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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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Dadwal UC, Bhatti FUR, Awosanya OD, de Andrade Staut C, Nagaraj RU, Perugini AJ, Tewari NP, Valuch CR, Sun S, Mendenhall SK, Zhou D, Mostardo SL, Blosser RJ, Li J, Kacena MA. The Effects of SRT1720 Treatment on Endothelial Cells Derived from the Lung and Bone Marrow of Young and Aged, Male and Female Mice. Int J Mol Sci 2021; 22:11097. [PMID: 34681756 PMCID: PMC8540697 DOI: 10.3390/ijms222011097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/10/2021] [Accepted: 10/10/2021] [Indexed: 02/07/2023] Open
Abstract
Angiogenesis is critical for successful fracture healing. Age-related alterations in endothelial cells (ECs) may cause impaired bone healing. Therefore, examining therapeutic treatments to improve angiogenesis in aging may enhance bone healing. Sirtuin 1 (SIRT1) is highly expressed in ECs and its activation is known to counteract aging. Here, we examined the effects of SRT1720 treatment (SIRT1 activator) on the growth and function of bone marrow and lung ECs (BMECs and LECs, respectively), derived from young (3-4 month) and old (20-24 month) mice. While aging did not alter EC proliferation, treatment with SRT1720 significantly increased proliferation of all LECs. However, SRT1720 only increased proliferation of old female BMECs. Vessel-like tube assays showed similar vessel-like structures between young and old LECs and BMECs from both male and female mice. SRT1720 significantly improved vessel-like structures in all LECs. No age, sex, or treatment differences were found in migration related parameters of LECs. In males, old BMECs had greater migration rates than young BMECs, whereas in females, old BMECs had lower migration rates than young BMECs. Collectively, our data suggest that treatment with SRT1720 appears to enhance the angiogenic potential of LECs irrespective of age or sex. However, its role in BMECs is sex- and age-dependent.
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Affiliation(s)
- Ushashi Chand Dadwal
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Fazal Ur Rehman Bhatti
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Olatundun Dupe Awosanya
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Caio de Andrade Staut
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Rohit U. Nagaraj
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Anthony Joseph Perugini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Nikhil Prasad Tewari
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Conner Riley Valuch
- Department of Biology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.R.V.); (J.L.)
| | - Seungyup Sun
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Stephen Kyle Mendenhall
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Donghui Zhou
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Sarah Lyn Mostardo
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
| | - Rachel Jean Blosser
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Jiliang Li
- Department of Biology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.R.V.); (J.L.)
| | - Melissa Ann Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (U.C.D.); (F.U.R.B.); (O.D.A.); (C.d.A.S.); (R.U.N.); (A.J.P.III); (N.P.T.); (S.S.); (S.K.M.); (D.Z.); (S.L.M.); (R.J.B.)
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
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Wagner DR, Karnik S, Gunderson ZJ, Nielsen JJ, Fennimore A, Promer HJ, Lowery JW, Loghmani MT, Low PS, McKinley TO, Kacena MA, Clauss M, Li J. Dysfunctional stem and progenitor cells impair fracture healing with age. World J Stem Cells 2019; 11:281-296. [PMID: 31293713 PMCID: PMC6600851 DOI: 10.4252/wjsc.v11.i6.281] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/26/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023] Open
Abstract
Successful fracture healing requires the simultaneous regeneration of both the bone and vasculature; mesenchymal stem cells (MSCs) are directed to replace the bone tissue, while endothelial progenitor cells (EPCs) form the new vasculature that supplies blood to the fracture site. In the elderly, the healing process is slowed, partly due to decreased regenerative function of these stem and progenitor cells. MSCs from older individuals are impaired with regard to cell number, proliferative capacity, ability to migrate, and osteochondrogenic differentiation potential. The proliferation, migration and function of EPCs are also compromised with advanced age. Although the reasons for cellular dysfunction with age are complex and multidimensional, reduced expression of growth factors, accumulation of oxidative damage from reactive oxygen species, and altered signaling of the Sirtuin-1 pathway are contributing factors to aging at the cellular level of both MSCs and EPCs. Because of these geriatric-specific issues, effective treatment for fracture repair may require new therapeutic techniques to restore cellular function. Some suggested directions for potential treatments include cellular therapies, pharmacological agents, treatments targeting age-related molecular mechanisms, and physical therapeutics. Advanced age is the primary risk factor for a fracture, due to the low bone mass and inferior bone quality associated with aging; a better understanding of the dysfunctional behavior of the aging cell will provide a foundation for new treatments to decrease healing time and reduce the development of complications during the extended recovery from fracture healing in the elderly.
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Affiliation(s)
- Diane R Wagner
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Sonali Karnik
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Zachary J Gunderson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Jeffery J Nielsen
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN 47907, United States
| | - Alanna Fennimore
- Department of Physical Therapy, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Hunter J Promer
- Division of Biomedical Science, Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, United States
| | - Jonathan W Lowery
- Division of Biomedical Science, Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, United States
| | - M Terry Loghmani
- Department of Physical Therapy, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, IN 47907 United States
| | - Todd O McKinley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, United States
| | - Matthias Clauss
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Jiliang Li
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
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Overdosing of benzodiazepines/Z-drugs and falls in older adults: Costs for the health system. Exp Gerontol 2018; 110:42-45. [DOI: 10.1016/j.exger.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 02/01/2023]
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Determinants of functional outcome in hip fracture: the role of comorbidity. Aging Clin Exp Res 2018; 30:643-650. [PMID: 28803357 DOI: 10.1007/s40520-017-0812-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Executed studies did not clearly identify which index of comorbidity was an independent outcome determinant. The aim of this prospective observational cohort study was to address this issue. METHODS We analyzed 200 consecutive patients with hip fracture. All patients underwent rehabilitation. At admission comorbidity was assessed through the cumulative severity, severity index, and comorbidity index of the Cumulative Illness Rating Scale. Discharge scores and effectiveness in the Functional Independence Measure motor subscale, and discharge destination were the outcome measures. Multivariate regression analyses were performed to identify determinants of outcome. RESULTS Mini Mental State Examination and comorbidity index of the Cumulative Illness Rating Scale were important independent determinants of final (respectively, β = 0.46 and -0.25) and effectiveness (respectively, β = 0.47 and -0.25) in motor Functional Independence Measure scores, while hip strength and Rankin score were determinants of final motor Functional Independence Measure score (respectively, β = 0.21 and -0.20). Comorbidity index of the Cumulative Illness Rating Scale (odds ratio 8.18 for ≥3 versus < 3 comorbidity score; 95% confidence interval, 1.03-64.7) and Geriatric Depression Scale (odds ratio 4.02 for ≥6 versus ≤5 depression scale score; 95% confidence interval, 1.52-10.63) were risk indicators for nursing home. CONCLUSIONS Among the indices of the Cumulative Illness Rating Scale, comorbidity index is the sole independent determinant of both motor Functional Independence Measure scores and discharge destination in hip fracture patients. This suggests to specifically evaluate this index to identify the patients who may be admitted to a rehabilitation program.
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Predictors of Long-Term Mortality in Older People With Hip Fracture. Arch Phys Med Rehabil 2015; 96:1215-21. [DOI: 10.1016/j.apmr.2015.01.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 11/18/2022]
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Han SK, Song HS, Kim R, Kang SH. Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old. Eur J Trauma Emerg Surg 2015; 42:191-6. [PMID: 26038046 DOI: 10.1007/s00068-015-0528-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We retrospectively analyzed the clinical results of treatment of impacted or undisplaced femoral neck fractures (Garden types 1 and 2) by osteosynthesis in elderly patients >70-year old. MATERIALS AND METHODS We retrospectively reviewed the radiological results of 52 patients who were followed up for at least 6 months from April 2002 to December 2008. The average age of the patients was 77.6 years (range 70-97 years), and 38 patients were females. The mean follow-up period was 11.7 months (range 6-19 months). Thirteen cases were Garden type 1 fractures, and 39 were Garden type 2 fractures. We assessed the relationships between the occurrence of complications and age, sex, Garden stage, bone mineral density (BMD), history of contralateral hip fracture, and any additional hip injury. RESULTS Major complications occurred in 18 cases (34.6 %), including nonunion (8 cases), osteonecrosis (6 cases), stress fracture of the subtrochanter (2 cases), excessive pull-out of a screw (1 case), and deep infection (1 case). The development of complications was associated with Garden stage 2, BMD, and additional hip injury. However, other factors were not associated with complications. Reoperations were performed in 16 cases (30.1 %), and 2 of the patients died during follow-up. CONCLUSION A relatively high rate of complications or reoperations developed after treatment of Garden 2 femoral neck fractures in senile patients >70 years of age with osteoporosis. Although internal fixation has been recommended in the literature for undisplaced femoral neck fractures, primary arthroplasty may be a better option for treatment of Garden type 2 fractures in elderly patients.
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Affiliation(s)
- S K Han
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Dongdaemun-gu, Seoul, 130-709, Republic of Korea
| | - H S Song
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Dongdaemun-gu, Seoul, 130-709, Republic of Korea
| | - R Kim
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Dongdaemun-gu, Seoul, 130-709, Republic of Korea
| | - S H Kang
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Dongdaemun-gu, Seoul, 130-709, Republic of Korea.
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