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Kaizu Y, Tamura S, Iwamura T, Saito S, Kobayashi S, Takeda R, Iwamoto H, Miyata K. Development and validation of a clinical prediction rule for walking independence in hospitalized older adults with a vertebral compression fracture. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2117. [PMID: 39101274 DOI: 10.1002/pri.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE No reports on factors or Clinical prediction rules (CPRs) associated with walking independence among patients with vertebral compression fractures (VCFs) are available. Evidence regarding epidemiological walking independence rates is also sparse. Here, we sought to (i) obtain epidemiological data on the probability of inpatients with VCFs achieving walking independence, and (ii) develop and validate a CPR to determine walking independence in hospitalized patients with VCFs. PATIENTS AND METHODS We conducted a retrospective cross-sectional observational study of patients aged ≥60 years who were hospitalized for VCF at four hospitals in Japan in 2019-2022. The outcome was walking independence at discharge. We performed a binomial logistic regression analysis to assess predictors of walking independence. Five independent variables were entered: age, American Society of Anesthesiologists physical status, cognitive function, Berg Balance Scale (BBS), and 10-m walking test. Among the independent variables that were significant, we converted the continuous variables to binary data by calculating cut-off values and then created the CPR. The area under the curve (AUC) was calculated as the measure of the CPR's diagnostic accuracy, and internal validation was conducted by bootstrapping. RESULTS Of the 240 patients, 188 (78.3%) achieved walking independence. Cognitive function and the BBS score (with a cut-off of 45 points) were identified as significant predictors. We created a CPR using these two items (0-2 points). The CPR's AUC was 0.92 (0.874-0.967), and internal validation by bootstrapping yielded a mean AUC of 0.919 with a slope of 0.965. CONCLUSION The walking independence rate of patients with a VCF during hospitalization was 78.3%, with cognitive function and BBS being predictors. The developed CPR performed well enough to retrospectively predict walking independence in VCF patients. The BBS cut-off value and the CPR may serve as useful indicators for clinicians to predict VCF patients' walking independence.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Rehabilitation Hospital, Takasaki, Gunma, Japan
| | - Shuntaro Tamura
- Department of Physical Therapy, Ota College of Medical Technology, Ota, Gunma, Japan
| | - Taiki Iwamura
- Department of Rehabilitation, Azumabashi Orthopedics, Tokyo, Japan
| | - Shota Saito
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Gunma, Japan
| | - Sota Kobayashi
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ren Takeda
- Day Care Specialized in Stroke Rehabilitation "with Reha", Maebashi, Gunma, Japan
| | - Hiroki Iwamoto
- Department of Rehabilitation Center, Hidaka Rehabilitation Hospital, Takasaki, Gunma, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, 4669-2 Inashiki-gun, Ibaraki, Japan
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Walsh ME, Kristensen PK, Hjelholt TJ, Hurson C, Walsh C, Ferris H, Crozier-Shaw G, Keohane D, Geary E, O'Halloran A, Merriman NA, Blake C. Systematic review of multivariable prognostic models for outcomes at least 30 days after hip fracture finds 18 mortality models but no nonmortality models warranting validation. J Clin Epidemiol 2024; 173:111439. [PMID: 38925343 DOI: 10.1016/j.jclinepi.2024.111439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Prognostic models have the potential to aid clinical decision-making after hip fracture. This systematic review aimed to identify, critically appraise, and summarize multivariable prediction models for mortality or other long-term recovery outcomes occurring at least 30 days after hip fracture. STUDY DESIGN AND SETTING MEDLINE, Embase, Scopus, Web of Science, and CINAHL databases were searched up to May 2023. Studies were included that aimed to develop multivariable models to make predictions for individuals at least 30 days after hip fracture. Risk of bias (ROB) was dual-assessed using the Prediction model Risk Of Bias ASsessment Tool. Study and model details were extracted and summarized. RESULTS From 5571 records, 80 eligible studies were identified. They predicted mortality in n = 55 studies/81 models and nonmortality outcomes (mobility, function, residence, medical, and surgical complications) in n = 30 studies/45 models. Most (n = 46; 58%) studies were published since 2020. A quarter of studies (n = 19; 24%) reported using 'machine-learning methods', while the remainder used logistic regression (n = 54; 68%) and other statistical methods (n = 11; 14%) to build models. Overall, 15 studies (19%) presented 18 low ROB models, all predicting mortality. Common concerns were sample size, missing data handling, inadequate internal validation, and calibration assessment. Many studies with nonmortality outcomes (n = 11; 37%) had clear data complexities that were not correctly modeled. CONCLUSION This review has comprehensively summarized and appraised multivariable prediction models for long-term outcomes after hip fracture. Only 15 studies of 55 predicting mortality were rated as low ROB, warranting further development of their models. All studies predicting nonmortality outcomes were high or unclear ROB. Careful consideration is required for both the methods used and justification for developing further nonmortality prediction models for this clinical population.
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Affiliation(s)
- Mary E Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, D04 C7X2, Ireland.
| | - Pia Kjær Kristensen
- The Department of Clinical Medicine, Orthopaedic, Aarhus University, DK-8200, Aarhus, Denmark
| | - Thomas J Hjelholt
- Department of Geriatrics, Aarhus University Hospital, DK-8200, Aarhus, Denmark
| | - Conor Hurson
- Department of Trauma and Orthopaedics, St Vincent's University Hospital, Dublin D04 T6F4, Ireland
| | - Cathal Walsh
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Helena Ferris
- Department of Public Health, Health Service Executive - South West, St. Finbarr's Hospital, Cork, T12 XH60, Ireland
| | - Geoff Crozier-Shaw
- Department of Trauma and Orthopaedics, Mater Misercordiae University Hospital, Eccles Street, Dublin, Ireland
| | - David Keohane
- Department of Orthopaedics, St. James' Hospital, Dublin, Ireland
| | - Ellen Geary
- Department of Trauma and Orthopaedics, St Vincent's University Hospital, Dublin D04 T6F4, Ireland
| | | | - Niamh A Merriman
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, D04 C7X2, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, D04 C7X2, Ireland
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Dissaneewate K, Dissaneewate P, Orapiriyakul W, Kritsaneephaiboon A, Chewakidakarn C. Development and Validation of Two-Step Prediction Models for Postoperative Bedridden Status in Geriatric Intertrochanteric Hip Fractures. Diagnostics (Basel) 2024; 14:804. [PMID: 38667450 PMCID: PMC11049116 DOI: 10.3390/diagnostics14080804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Patients with intertrochanteric hip fractures are at an elevated risk of becoming bedridden compared with those with intraarticular hip fractures. Accurate risk assessments can help clinicians select postoperative rehabilitation strategies to mitigate the risk of bedridden status. This study aimed to develop a two-step prediction model to predict bedridden status at 3 months postoperatively: one model (first step) for prediction at the time of admission to help dictate postoperative rehabilitation plans; and another (second step) for prediction at the time before discharge to determine appropriate discharge destinations and home rehabilitation programs. Three-hundred and eighty-four patients were retrospectively reviewed and divided into a development group (n = 291) and external validation group (n = 93). We developed a two-step prediction model to predict the three-month bedridden status of patients with intertrochanteric fractures from the development group. The first (preoperative) model incorporated four simple predictors: age, dementia, American Society of Anesthesiologists physical status classification (ASA), and pre-fracture ambulatory status. The second (predischarge) model used an additional predictor, ambulation status before discharge. Model performances were evaluated using the external validation group. The preoperative model performances were area under ROC curve (AUC) = 0.72 (95%CI 0.61-0.83) and calibration slope = 1.22 (0.40-2.23). The predischarge model performances were AUC = 0.83 (0.74-0.92) and calibration slope = 0.89 (0.51-1.35). A decision curve analysis (DCA) showed a positive net benefit across a threshold probability between 10% and 35%, with a higher positive net benefit for the predischarge model. Our prediction models demonstrated good discrimination, calibration, and net benefit gains. Using readily available predictors for prognostic prediction can assist clinicians in planning individualized postoperative rehabilitation programs, home-based rehabilitation programs, and determining appropriate discharge destinations, especially in environments with limited resources.
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Affiliation(s)
- Kantapon Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
- Department of Clinical Research and Medical Data Science, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Pornpanit Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Wich Orapiriyakul
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Apipop Kritsaneephaiboon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Chulin Chewakidakarn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
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Ohyama Y, Iwamura T, Hoshino T, Miyata K. Prognostic models of quality of life after total knee replacement: A systematic review. Physiother Theory Pract 2023:1-12. [PMID: 37162481 DOI: 10.1080/09593985.2023.2211716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To systematically review and critically appraise prognostic models for quality of life (QOL) in patients with total knee replacement (TKA). METHODS Subjects were TKA recipients recruited from inpatient postoperative settings. Searches were made on June 2022 and updated on April 2023. Databases included PubMed.gov, CINAHL, The Cochrane Library, Web of Science. Two authors performed all review stages independently. Risk of bias assessments on participants, predictors, outcomes and analysis methods followed the Prediction study Risk Of Bias ASsessment Tool (PROBAST). RESULTS After screening 2204 studies, 9 were eligible for inclusion. Twelve prognostic models were reported, of which 10 models were developed from data without validation and 2 were both developed and validated. The most frequently applied predictor was the pre-TKA QOL score. Discriminatory measures were reported for 9 (75.0%) models with areas under the curve values of 0.66-0.95. All models showed a high risk of bias, mostly due to limitations in statistical methods and outcome assessments. CONCLUSION Several prognostic models have been developed for QOL in patients with TKA, but all models show a high risk of bias and are unreliable in clinical practice. Future, prognostic models overcoming the risk of bias identified in this study are needed.
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Affiliation(s)
- Yuki Ohyama
- Department of Rehabilitation, Hidaka Rehabilitation Hospital, Takasaki, Japan
| | - Taiki Iwamura
- Department of Rehabilitation, Azumabashi Orthopedics, Tokyo, Japan
| | - Taichi Hoshino
- Department of Rehabilitation, Gunma Chuo Hospital, Maebashi, Gunma, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
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Treatment of Elderly Femoral Intertrochanteric Fracture by InterTan Intramedullary Nail and PFNA. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5020960. [PMID: 35958926 PMCID: PMC9357690 DOI: 10.1155/2022/5020960] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
To analyze the treatment of elderly femoral intertrochanteric fracture (EFIF) using InterTan intramedullary nail (InterTanIN) and proximal femoral nail antirotation (PFNA). A total of 75 patients suffering from EFIF receiving intramedullary fixation were retrospectively collected. According to intramedullary fixation methods, the patients were separated into InterTanIN group and PFNA group. Parameters including the surgery time, blood loss, number of X-ray fluoroscopy, hospital stays, bone-healing time, postoperative Harris hip score (HIS) (1 month, 3 months, 6 months, and 12 months), and complications were collected and analyzed. The results showed surgery time, blood loss, and number of X-ray fluoroscopy in InterTanIN group were higher than those in PFNA group (P < 0.05). The mean hospital stay in the InterTanIN group was comparable to that in the PFNA group (P > 0.05). There was no significant difference in bone-healing time between the InterTanIN group and PFNA group (P > 0.05). The postoperative HIS of InterTanIN group was statistically better than PFNA group at the 3rd month and the 6th month (P < 0.05). With the extension of recovery time, the gap between the two groups gradually narrowed. The postoperative implant displacement happened more often in the PFNA group than in the InterTanIN group. EFIF treated with InterTanIN or PFNA could achieve good long-term efficacy. Although InterTanIN has the disadvantages of increased operative time, blood loss, and radiation exposure compared to PFNA, the postoperative hip function recovery of InterTanIN seems to be more reliable and stable than PFNA.
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Tomita Y, Yamamoto N, Inoue T, Ichinose A, Noda T, Kawasaki K, Ozaki T. Preoperative and perioperative factors are related to the early postoperative Barthel Index score in patients with trochanteric fracture. Int J Rehabil Res 2022; 45:154-160. [PMID: 35170497 DOI: 10.1097/mrr.0000000000000522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous studies have shown that preoperative factors predict the postoperative Barthel Index score in patients with trochanteric fractures, while there is less evidence on the effects of perioperative factors on the prediction. This study aimed to assess the effects of preoperative and perioperative factors on the early postoperative Barthel Index score in patients with trochanteric fractures. Consecutive 288 patients aged ≥60 years with trochanteric fractures who could independently walk before injury were included. Patients were grouped according to the Barthel Index score measured after 2 weeks of surgery; the cut-off value was 20 points. Two logistic regression models were created to assess the effects of preoperative (model 1: dementia, walking ability before injury, and nutrition status) and perioperative (model 2: independent variables in model 1, reduction quality, and basic mobility function) factors on the Barthel Index score. Sensitivity and specificity were used to assess the predicative accuracy of the models. Poor preoperative (model 1: χ2 = 34.626, P < 0.01) and perioperative (model 2: χ2 = 43.956, P < 0.01) characteristics were significantly related to lower Barthel Index score. Sensitivity and specificity were similar between the models (model 1: 83.3% and 38.9% and model 2: 82.2% and 42.6%, respectively). Both preoperative and perioperative factors were significantly related to the early postoperative Barthel Index score after trochanteric fracture. However, only minimal increase in predictive accuracy was observed when perioperative predictors were analyzed along with preoperative factors. Both baseline characteristics and basic postoperative mobility should be considered when treating patients with trochanteric fractures.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma
| | - Norio Yamamoto
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka
| | - Tomoo Inoue
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital
| | - Arisa Ichinose
- Department of Physical Therapy, Kagawa Prefectural Central Hospital, Kagawa
| | - Tomoyuki Noda
- Department of Orthopaedic Surgery and Traumatology, Kawasaki Medical School General Medical Center
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
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