To evaluate the effects (benefits and harms) of interventions aimed at improving mobility and physical functioning after hip fracture surgery in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, trial registers and reference lists, to March 2021. SELECTION CRITERIA All randomised or quasi-randomised trials assessing mobility strategies after hip fracture surgery. Eligible strategies aimed to improve mobility and included care programmes, exercise (gait, balance and functional training, resistance/strength training, endurance, flexibility, three-dimensional (3D) exercise and general physical activity) or muscle stimulation. Intervention was compared with usual care (in-hospital) or with usual care, no intervention, sham exercise or social visit (post-hospital). DATA COLLECTION AND ANALYSIS Members of the review author team independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We used the assessment time point closest to four months for in-hospital studies, and the time point closest to the end of the intervention for post-hospital studies. Critical outcomes were mobility, walking speed, functioning, health-related quality of life, mortality, adverse effects and return to living at pre-fracture residence. MAIN RESULTS We included 40 randomised controlled trials (RCTs) with 4059 participants from 17 countries. On average, participants were 80 years old and 80% were women. The median number of study participants was 81 and all trials had unclear or high risk of bias for one or more domains. Most trials excluded people with cognitive impairment (70%), immobility and/or medical conditions affecting mobility (72%). In-hospital setting, mobility strategy versus control Eighteen trials (1433 participants) compared mobility strategies with control (usual care) in hospitals. Overall, such strategies may lead to a moderate, clinically-meaningful increase in mobility (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.10 to 0.96; 7 studies, 507 participants; low-certainty evidence) and a small, clinically meaningful improvement in walking speed (CI crosses zero so does not rule out a lack of effect (SMD 0.16, 95% CI -0.05 to 0.37; 6 studies, 360 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to short-term (risk ratio (RR) 1.06, 95% CI 0.48 to 2.30; 6 studies, 489 participants; low-certainty evidence) or long-term mortality (RR 1.22, 95% CI 0.48 to 3.12; 2 studies, 133 participants; low-certainty evidence), adverse events measured by hospital re-admission (RR 0.70, 95% CI 0.44 to 1.11; 4 studies, 322 participants; low-certainty evidence), or return to pre-fracture residence (RR 1.07, 95% CI 0.73 to 1.56; 2 studies, 240 participants; low-certainty evidence). We are uncertain whether mobility strategies improve functioning or health-related quality of life as the certainty of evidence was very low. Gait, balance and functional training probably causes a moderate improvement in mobility (SMD 0.57, 95% CI 0.07 to 1.06; 6 studies, 463 participants; moderate-certainty evidence). There was little or no difference in effects on mobility for resistance training. No studies of other types of exercise or electrical stimulation reported mobility outcomes. Post-hospital setting, mobility strategy versus control Twenty-two trials (2626 participants) compared mobility strategies with control (usual care, no intervention, sham exercise or social visit) in the post-hospital setting. Mobility strategies lead to a small, clinically meaningful increase in mobility (SMD 0.32, 95% CI 0.11 to 0.54; 7 studies, 761 participants; high-certainty evidence) and a small, clinically meaningful improvement in walking speed compared to control (SMD 0.16, 95% CI 0.04 to 0.29; 14 studies, 1067 participants; high-certainty evidence). Mobility strategies lead to a small, non-clinically meaningful increase in functioning (SMD 0.23, 95% CI 0.10 to 0.36; 9 studies, 936 participants; high-certainty evidence), and probably lead to a slight increase in quality of life that may not be clinically meaningful (SMD 0.14, 95% CI -0.00 to 0.29; 10 studies, 785 participants; moderate-certainty evidence). Mobility strategies probably make little or no difference to short-term mortality (RR 1.01, 95% CI 0.49 to 2.06; 8 studies, 737 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to long-term mortality (RR 0.73, 95% CI 0.39 to 1.37; 4 studies, 588 participants; low-certainty evidence) or adverse events measured by hospital re-admission (95% CI includes a large reduction and large increase, RR 0.86, 95% CI 0.52 to 1.42; 2 studies, 206 participants; low-certainty evidence). Training involving gait, balance and functional exercise leads to a small, clinically meaningful increase in mobility (SMD 0.20, 95% CI 0.05 to 0.36; 5 studies, 621 participants; high-certainty evidence), while training classified as being primarily resistance or strength exercise may lead to a clinically meaningful increase in mobility measured using distance walked in six minutes (mean difference (MD) 55.65, 95% CI 28.58 to 82.72; 3 studies, 198 participants; low-certainty evidence). Training involving multiple intervention components probably leads to a substantial, clinically meaningful increase in mobility (SMD 0.94, 95% CI 0.53 to 1.34; 2 studies, 104 participants; moderate-certainty evidence). We are uncertain of the effect of aerobic training on mobility (very low-certainty evidence). No studies of other types of exercise or electrical stimulation reported mobility outcomes. AUTHORS' CONCLUSIONS Interventions targeting improvement in mobility after hip fracture may cause clinically meaningful improvement in mobility and walking speed in hospital and post-hospital settings, compared with conventional care. Interventions that include training of gait, balance and functional tasks are particularly effective. There was little or no between-group difference in the number of adverse events reported. Future trials should include long-term follow-up and economic outcomes, determine the relative impact of different types of exercise and establish effectiveness in emerging economies.
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Affiliation(s)
- Nicola J Fairhall
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Jenson Cs Mak
- Healthy Ageing, Mind & Body Institute, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wing S Kwok
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Rehabilitation interventions for persons with hip fracture and cognitive impairment: A scoping review. PLoS One 2022; 17:e0273038. [PMID: 35969624 PMCID: PMC9377630 DOI: 10.1371/journal.pone.0273038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Hip fractures are common fall-related injuries, with rehabilitation and recovery often complicated by cognitive impairment. Understanding what interventions exist, and in what settings, for people with hip fracture and co-occurring cognitive impairment is important in order to provide more evidence on rehabilitation and related outcomes for this population.
Objective
To examine the extent, nature, and range of literature on rehabilitation interventions for adults with hip fracture and cognitive impairment.
Methods
Articles were required to: include an adult population with hip fracture and cognitive impairment, include a rehabilitation intervention, and be published between January 1, 2000 and November 19, 2021. Articles were excluded if they were opinion pieces, study protocols, conference abstracts, or if they did not describe the rehabilitation intervention. Relevant articles were searched on the following electronic databases: MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database. All articles were double-screened by two reviewers and disagreements were resolved through consensus. Data were extracted and synthesized using descriptive approaches.
Results
Seventeen articles were included in this scoping review. We identified a variety of interventions targeting this population; about half were specific to physical rehabilitation, with the other half incorporating components that addressed multiple aspects of the care journey. Interventions had varying outcomes and no studies qualitatively explored patient or family experiences. All intervations were initiated in hospital, with less than half including cross-sectoral components. About half of the articles described modifying or tailoring the intervention to the participants’ needs, but there was limited information on how to adapt rehabilitation interventions for individuals with cognitive impairment.
Conclusions
More work is need to better understand patient, family, and provider experiences with rehabilitation interventions, how to tailor interventions for those with cognitive impairment, and how to successfully implement sustainable interventions across sectors.
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Mora‐Traverso M, Molina‐Garcia P, Prieto‐Moreno R, Borges‐Cosic M, Cruz Guisado V, Pino Algarrada R, Moreno‐Ramírez P, Gomez‐Jurado G, Gomez Tarrias C, Hidalgo Isla M, Jimenez Andrés P, Linares Gago M, Lirola‐Liebanas A, Mesa‐Ruiz A, Muñoz‐Garach A, Salazar‐Graván S, Estevez‐Lopez F, Martín‐Matillas M, Ariza‐Vega P. An m‐Health telerehabilitation and health education program on physical performance in patients with hip fracture and their family caregivers: Study protocol for the ActiveHip+ randomized controlled trial. Res Nurs Health 2022; 45:287-299. [DOI: 10.1002/nur.22218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Marta Mora‐Traverso
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service Virgen de las Nieves University Hospital 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
| | - Rafael Prieto‐Moreno
- Department of Physical and Sport Education, PA‐HELP “Physical Activity for HEaLth Promotion” Research Group, Faculty of Sports Sciences University of Granada Granada Spain
| | - Milkana Borges‐Cosic
- Department of Physical and Sport Education, PA‐HELP “Physical Activity for HEaLth Promotion” Research Group, Faculty of Sports Sciences University of Granada Granada Spain
- Department of Physical Education, Faculty of Education Sciences University of Cádiz Cádiz Spain
| | - Victor Cruz Guisado
- Department of Physical Medicine and Rehabilitation University Hospital Jerez de la Frontera Cadiz Spain
| | - Rogelio Pino Algarrada
- Department of Physical Medicine and Rehabilitation University Hospital Puerto Real Cadiz Spain
| | - Paz Moreno‐Ramírez
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Gema Gomez‐Jurado
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Consuelo Gomez Tarrias
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Margarita Hidalgo Isla
- Department of Physical Medicine and Rehabilitation University Hospital Puerto Real Cadiz Spain
| | - Patricia Jimenez Andrés
- 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
| | - Ana Lirola‐Liebanas
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Antonio Mesa‐Ruiz
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Araceli Muñoz‐Garach
- Department of Endocrinology and Nutrition University Hospital Virgen de las Nieves Granada Spain
| | - Susana Salazar‐Graván
- Department of Physical Medicine and Rehabilitation University Hospital Virgen de las Nieves Granada Spain
| | - Fernando Estevez‐Lopez
- Department of Child and Adolescent Psychiatry/Psychology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - 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
- Department of Physical and Sport Education, PA‐HELP “Physical Activity for HEaLth Promotion” Research Group, Faculty of Sports Sciences University of Granada Granada Spain
- Department of Physiotherapy, Faculty of Health Science University of Granada Granada Spain
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49
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Prommik P, Tootsi K, Veske K, Strauss E, Saluse T, Kolk H, Märtson A. Isolated greater trochanter fracture may impose a comparable risk on older patients' survival as a conventional hip fracture: a population-wide cohort study. BMC Musculoskelet Disord 2022; 23:394. [PMID: 35477499 PMCID: PMC9044808 DOI: 10.1186/s12891-022-05336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, IGT’s effect on mortality is unknown, and its best management strategies are unclear. This study aims to compare these patient populations, their acute- and post-acute care, physical and occupational therapy use, and up to three-year mortality. Methods This retrospective cohort study is based on population-wide data of Estonia, where routine IGT management is non-operative and includes immediate weight-bearing as tolerated. The study included patients aged ≥ 50 years with a validated index HF or IGT diagnosis between 2009–2017. The fracture populations’ acute- and post-acute care, one-year physical and occupational therapy use and three-year mortality were compared. Results A total of 0.4% (50/11,541) of included patients had an IGT. The baseline characteristics of the fracture cohorts showed a close resemblance, but the IGT patients received substantially less care. Adjusted analyses showed that the IGT patients’ acute care was 4.5 days [3.4; 5.3] shorter they had 39.2 percentage points [25.5; 52.8] lower probability for receiving post-acute care, and they had 50 percentage points [5.5: 36]] lower probability for receiving physical and occupational therapy. The IGT and HF patients’ mortality rates were comparable, being 4% and 9% for one month, 28% and 31% for one year, and 46% and 49% for three years, respectively. Crude and adjusted analyses could not find significant differences in their three-year mortality, showing a p-value of 0.6 and a hazard ratio of 0.9 [0.6; 1.3] for the IGT patients, retrospectively. Conclusions Despite IGT being a relatively minor injury, the evidence from this study suggests that it may impose a comparable risk on older patients’ survival, as does HF due to the close resemblance of the two fracture populations. Therefore, IGT in older patients may signify an underlying need for broad-based medical attention, ensuring need-based, ongoing, coordinated care. Trial registration Retrospectively registered.
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Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia.
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Karin Veske
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Eiki Strauss
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Toomas Saluse
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
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50
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Goubar A, Ayis S, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ. The impact of the frequency, duration and type of physiotherapy on discharge after hip fracture surgery: a secondary analysis of UK national linked audit data. Osteoporos Int 2022; 33:839-850. [PMID: 34748023 PMCID: PMC8930962 DOI: 10.1007/s00198-021-06195-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Additional physiotherapy in the first postoperative week was associated with fewer days to discharge after hip fracture surgery. A 7-day physiotherapy service in the first postoperative week should be considered as a new key performance indicator in evaluating the quality of care for patients admitted with a hip fracture. INTRODUCTION To examine the association between physiotherapy in the first week after hip fracture surgery and discharge from acute hospital. METHODS We linked data from the UK Physiotherapy Hip Fracture Sprint Audit to hospital records for 5395 patients with hip fracture in May and June 2017. We estimated the association between the number of days patients received physiotherapy in the first postoperative week; its overall duration (< 2 h, ≥ 2 h; 30-min increment) and type (mobilisation alone, mobilisation and exercise) and the cumulative probability of discharge from acute hospital over 30 days, using proportional odds regression adjusted for confounders and the competing risk of death. RESULTS The crude and adjusted odds ratios of discharge were 1.24 (95% CI 1.19-1.30) and 1.26 (95% CI 1.19-1.33) for an additional day of physiotherapy, 1.34 (95% CI 1.18-1.52) and 1.33 (95% CI 1.12-1.57) for ≥ 2 versus < 2 h physiotherapy, and 1.11 (95% CI 1.08-1.15) and 1.10 (95% CI 1.05-1.15) for an additional 30-min of physiotherapy. Physiotherapy type was not associated with discharge. CONCLUSION We report an association between physiotherapy and discharge after hip fracture. An average UK hospital admitting 375 patients annually may save 456 bed-days if current provision increased so all patients with hip fracture received physiotherapy on 6-7 days in the first postoperative week. A 7-day physiotherapy service totalling at least 2 h in the first postoperative week may be considered a key performance indicator of acute care quality after hip fracture.
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Affiliation(s)
- A Goubar
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - L Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - R Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Johansen
- Cardiff Trauma Unit, University Hospital of Wales, Cardiff, UK
| | - M T Kristensen
- Department of Physical & Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
- Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - E Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - T O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - K J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK.
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