Rehabilitation Of Hip Fracture Patients Research Articles

Effect of Suanzaoren on Perioperative Analgesia, Hemodynamics and Postoperative Delirium

Hip fracture is not only accompanied by severe pain, but also impair body tissue and organ functions in patients, particularly in elderly individuals who have reduced tolerance and are prone to organ damage after experiencing a hip fracture. Surgery is the primary clinical approach for treating hip fractures. However, both the fracture trauma and surgical procedure can result in significant pain during the perioperative period, leading to abnormal hemodynamic fluctuations and an increased risk of postoperative delirium. Therefore, it is crucial to select an appropriate intervention method to facilitate the postoperative rehabilitation of hip fracture patients. Traditional Chinese Medicine (TCM) acknowledges that surgery will have different degrees of impact on muscles and bones, Qi and blood. Suanzaoren Decoction contains suanzaoren, anemarrhena asphodeloides, ligusticum chuanxiong and other TCM. The effective components of these TCM, such as spinosin, sarsasapogenin, and tetramethylpyrazine, have been proved to have analgesic effects. This study demonstrates, through clinical trials, that Suanzaoren Decoction exerts a positive influence on promoting the postoperative rehabilitation of hip fracture patients by reducing postoperative pain, stabilizing hemodynamic indexes, improving inflammatory state, and shortening the duration of postoperative delirium (all P <0.05). The fact that Suanzaoren Decoction can effectively promote the postoperative rehabilitation of hip fracture patients may be related to the anti-inflammatory, analgesic and neuroprotective effects of the effective ingredients in the prescription, such as spinosin, sarsasapogenin and tetramethylpyrazine. Therefore, this study believes that Suanzaoren Decoction+ERAS intervention program represents an optimal approach for hip fracture surgery patients within the perioperative period.

250 Streamlining rehabilitation for hip fracture patients: a pilot quality improvement project

Abstract Background University Hospital Waterford (UHW) is a busy trauma unit, serving five counties in Ireland’s South East. UHW treats approximately 400 hip fracture patients annually, 27% of whom are referred for off-site rehabilitation either locally or regionally. The national average Length-of-Stay (LoS) for hip fracture patients is 12 days, whereas in UHW the average LoS is 17 days, higher in those awaiting off-site rehabilitation (19 days). Earlier access to rehabilitation results in reduced LoS, better patient outcomes, and enhanced patient flow through the hospital system. Methods We created a pilot six-bedded rehabilitation unit in Kilcreene Regional Orthopaedic Hospital (KROH, an orthopaedic hospital affiliated with UHW) for hip fracture patients. Hip fracture patients for rehabilitation in KROH are identified by the Orthogeriatric team. Weekly multidisciplinary team meetings and wards rounds are conducted by the UHW based Orthogeriatric Consultant and Advanced Nurse Practitioner (ANP). We measured duration of time waiting for rehabilitation in hip fracture patients since this unit’s commencement and compared to data from a previous audit conducted in 2020 in hip fracture patients awaiting rehabilitation. Results Since April 19th 2023, seventeen hip fracture patients have been transferred to KROH for rehabilitation, fifteen of whom were transferred on the same day or the day after they were identified as medically fit and rehabilitation ready. To date, the longest wait time for transfer was three days in two patients. Data from 2020 indicated that the median wait for off-site rehabilitation in centres across the south-east was six days. Conclusion Early results indicate that this pilot six-bedded rehabilitation unit reduces the wait time for rehabilitation in selected hip fracture patients, enhances continuity of care, and improves patient flow through the hospital system. Our future aims include expansion of the unit and collaborating with regional integrated care services to ensure continuity of care post-discharge.

Feasibility, acceptability, and preliminary effects of PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP): a protocol for a mixed method study

BackgroundHip fractures in older adults are significant contributors to severe functional decline and disability as well as hospitalization and increased health care costs. Research shows that timely referral to geriatric rehabilitation leads to better patient outcomes. Currently, a wide variability in the timing, the frequency, and the choice of appropriate setting for rehabilitation of hip fracture patients exists.AimEvaluate the feasibility, acceptability, and preliminary effectiveness of PATH4HIP, a pathway intervention for timely transfer of post-operative geriatric hip fracture patients from hospital to rehabilitation to home.MethodsThis is a single-arm, pragmatic feasibility study to measure reach, effectiveness, adoption, implementation, and maintenance of PATH4HIP, a pathway for post-operative hip fracture patients from a large academic health science center to a geriatric rehabilitation service in Ottawa, Canada. During a 6-month period, all hip fracture patients, 65 years of age or older who have undergone surgery and have met the eligibility criteria (n = 96), will be transferred to the geriatric rehabilitation service no later than post-operative day 6. Patients (n = 10–12) and clinicians who are working on the orthopedic team (n = 10–12) and on the geriatric rehabilitation service (n = 10–12) will be invited to participate in an interview to share their feedback on the intervention’s feasibility and acceptability and to provide suggestions to improve PATH4HIP. Descriptive statistics will be used to summarize results of the quantitative data and content analysis will be used to analyze the qualitative data. The study will be open for recruitment from January to July 2022.DiscussionIf feasible, PATH4HIP will result in the reduction of the post-operative acute care length of stay to less than or equal to 6 days, while having no detrimental effect on rehabilitation outcomes such as functional gains, or discharge destination.

Evaluation of minimal fracture liaison service resource: costs and survival in secondary fracture prevention\u2014a prospective one-year study in South-Finland

BackgroundFracture liaison service (FLS) is a secondary prevention model for identification of patients at risk for fragility fractures.AimsThis study was conducted to evaluate the number and costs of secondary prevention of low-energy fractures in the city of Kouvola in Finland.MethodsWomen aged ≥ 45 years and men ≥ 60 years treated in the emergency department with a low-energy fracture were identified. Laboratory testing, BMI, and DXA scans were performed. Fracture Risk Assessment Tool was used. The direct FLS costs were calculated. Survival was analyzed using univariate and multivariate analysis and the life-table method.Results525 patients with 570 fractures were identified. The mean age of women was 73.8 years and of men 75.9 years. Most patients sustained wrist (31%), hip (21%) or proximal humerus (12%) fractures. 41.5% of the patients had osteoporosis according to DXA scans. 62% of patients used calcium and vitamin D daily and 38% started anti-osteoporotic medication. Protective factors for survival were: age < 80 years, female sex, and S-25OHD concentration of 50–119 nmol/L. Excess mortality was highest among patients with a fracture of the femur. The total annual direct costs of FLS were 1.3% of the costs of all fractures.DiscussionMany low-energy fracture types were associated with excess mortality. The use of anti-osteoporotic medication was not optimal.ConclusionsFLS increased the catchment of low-energy fracture patients and was inexpensive. However, identification, evaluation and post-fracture assessment of patients should be expedited. Rehabilitation of hip fracture patients needs to be improved.

Rehabilitation of hip fracture patients with Parkinson's Disease.

The incidence of hip fractures has increased over the past decades, and for patients with hip fractures, medical and social conditions have deteriorated during the same time. In this study the results of orthopaedic rehabilitation of patients with Parkinson's disease and a hip fracture are compared with those in all other hip fracture patients. A total of 74 patients with Parkinson's disease and hip fracture were compared with 1,361 patients without the disease. Prior to fracture, patients with Parkinson's disease were less likely to be living an independent life in their own homes. Postoperatively women with Parkinson's disease were hospitalized for a significantly longer period. Postoperative rehabilitation was significantly slower and less successful than among patients without the disease. Patients with Parkinson's disease comprise a subgroup of hip fracture patients who need more rehabilitation resources than can easily be provided at an ordinary orthopaedic ward. A team-work between an orthopaedic surgeon, a neurologist and a rehabilitation unit seems to be mandatory in order to achieve shorter hospitalization and earlier return to the pre-fracture environment.

Effect of hip rehabilitation exercise on functional rehabilitation of hip fracture patients after operation

目的 探讨髋部康复操训练对髋部骨折术后患者功能康复效果的影响。 方法 选取绍兴市中心医院2015年6月至2017年6月收治的68例髋部骨折术后的患者进行研究，按照随机数字表法将其分成两组。对照组给予一般性的护理指导，观察组在对照组基础上，对患者术后12个月内进行髋部康复操训练的护理。分析比较干预前和干预3、6、12个月，两组患者的Harris髋关节功能评分和生活活动能力评分。并对两组患者护理前后的情绪状况以及并发症的发生情况进行记录分析。 结果 干预前，两组患者Harris髋关节功能评分差异无统计学意义(P>0.05)；干预3、6、12个月后，两组患者Harris髋关节功能评分均显著升高[观察组干预前(53.76±2.94)分，干预3个月后(76.35±3.78)分，6个月后(80.31±4.26)分，12个月后(91.45±4.13)分，F＝5.039，P 0.05)；干预3、6、12个月后，两组患者生活活动能力评分均显著升高[观察组干预前(52.76±2.94)分，干预3个月后(65.44±7.71)分，6个月后(83.68±8.27)分，12个月后(92.46±8.13)分，F＝33.927，P<0.001；对照组干预前(51.34±2.95)分，干预3个月后(60.13±7.45)分，6个月后(72.91±7.69)分，12个月后(81.46±8.79)分，F＝34.318，P<0.001]，且观察组患者不同时间生活活动能力评分均明显比对照组患者高，两组比较差异有统计学意义(干预3个月后，t＝2.888，P＝0.0052；干预6个月后，t＝5.561，P<0.001；干预12个月后，t＝11.443，P<0.001)。干预后，两组患者的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均明显降低[观察组干预前SAS(64.78±7.03)分，干预后SAS(25.98±4.43)分，t＝27.227，P<0.001，干预前SDS(57.67±5.45)分，干预后SDS(23.54±4.43)分，t＝28.336，P<0.001；对照组干预前SAS(64.32±6.92)分，干预后SAS(43.12±5.34)分，t＝14.142，P<0.001，干预前SDS(58.24±6.01)分，干预后SDS(40.62±7.34)分，t＝10.830，P<0.001]，且观察组明显低于对照组，两组比较差异有统计学意义(干预前后，两组SAS比较，t＝14.404，P<0.001；干预前后，两组SDS比较，t＝11.617，P<0.001)。术后1个月，观察组患者腹胀、便秘发生率均明显低于对照组(观察组腹胀4例，便秘7例；对照组腹胀11例，便秘15例)，两组比较差异有统计学意义(两组腹胀例数比较，χ2＝4.191，P＝0.041；两组便秘例数比较，χ2＝4.300，P＝0.038)。 结论 髋部康复操训练在髋部骨折术后患者中的应用效果显著，能够有效改善髋关节功能以及生活活动能力，缓解患者不良心理，降低并发症发生率，值得广泛应用。

Functional recovery in hip fracture patients: the role of pharmacotherapy.

The aim of this prospective observational cohort study was to verify the relationship between number of drugs used and functional outcome in hip fracture patients undergoing rehabilitation. This study was conducted on 139 patients with hip fracture who underwent a rehabilitation program. Efficiency rate in the Functional Independence Measure (FIM) and Berg Balance Scale (BBS), and length of stay (LOS) were the outcome measures. At the end of rehabilitation, 66.1% of patients showed an increase in number of drugs used, while 33.9% used the same or lower number of drugs than at admission. At the end of rehabilitation patients with increased pharmacotherapy took a higher total number of drug classes (p = 0.001), had longer LOS (p = 0.009) and lower Berg efficiency (p = 0.048) than patients with the same or lower pharmacotherapy. The number of drugs used at discharge was an independent determinant of LOS (beta = 0.19, p = 0.022) and FIM efficiency (beta = - 0.20, p = 0.025). Age was a determinant of LOS (beta = 0.17, p = 0.044) and BBS efficiency (beta = - 0.23, p = 0.009), while CIRS severity was a determinant of BBS efficiency only (beta = - 0.22, p = 0.016). Findings of study indicate that in hip fracture patients, the number of drugs prescribed at discharge is an important indicator of LOS and rehabilitation efficiency. These findings can help the physician to better plan the rehabilitation of hip fracture patients who require polypharmacy.

Impact of heart failure on functional recovery after hip fracture.

[Purpose] Heart failure has been identified as a risk factor for reduced physical function and falls; however, the impact of heart failure on functional recovery after a hip fracture is unclear. This study aimed to examine how heart failure and pre-fracture physical function affect recovery after a hip fracture. [Participants and Methods] The study population consisted of 122 patients with sub-acute hip fracture (mean age 81.7 ± 9.7 years, 18.9% male) who were divided into two groups: heart failure and non-heart failure. The outcome measurement was the functional independence measure effectiveness. A two-way analysis of variance was performed to investigate how heart failure and ambulatory ability prior to hip fracture were related to the functional independence measure effectiveness. [Results] Seventeen patients (13.9%) had a history of heart failure. The two-way analysis of variance showed the two independent variables (heart failure and ambulatory ability before fracture) had significant main effects; however, their interaction effect was not significant. [Conclusion] Heart failure affects functional recovery after hip fracture independent of the pre-fracture physical function, and vice versa. Further research on rehabilitation in hip fracture patients with heart failure is required to develop strategies to overcome poor functional recovery in such patients.

Variation in Rehabilitation Treatment Patterns for Hip Fracture Treated With Arthroplasty

BackgroundRecommendations for health care redesign often advocate for comparative effectiveness research that is patient-centered. For patients who require rehabilitation services, a first step in this research process is to understand current practices for specific patient groups. ObjectiveTo document in detail the physical and occupational therapy treatment activities for inpatient hip fracture rehabilitation among 3 patient subgroups distinguished by their early rate of functional recovery between time of surgery to rehabilitation admission. DesignMulticenter prospective observational cohort, practice-based evidence, study. SettingSeven skilled nursing facilities and 11 inpatient rehabilitation facilities across the United States. ParticipantsA total of 226 patients with hip fractures treated with hip arthroplasty. MethodsComparisons of physical and occupational therapy treatment activities among 3 groups with different initial recovery trajectory (IRT) rates (slower, moderate, faster). Main Outcome Measure(s)Percent of patients in each IRT group exposed to each physical and occupational therapy activity (exposure), and mean minutes per week for each activity (intensity). ResultsThe number of patients exposed to different physical or occupational therapy activities varied within the entire sample. More specifically, among the 3 IRT groups, significant differences in exposure occurred for 44% of physical therapy activities and 39% of occupational therapy activities. More patients in the slower recovery group, IRT 1, received basic activities of daily living treatments and more patients in the faster recovery group, IRT 3, received advanced activities. The moderate recovery group, IRT 2, had some treatments similar to IRT 1 group and others similar to IRT 3 group. ConclusionsAnalyses of practice-based evidence on inpatient rehabilitation of hip fracture patients treated with arthroplasty identified differences in therapy activities among three patient groups classified by IRT rates. These results may enhance physiatrists', other physicians', and rehabilitation teams' understanding of inpatient rehabilitation for these patients and help design future comparative effectiveness research.

Men Recover Ability to Function Less Than Women Do

The aim of this study was to investigate the association between sex and functional outcome after acute inpatient rehabilitation in hip-fracture patients. We investigated 1094 of 1186 people admitted consecutively to our rehabilitation hospital because of a hip fracture. Functional outcome was assessed using Barthel Index scores. Barthel Index efficiency (improvement per day of stay length) and Barthel Index effectiveness (proportion of potential improvement achieved) were calculated. The median Barthel Index score at discharge from inpatient rehabilitation was 85 in the 970 women and 75 in the 124 men (interquartile range, 65-95 in women and 60-95 in men, P = 0.001). Both Barthel Index efficiency and effectiveness were significantly lower in men (P = 0.030 and P = 0.007, respectively). After adjustment for six confounders, we confirmed that men had lower Barthel Index scores (P = 0.030), Barthel Index efficiency (P = 0.024), and Barthel Index effectiveness (P = 0.040). The risk of achieving a low Barthel Index score (i.e., <85) at the end of acute inpatient rehabilitation was higher for men than for women (adjusted odds ratio, 2.055; 95% CI, 1.212-3.483; P = 0.007). In our large sample of hip-fracture patients, men had a significantly worse functional outcome than did women after acute inpatient rehabilitation.

Modeling the volume-effectiveness relationship in the case of hip fracture treatment in Finland

BackgroundA common argument in the recent health policy debate is that treatment is more effective among care providers with large volumes. It is challenging, however, to examine the volume-effectiveness relationship empirically. Several suggestions have recently been made for methodological improvements in the examination of the volume-effectiveness relationship. The aim of this study is to develop an extended methodology for examining the volume-effectiveness relationship and demonstrate it for the case of hip fracture treatment.MethodsData consisting of 22,857 hip fracture patients from 52 hospitals in Finland in 1998-2001 were extracted from the administrative registers. The relationship between hospital and rehabilitation unit volumes and effectiveness was examined using a statistical model that allowed risk adjustments and hierarchical modeling of volume trends, developed for the purposes of this study. Four-month mortality and the alternative register-based measure of maintainability were used as effectiveness indicators.ResultsNo clear relationship was found between hospital volume and the effectiveness of hip fracture treatment, but a novel result showing an association between the rehabilitation unit volume and effectiveness was detected. The face validity of the maintainability indicator seemed to be acceptable.ConclusionsThe methodological ideas presented allow for improved examination of the volume-effectiveness relationship. There are no indications that patients with hip fractures should only be treated in high-volume hospitals, though it may be beneficial to centralize the rehabilitation of hip fracture patients to specialized units.

Balance Confidence and Functional Balance in Relation to Falls in Older Persons with Hip Fracture History

To investigate whether self-assessed balance confidence and functional balance are associated with falls in older persons with hip fracture history. This study is a part of a larger study on functional capacity and exercise rehabilitation in hip fracture patients. Seventy-nine patients, operated at the local hospital for collum or trochanter fracture within one-half to 7 years, participated in the laboratory measurements. Balance confidence was assessed with Activities-specific Balance Confidence scale (ABC) and functional balance using the Berg Balance Scale (BBS). According to self-reported number of falls during the previous 6 months participants were classified as those with falls vs. no falls; recurrent falls (3 or more falls) vs. occasional/no falls (< 3 falls); indoor falls vs. no indoor falls; outdoor falls vs. no outdoor falls. The relationships between ABC, BBS, and fall status were tested by logistic regression. Lower BBS score was associated with all falls during previous 6 months (OR 0.929, 95% CI 0.875-0.987). Lower ABC score was associated with recurrent falling (OR 0.974, 0.952-0.998), as well as lower BBS score (OR 0.876, 0.797- 0.962). Additionally, lower ABC and lower BBS scores were related to indoor falls (ABC OR 0.975, 0.957-0.993; BBS OR 0.913, 0.852-0.978). Participants with outdoor falls did not differ from those with no outdoor falls in ABC scores or BBS. Self-assessed balance confidence and functional balance are related to prevalence of recurrent and indoor falls in older hip fracture patients. Therefore use of Activities-specific Balance Confidence scale and Berg Balance Scale might be reasoned to expand in evaluating the probability for falls among at-risk elders.

Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score

Objective: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients. Design: Prospective, descriptive study. Setting: An orthopaedic hip fracture unit in a university hospital. Patients: Four hundred and twenty-six consecutive hip fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria. Main outcome measure: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental score for cognitive dysfunction were performed. On the first three postoperative days patients were assessed with the cumulated ambulation score consisting of a cumulated assessment of simple ambulation characteristics with a score from 0 to18 (fully mobile). The three assessments were correlated to short-term outcome parameters. Results: The cumulated ambulation score was a highly significant predictor for length of hospitalization, time to discharge status, 30-day mortality and postoperative medical complications (P < 0.001 for all). The cumulated ambulation score was superior in its association with all postoperative outcome parameters to both the New Mobility Score and the mental score. A cumulated ambulation score of ±10 correlated with a 99% survival at one month and 93% discharge to own home. Conclusion: The cumulated ambulation score is a potentially valuable score for early prediction of short-term postoperative outcome after hip fracture surgery.

Influence of age, sex, fracture type and pre-fracture living on rehabilitation pattern after hip fracture in the elderly

Purpose: To evaluate the influence of background factors on the rehabilitation pattern after a hip fracture in the elderly.Method: Prospective registration based on the Swedish national register for hip fracture patients called RIKSHÖFT/SAHFE (Standardised Audit of Hip Fractures in Europe). The place of living was registered both before fracture and during the following four months period (120 days). Graphs were calculated and drawn based on day-to‐day changes. Also influences of age, sex, fracture type and type of operation were analyzed.Results: The patient's pre-fracture functional capacity as evidence by the place they were able to manage to live before the fracture was the most discriminating factor for the rehabilitation; more than sex, fracture type or type of operation. Age was also a highly discriminating factor with a pronounced influence on the rehabilitation pattern.Conclusions: These background parameters are very important factors when planning the rehabilitation of hip fracture patients. A strategy with individualized planning of the rehabilitation procedure will be highly necessary in the future, in view of the increasing amount of elderly with hip fractures prognosticated during the coming decades. The knowledge about influencing factors here presented will be useful when planning and performing the rehabilitation for this resource-consuming group of patients.

Rehabilitation of hip fracture patients with Parkinson's Disease

The incidence of hip fractures has increased over the past decades, and for patients with hip fractures, medical and social conditions have deteriorated during the same time. In this study the results of orthopaedic rehabilitation of patients with Parkinson's disease and a hip fracture are compared with those in all other hip fracture patients. A total of 74 patients with Parkinson's disease and hip fracture were compared with 1,361 patients without the disease. Prior to fracture, patients with Parkinson's disease were less likely to be living an independent life in their own homes. Postoperatively women with Parkinson's disease were hospitalized for a significantly longer period. Postoperative rehabilitation was significantly slower and less successful than among patients without the disease. Patients with Parkinson's disease comprise a subgroup of hip fracture patients who need more rehabilitation resources than can easily be provided at an ordinary orthopaedic ward. A team-work between an orthopaedic surgeon, a neurologist and a rehabilitation unit seems to be mandatory in order to achieve shorter hospitalization and earlier return to the pre-fracture environment.

Perceived health in hip-fracture patients: a prospective follow-up of 100 patients.

We report the impact of the treatment and rehabilitation in hip-fracture patients by using self-assessment instruments of perceived health and relate them to objective outcome assessments, such as ADL (personal hygiene/dressing), walking ability and technical complications. Subjective and objective status for 100 hip-fracture patients admitted from their own home, and rehabilitated in primary health care, were registered over 1 year after fracture. Mean age was 74, and 80% of the patients were women. Two self-assessment questionnaires: the Nottingham Health Profile (NHP part 1) and the Mood Adjective Checklist (MACL) were answered by the patients 6 and 12 months after fracture and compared with functional status (ADL, and walking ability) 4 months after fracture. Problems related to the hip fracture such as pain and physical mobility had most effect on the self-assessment questionnaire (NHP) and were in accordance with the district physiotherapists' evaluation of function. Patients with complications (resulting in nail extraction and total hip replacement) after the primary hip osteosynthesis and patients with a poor function 4 months after fracture had scores in the self-assessment questionnaires indicating a more pronounced and distressing impact of the disease. Small changes in subjective mood (MACL) were found. In an acute, curable, disease such as hip fracture the objective outcome seems as informative as the subjective evaluations of patients' self-assessment.