Barthel Score Research Articles

A Study of Engagement in Active and Passive Roles in Casual Leisure Occupations

Background: This article explores whether engagement with listening occupations varies depending on the occupational role or the level of sensory stimulation presented to participants with neuropalliative conditions. Method: The study used a multiple case quasi-experimental study involving marginal-participant time-sampled observations of engagement of individuals with neuropalliative conditions, with casual leisure occupations using the Individual Child Engagement Record. Data was collected using the Individual Child Engagement Record with 14 participants (who had Barthel scores averaging 7/100). The participants represented a particular sub-group of individuals with profound levels of neurological disability. Results: The time-sampled observations of engagement showed a significant difference between the scores for the control condition, engagement in a potentially active role at a music-making group, and engagement in a passive audience role when listening to an audio recording. Therefore, passively listening to an audio recording appears to be less engaging than the potentially active role offered by the music-making group for participants with neuropalliative conditions. Conclusion: The small sample size and the use of a single observer without video recording backup compromised the reliability of the data while complying with the facility’s POVA policy. Switching on an auditory recording or broadcast, while easy to arrange, may not be sufficiently engaging to prevent boredom and occupational deprivation. Consideration of an individual’s sensory, support, and role preference should be undertaken when designing leisure occupations for individuals with neuropalliative conditions rather than simply switching on an audio recording or broadcast.

The Association of Grip Strength With Severity and Duration of Parkinson’s

Background. Weakness is reported in Parkinson’s but always unadjusted for recognized factors that influence muscle strength such as participants’ age, gender, and body size. This may obscure the true association of Parkinson’s with muscle strength. Objective. To evaluate the relationship between grip strength, Parkinson’s severity, and duration adjusting for these factors. Methods. Age, gender, height, weight, grip strength, Unified Parkinson’s Disease Rating Score (UPDRS) motor score, Hoehn and Yahr (H&Y) stage, disease duration, number of comorbidities and medications, Barthel score, Mini Mental State Examination (MMSE) score, and Malnutrition Universal Screening Tool (MUST) score were recorded. Results. Fifty-seven of 79 (72%) people with Parkinson’s resident in one town were recruited. Age, gender, height, and Parkinson’s severity were the most significant determinants of grip strength. Each unit increase in UPDRS motor score and H&Y stage was associated with lower grip strength in univariate linear regression analyses adjusted for gender: −0.3 kg strength (95% confidence interval = −0.51, −0.09), P = .006 for each additional UPDRS point, and −3.87 kg strength (95% confidence interval = −6.54, −1.21), P = .005 for each additional H&Y stage. Disease duration was not associated with grip strength. In multivariate regression, Parkinson’s severity remained strongly associated with grip strength (UPDRS score P = .09; H&Y stage P = .04). Conclusions. This is the first demonstration that increasing severity of Parkinson’s was associated with weaker grip after adjustment for known influences on muscle strength. Participants’ age, gender, and body size also had a significant impact on strength. Adjustment of reported values for all these factors is essential to allow accurate reporting of grip strength values in intervention trials and comparison between different groups.

Coordination strategies of care across stroke recovery: Proposals for nursing interventions in primary care

Introduction: Stroke is characterized by its complexity as a result of residual deficits, dependence in basic activities of daily living, and new needs for caregivers. The purpose of this study was to propose nursing interventions in accordance with general practice to provide continuity of care of stroke patients across the stroke-recovery trajectory and support for caregivers beyond the patient’s length of stay. Methods: This is a longitudinal prospective study of a population-based cohort of all cases recorded in inpatient care of a first episode of stroke that occurred between 1 April, 2006 and 31 December, 2013. Results: There were 1,337 cases (54.1% male) and the mean age was 73.9 ± 12.5 years. Only 24.6% were evaluated by their disability after hospital discharge. Ischemic stroke treated with thrombolysis had the best results in mortality (5.1%) and Barthel score (85.4). Mild dependence for thrombolysis was OR = 2.5 with RRR = 46%, ARR = 9.4%, and NNT = 10 to get a Barthel score > 60 at discharge. After the episode the percentage of individuals with moderate or greater dependence increased up to 19.3%, with a loss ( p = .023) higher in women, halving the number of individuals with early independence. Of the stroke survivors 44.9% went directly home after acute care and needed a home caregiver. Age ( p 60). Conclusions: This study recommends consideration of special interests, both standardization of a discharge report as organizing an individualized primary care plan and the unification of processes for assessment of the situation of dependency among all public administrations to facilitate the necessary support planning for the stroke patient and their family in primary care.

Ten-year mortality in older patients attending the emergency department after a fall.

To determine the dependency scores, long-term mortality and factors associated with mortality in older people presenting to the emergency department (ED) with a fall. Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6-month period. Barthel score was reassessed at 12 months. Ten-year mortality data were obtained through the National Registry Department. A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1-year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P < 0.001). Age ≥75 years was significantly associated with mortality at 1, 3, 5 and 10 years (HR 3.12, 95% CI 1.48-6.56; HR 2.32, 95% CI 1.37-3.92; HR 1.87, 95% CI 1.21-2.88; and HR 2.25, 95% CI 1.60-3.17, respectively). Indoor falls (HR 2.54, 95% CI 1.07-6.06; HR 2.01, 95% CI 1.10-3.69), hospital admission (HR 2.16, 95% CI 1.14-4.10; HR 1.84, 95% CI 1.11-3.07) and Barthel ≤18 (HR 2.99, 95% CI 1.39-6.44; HR 2.47, 95% CI 1.40-4.33) were significantly associated with 1-year and 3-year mortality. Hospital admission (HR 1.94, 95% CI 1.24-3.01; HR 1.53, 95% CI 1.06-2.23) and Barthel ≤18 (HR 2.27, 95% CI 1.41-3.66; HR 1.85, 95% CI 1.27-2.68) remained significantly associated with increased mortality at 5 and 10 years. Functional ability is significantly reduced at 1 year after an initial presentation to the ED with a fall. Mortality is increased at 1 and 3 years in fallers who experienced indoor falls. The excess mortality associated with hospital admission and lower disability scores is persistent at 5 and 10 years. The results of the present study are invaluable in prognostication and healthcare decision-making for this group of frail older patients.

Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care

Background. Stroke is characterized by its complexity as a result of residual deficits, dependence in basic activities of daily living, and new needs for caregivers. The purpose of this study was to propose nursing interventions in accordance with general practice to provide continuity of care of stroke patients across the stroke-recovery trajectory and support for caregivers beyond the patient’s length of stay. Methods. This is a longitudinal prospective study of a population-based cohort of all cases recorded in inpatient care of a first episode of stroke that occurred between 1 April 2006 and 31 December 2014. Results. There were 1,494 cases (54.1% male) and the mean age was 77.4±12.9 years. Only 27.9% were evaluated by their disability after hospital discharge. Ischemic stroke treated with thrombolysis had the best results in mortality (6.3%) and Barthel score (85.5). Mild dependence for thrombolysis was OR=2.5 with RRR=46%, ARR=9.4%, and NNT=10 to get a Barthel score >60 at discharge. After the episode the percentage of individuals with moderate or greater dependence increased up to 22.5%, with a loss (p=0.023) higher in women, halving the number of individuals with early independence. Of the stroke survivors 43.4% went directly home after acute care and needed a home caregiver. Age (p<0.001) and NIHSS <12 (p=0.045) were identified as the only prognostic factors associated with mild dependence (Barthel>60).Conclusions. This study recommends consideration of special interests, both standardization of a discharge report as organizing an individualized primary care plan and the unification of processes for assessment of the situation of dependency among all public administrations to facilitate the necessary support planning for the stroke patient and their family in primary care.

Salvage for nail breakage in femoral intramedullary nailing

Proximal fractures of femur represent an important cause of hospitalization, morbidity and mortality for elderly patients. Femoral intramedullary nailing is an option to achieve a stable osteosynthesis but the breakage is a rare complication.The aim was to determinate the prevalence, causes, management and functional outcomes of this patients in our hands.Retrospective review of 1246 proximal femur fractures operated between 2003 and 2012. We analyse epidemiological data, fracture type and the quality of closed reduction and fixation by preoperative and postoperative radiology. Type of salvage procedure chosen for each case is presented. Functional outcome and quality of life questionnaire was obtained by Barthel index and Short Form 12 version 2.11 cases (0.88%) were identified. The type of initial fracture was 7 cases AO/OTA 31A3 and 4 cases AO/OTA 31A2. The implant failure was detected at 11 months after surgery (SD 6.39). Nail breakage occurred in three different points: 7 cases in the proximal aperture, 3 cases in cervicocephalic screw and 1 case in the distal aperture of the nail. The association of nonunion at fracture site and progressive hip pain was observed in all cases. Different salvage procedures were performed: 7 cases osteosynthesis revision (nail or dynamic condilar screw plate), 2 cases arthroplasty and 2 cases conservative treatment. The main Barthel score before the salvage procedure was 63.2 (SD 13). At final follow-up, this score improved to 72.8 (SD 20.38).To the best of our knowledge, this study represents the largest series of cases of trochanteric nail breakage due to material fatigue. This complication is rare (0.88%) that can foresee in unstable fractures with delayed union. The type of salvage should be individualized showing acceptable functional outcome in our series.

Effect of acupuncture combined with rehabilitative training on neural functional recovery of stroke patients during recovery phase: a randomized controlled trial

ObjectiveTo compare the influences of acupuncture combined with rehabilitative training and simple rehabilitative training on neural functional recovery of stroke patients during recovery phase. MethodsSixty-seven stroke patients during recovery phase were randomly divided into an acupuncture combined with rehabilitative training group (group A) and a simple rehabilitative training group (group B) through random number table method, with 34 cases and 33 cases respectively; 33 cases and 31 cases were respectively completed actually other than cases dropped out during the observation. Rehabilitation methods such as motion control and functional exercise training were primarily used for rehabilitative training, once daily for 45 min at a time, and 6 times a week; Băihuì (▪ GV 20) and Fēngchí (▪ GB 20) on the head and relevant acupoints on limbs were selected for acupuncture, once every other day, and 3 times a week. Both groups were treated for 8 weeks, National lnstitnte of Health Stroke Scale (NIHSS) was used to assess neurologic impairment, Fugl-Meyer scale was used to assess motor function, Barthel was used to assess activity of daily living, and comprehensive assessment was finally made to patients. ResultsNIH score, Fugl-Meyer scale scores of upper and lower limbs, Barthel score, and comprehensive assessment of group A after treatment were respectively: 12.78±2.99, 37.55±2.09 and 25.67±3.93, 63.76+4.65, 11.33±1.98, superior to 16.06±4.57, 28.71+4.07 and 20.41±2.98, 53.82±4.35, 15.18±1.72 of group B. Indices of both groups were significantly improved compared with those before treatment (P<.01, P<0.05), but improvement of indices of group A was more obvious that that of group B after treatment subject to comparison (all P<0.05). ConclusionsAcupuncture combined with rehabilitative training has definite therapeutic effect on recovery of various functions such as neural functional recovery of stroke patients during recovery phase, obviously superior to simple rehabilitative training.

Dependence for basic and instrumental activities of daily living after hip fractures

The objective of the study is to determine basic activities of daily living (Barthel Index) and instrumental activities of daily living (Lawton-Brody Index) before and after hip fracture. Follow-up study of patients (n=100) with hip fracture, operated at Complejo Hospitalario Universitario de A Coruña (Spain). Period January/2009–December/2011. Demographic characteristic of the patients, Charlson Index, Glomerular filtration rate, Barthel index, Lawton index, type of proximal femur fracture and surgical treatment delay were recorded. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained. Before fracture were independent for activities of daily living (ADL) a 38.0%, at 90 days were 15.4%. The Barthel index score decreased from 75.2±28.2 to 56.5±31.8) (p<0.0001). If we consider the age, gender, comorbidity (Charlson index), renal function, fracture type and surgical delay objectify the only independent variable to predict dependency effect is age. If we also consider the Barthel score objectify the variable that significantly modifies that score at 90 days is the baseline value of the index. The prevalence of independence for instrumental activities of daily living (IADL) at the baseline moment is 11% and at 90 days is decreased to 2.2%. There is a decrease in the independence effect in all activities. The variable predictor of independence for all activities after taking into consideration age, sex, comorbidity, fracture type, surgical delay and renal function is the baseline score of the Barthel and Lawton index.

Atención al final de la vida en los pacientes con fibrosis pulmonar idiopática

AimTo describe the clinical course of patients with advanced idiopathic pulmonary fibrosis (IPF) followed up by a Palliative Home Care Supportive Team (PHCST). MethodsObservational, retrospective study of patients with IPF who were followed up by a PHCST during 2011,2012 and 2013. We analyzed: demographic characteristics, information level, performance status,, treatments, symptom control, last daýs situation, place of death, and care burden. Data were analyzed using SPSS®. ResultsA total of 6 patients were analyzed, with a mean age of 74, 4 males. At baseline: Barthel score 50 (SD 30), palliative performance score (PPS) 50 (SD 4), and Charlson Comorbidity Index 1.5 (SD 1.2). The main problems reported by patients were dyspnea with minimal activity (69% at baseline, 100% in the last week) and clinical signs of hypercapnia (16% at baseline, 50% in the last week). Five patients were informed about diagnosis and the prognosis. Patients were taking an average of 10 drugs, with 66% used inhalation drugs, and 100% used corticosteroids, opioids and high flow oxygen delivery. Four patients used subcutaneous route and morphine administration (mean dose of 25 mg/day). The place of death was at home (50%), and in a palliative care unit (50%). The median PHCST follow-up time was 18 days (4-210) with a mean of 5 (SD 4) PHCST visits during this period. The median survival time between diagnosis and death was 11.5 months (3-60). ConclusionPatients with IPF exhibit a very important dyspnea, very limiting that progresses even at rest, which would justify a narrow home monitoring by PHCST.

Stroke Recovery and Prevention Barriers Among Young African-American Men: Potential Avenues to Reduce Health Disparities

Background: African Americans (AAs) who experience a first time stroke are younger and have double the stroke rate and more poststroke complications than other Americans. Objective: To assess perceived poststroke care barriers among younger AA men and their care partners (CPs) in order to inform the development of acceptable and effective improvements in poststroke care for this high-risk group. Methods: Ten community-dwelling AA stroke survivors and 7 of their CPs participated in focus groups and advisory board meetings. Survivors had stroke or transient ischemic attack within 1 year and a Barthel Index score >60. In focus groups, using a semi-structured interview guide, survivors and CPs identified self-perceived barriers and facilitators to poststroke care. Thematic analysis of session transcripts and the constant comparative method were used to generate themes. Results: Survivor age ranged from 34 to 64 years. Mean Barthel score was 95.5. CPs, all AA women, ranged in age from 49 to 61 years. Five CPs were wives, 1 was a fiancée, and 1 was a niece. Participants cited multiple personal, social, and societal stroke recovery challenges. Although hypertension and smoking risks were acknowledged, stress, depression, posttraumatic stress disorder, anger/frustration, personal identity change, and difficulty communicating unique needs as AA men were more frequently noted. Facilitators included family support, stress reduction, and dietary changes. Conclusions: Younger AA men and their CPs perceive multiple poststroke care barriers. Biological risk reduction education may not capture all salient aspects of health management for AA stroke survivors. Leveraging family and community strengths, addressing psychological health, and directly engaging patients with health care teams may improve care management.

Predictive value of somatosensory evoked potentials for patients with severe traumatic brain injury.

RESIDENT AND YOUNG INVESTIGATOR AWARDS: Depuy Synthes Award for Resident Research on Brain and Craniofacial Injury

Avaliação da funcionalidade de pessoas com lesão medular para atividades da vida diária

Objetivo: aplicar el índice de Barthel en la evaluación de personas con lesión medular hospitalizada y en lo domicilio, comparando las condiciones de funcionalidad en el desarrollo de las Actividades de la Vida Diaria. Material y Método: estudio cuantitativo, transversal, realizado con 62 personas, hospitalizadas y en domicilios. Los datos fueron recolectados mediante un formulario con las variables de interés del estudio, en enero a mayo de 2010. Para a analice se utilizó el programa Predictive Analytics Software, con Pruebas de Mann — Whitney y Kruskal — Wallis. Resultados: la edad media de 37,5 años con desvío patrón de ± 13,74. En las actividades: baño un 79 % son dependientes; vestirse un 59 %; el uso de toielet un 91%; intestino un 81 % eran incontinentes; transferencias un 95 % presentaron incapacidad; actividad de movilidad un 94 % hacían con ayuda; utilización de escaleras con silla de ruedas en los hospitalizados un 94,1% presentaron incapacidad y en lo domicilio, un 78,5 %. El análisis de la puntuación final de Barthel obtuvo media del 48,4 % con desvío patrón de ± 32,62. Conclusiones: existe significancia acentuada en relación al grado de dependencia entre hospitalizados en relación a los que se encuentra en domicilio.

Physical inactivity post-stroke: a 3-year longitudinal study

Purpose: To explore change in activity levels post-stroke. Methods: We measured activity levels using the activPAL™ in hospital and at 1, 2 and 3 years’ post-stroke onset. Results: Of the 74 participants (mean age 76 (SD 11), 39 men), 61 were assessed in hospital: 94% of time was spent in sitting/lying, 4% standing and 2% walking. Activity levels improved over time (complete cases n = 15); time spent sitting/lying decreased (p = 0.001); time spent standing, walking and number of steps increased (p = 0.001, p = 0.028 and p = 0.03, respectively). At year 3, 18% of time was spent in standing and 9% walking. Time spent upright correlated significantly with Barthel (r = 0.69 on admission, r = 0.68 on discharge, both p < 0.01) and functional ambulation category scores (r = 0.55 on admission, 0.63 on discharge, both p < 0.05); correlations remained significant at all assessment points. Depression (in hospital), left hemisphere infarction (Years 1–2), visual neglect (Year 2), poor mobility and balance (Years 1–3) correlated with poorer activity levels. Conclusion: People with stroke were inactive for the majority of time. Time spent upright improved significantly by 1 year post-stroke; improvements slowed down thereafter. Poor activity levels correlated with physical and psychological measures. Larger studies are indicated to identify predictors of activity levels.Implications for RehabilitationActivity levels (measured using activPAL™ activity monitor), increased significantly by 1 year post-stroke but improvements slowed down at 2 and 3 years.People with stroke were inactive for the majority of their day in hospital and in the community.Poor activity levels correlated with physical and psychological measures.Larger studies are indicated to identify the most important predictors of activity levels.

Epidemiology, antibiotic therapy and clinical outcomes of healthcare-associated pneumonia in critically ill patients: a Spanish cohort study

PurposeInformation about healthcare-associated pneumonia (HCAP) in critically ill patients is scarce.MethodsThis prospective study compared clinical presentation, outcomes, microbial etiology, and treatment of HCAP, community-acquired pneumonia (CAP), and immunocompromised patients (ICP) with severe pneumonia admitted to 34 Spanish ICUs.ResultsA total of 726 patients with pneumonia (449 CAP, 133 HCAP, and 144 ICP) were recruited during 1 year from April 2011. HCAP patients had more comorbidities and worse clinical status (Barthel score). HCAP and ICP patients needed mechanical ventilation and tracheotomy more frequently than CAP patients. Streptococcus pneumoniae was the most frequent pathogen in all three groups (CAP, 34.2 %; HCAP, 19.5 %; ICP, 23.4 %; p = 0.001). The overall incidence of Gram-negative pathogens, methicillin-resistant Staphylococcus aureus (MRSA), and Pseudomonas aeruginosa was low, but higher in HCAP and ICP patients than CAP. Empirical treatment was in line with CAP guidelines in 73.5 % of patients with CAP, in 45.5 % of those with HCAP, and in 40 % of those with ICP. The incidence of inappropriate empirical antibiotic therapy was 6.5 % in CAP, 14.4 % in HCAP, and 21.8 % in ICP (p < 0.001). Mortality was highest in ICP (38.6 %) and did not differ between CAP (18.4 %) and HCAP (21.2 %).ConclusionsHCAP accounts for one-fifth of cases of severe pneumonia in patients admitted to Spanish ICUs. The empirical antibiotic therapy recommended for CAP would be appropriate for 90 % of patients with HCAP in our population, and consequently the decision to include coverage of multidrug-resistant pathogens for HCAP should be cautiously judged in order to prevent the overuse of antimicrobials.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-014-3239-2) contains supplementary material, which is available to authorized users.

Recovery coaching in an acute older people rehabiliation ward.

Our patient, carer, and staff feedback clearly tells us that elderly patients are frequently disempowered by acute care provision, environments, and attitudes. This debilitates individuals mentally and physically, reducing their independent functioning, and may mean that they require prolonged care or are unfit to return home.We developed the concept of “recovery coaching” to support acute inpatient elderly care rehabilitation. We designed a training intervention to achieve “coaching conversations” between our staff and our patients.Data were collected from 46 participants; 22 in the pre-intervention stage and 24 in the post-intervention stage. For the post-intervention patients, mean scores indicated that there was slightly higher increase in the patient's independence in terms of their Barthel (ADL) scores and that they reported higher feelings of self-efficacy. For this patient group it was also found that more returned home with the same level of care as on their admission, and that fewer patients required residential care placements at discharge.This innovative intervention allowed us to challenge the fundamental basis of “I do it for you” to “I will do it with you”, allowing the patient to become an integral partner in their health care.

Application of quantitative DTI metrics in sporadic CJD

Diffusion Weighted Imaging is extremely important for the diagnosis of probable sporadic Jakob–Creutzfeldt disease, the most common human prion disease. Although visual assessment of DWI MRI is critical diagnostically, a more objective, quantifiable approach might more precisely identify the precise pattern of brain involvement. Furthermore, a quantitative, systematic tracking of MRI changes occurring over time might provide insights regarding the underlying histopathological mechanisms of human prion disease and provide information useful for clinical trials. The purposes of this study were: 1) to describe quantitatively the average cross-sectional pattern of reduced mean diffusivity, fractional anisotropy, atrophy and T1 relaxation in the gray matter (GM) in sporadic Jakob–Creutzfeldt disease, 2) to study changes in mean diffusivity and atrophy over time and 3) to explore their relationship with clinical scales. Twenty-six sporadic Jakob–Creutzfeldt disease and nine control subjects had MRIs on the same scanner; seven sCJD subjects had a second scan after approximately two months. Cortical and subcortical gray matter regions were parcellated with Freesurfer. Average cortical thickness (or subcortical volume), T1-relaxiation and mean diffusivity from co-registered diffusion maps were calculated in each region for each subject. Quantitatively on cross-sectional analysis, certain brain regions were preferentially affected by reduced mean diffusivity (parietal, temporal lobes, posterior cingulate, thalamus and deep nuclei), but with relative sparing of the frontal and occipital lobes. Serial imaging, surprisingly showed that mean diffusivity did not have a linear or unidirectional reduction over time, but tended to decrease initially and then reverse and increase towards normalization. Furthermore, there was a strong correlation between worsening of patient clinical function (based on modified Barthel score) and increasing mean diffusivity.

Bipolar or unipolar hemiarthroplasty after femoral neck fracture in the geriatric population.

The choice of prosthesis in hemiarthroplasty is controversial for geriatric patients after femoral neck fracture. We hypothesised that selection criteria for unipolar or bipolar prostheses could be constructed based on factors affecting mortality. THE AIMS OF THIS RETROSPECTIVE STUDY WERE: (1) to determine the factors affecting mortality of femoral neck fracture patients ≥65 years of age; (2) to compare patient mortality rates, radiological findings, and functional outcomes according to prosthesis type (unipolar or bipolar); and (3) to evaluate the persistence of inner bearing mobility of bipolar prostheses. Retrospective comparative study. In total, 144 patients operated for hemiarthroplasty and aged ≥65 were included. We classified the patients into either unipolar or bipolar prosthesis groups. To reveal factors that affected mortality, age, sex, delay in surgery, and American Society of Anesthesiologists score were obtained from folders. Barthel Daily Living, Harris hip, and acetabular erosion scores were calculated and bipolar head movement was analysed for live patients. One-year mortality was 31.94%. Age ≥75 (p=0.029), male sex (p=0.048), and delay in surgery ≥6 (p=0.004) were the patient characteristics that were related to increased mortality. There were no significant differences in sex, age, American Society of Anesthesiologists score, delay in surgery, mortality, or Barthel, Harris, acetabulum scores between the two groups. Twenty patients from each group were admitted for last follow-up. Bipolar head movement was preserved for 33.3% of patients. They were inactive patients with low Barthel and Harris scores. Although bipolar head movement was preserved in inactive patients, we suppose that this conferred no advantage to these patients, who could hardly walk. In this study, male patients, those aged ≥75 years, and those operated at ≥6 days had an increased risk of mortality. Also, although not significant in multivariate analysis, high American Society of Anesthesiologists score (≥3) was related to increased mortality. Considering that one of three patients died during the first postoperative year, we think that these patients should be operated as soon as possible, and expensive bipolar prostheses must be used selectively in regard to patient characteristics.

Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case–control study

IntroductionHealthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current American Thoracic Society/Infectious Diseases Society...

Predictive factors for fear of falling after hip fracture

Introduction.– Bisphosphonate therapy may have biological effects beyond bone health, including effects on cardiovascular, immune and muscle function. We examined the association between bisphosphonate use and functional outcomes in the rehabilitation of older people. Methods.– This was a retrospective cohort analysis of routine data collected from the Dundee Medicine for the Elderly Service between 1999 and 2011. Data on admission and discharge 20-point Barthel score was combined with comorbid disease, biochemistry, haematology and community prescribing data. The cohort was split into four groups: current bisphosphonate users, previous users (prescribed prior to admission); subsequent users (prescribed only after admission); and never users. Difference in Barthel between admission and discharge was analysed, adjusting for baseline Barthel score, age, sex, comorbid disease, medication burden, recent hip fracture, baseline albumin, calcium, renal function and haemoglobin. Results.– Two thousand seven hundred and ninety-seven patients were included in this analysis. Mean age was 84.1 (SD 7.5); 1153 (41%) were male, and the mean baseline admission Barthel score was10.5 (SD3.8). After adjustment for theabovecovariates, current bisphosphonate therapy was associated with a greater improvement in Barthel score (5.0 points, 95% CI 4.3 to 5.7) compared to the never users (3.8 points, 95% CI 3.6 to 3.9, P<0.001) and previous users (3.4 points, 95% CI 2.8 to 4.0, P<0.001) groups. However, therewasnodifference from thosenot taking bisphosphonates, but who started use after discharge from rehabilitation (5.1 points, 95% CI 4.6 to 5.5, P=0.82). Conclusion.– Bisphosphonate therapy is not causally associated with improved functional outcomes from inpatient rehabilitation.

Bilateral leg edema in older patients

function and cognitive function on muscle strength. We evaluated the relationship between grip strength and severity of PD adjusting for major determinants of muscle strength. Methods.– Age, height, weight, maximum grip strength, Unified Parkinson’s Disease Rating Scale (UPDRS) motor score, Hoehn and Yahr (H & Y) stage, number of co-morbidities and medications, Barthel score, Mini Mental State Examination (MMSE), Malnutrition Universal Screening Tool (MUST) and number of falls in the last year were assessed with participants in the “on” state. Results.– Thirty-four men and 23 women with PD, mean age 71.3 (standard deviation (SD) 8.0) and 72.6 years (SD 7.6), living in one town in England were recruited. Each unit increase in UPDRS score (–0.3 kg (95% confidence interval (C.I.)–0.51, –0.09): P=0.006) and H & Y stage (–3.87kg (95%C.I.–6.54, –1.21): P=0.005) was significantly associated with lower grip strength in univariate linear regression analyses adjusted for gender. In a multivariate regression model the severity of PD (as indicated by UPDRS score or H&Y stage) was the most important determinant of grip strength after age, gender and height. Key conclusions.– Increased severity of Parkinson’s disease is significantly associatedwithmuscleweakness. This appears to be distinct from the effects of reduced physical function or poor cognition and the mechanism is unclear.