Walking Aids Research Articles

Can Timed Up and Go Test discriminate the risk of falling in patients with Multiple Sclerosis with low to moderate impairment?

Purpose The aim of the study was to discriminate the risk of falling in patients with Multiple Sclerosis with low to moderate impairment who do not use walking aid using the Timed Up and Go (TUG) Test. Methods This study was planned as a prospective descriptive study with 204 patients. Falls were recorded in three-month prospective diaries, and the balance was evaluated using the TUG Test. Results By using three-month prospective diaries, the mean age of 109 faller patients and 95 non-faller patients was 35.87 ± 8.35 and 35.35 ± 9.39 years, respectively. The faller group’s mean TUG Test score was 9.46 ± 4.14, whereas the non-faller group’s was 7.74 ± 2.02 s. The TUG Test has an area under the receiver operating characteristic curve value of 0.666 in discriminating fallers from non-fallers (0.592–0.740, %95 Cl). To identify fallers, the TUG Test score of ≥7.85 s has a sensitivity of 0.65 and a specificity of 0.65. Conclusion As a result of the present study, the TUG Test was found to have moderate sensitivity and specificity in predicting the risk of falling. It is not a sufficient stand-alone measure for fall risk prediction, so it is recommended that this test be included as part of a comprehensive falls screening programme.

Contemporary Outcomes of a National Fetal Spina Bifida Surgery Service.

To assess contemporary outcomes of fetuses who underwent open fetal spina bifida surgery in Canada. Our clinical program prospectively collected outcomes of all consecutive fetuses who underwent open fetal spina bifida closure at the Ontario Fetal Center in Toronto and who were at least 1year of age at the time of postnatal follow-up. We gathered information on the need for hydrocephalus treatment, motor function, bladder function, as well as neurodevelopment (Ages and Stages Questionnaire and Bayley's scales of infant development). Developmental outcomes were categorized as "Typical Development," "Possible Delay," or "Significantly Delayed." Between 2017 and 2022, 41 fetuses underwent open fetal spina bifida closure. Twenty-four patients (58.5%) responded to the questionnaire at a median age of 46.5months. Eight children (33.3%) required CSF diversion procedures. Bladder management included clean intermittent catheterization (43.5%), spontaneous voiding (34.8%), or both (21.7%), with 43.5% needing medication for overactive bladder. All patients could sit independently, with 50% walking outside and 50% crawling indoors. Among those walking outdoors (50%), 25% did so without orthotics or aid, 58.3% with orthotics, and 16.7% required additional walking aids. Most children demonstrated typical communication and problem-solving skills (79.2%), while gross motor development was significantly delayed in 91.7% of cases. Fine motor skills varied, with 56.5% showing typical development and 34.8% possibly experiencing delays. This study showed a mixed developmental profile among patients who underwent open fetal spina bifida repair, consistent with the MOMs trial findings.

Single-centre results of a randomised controlled trial comparing the Gamma3 nail and a sliding hip screw to treat AO type 31-A1 and 31-A2 trochanteric fractures.

The primary goal of this randomised controlled trial was to investigate whether there are differences in the outcome between the Gamma3 nail and a sliding hip screw (SHS) regarding quality of life 1 year after surgery. In a controlled randomised trial, we compared the Gamma3 nail (Stryker) and a SHS(Omega, Stryker) in the treatment of 193 patients with pertrochanteric fractures. The follow-up period was 12 months. The outcomes included the surgical duration, health-related quality of life measured with the EQ-5D Index and a Visual Analogue Scale (VAS), the living situation and use of walking aid before trauma and 52 weeks after surgery; the Parker Mobility Score; the Harris Hip Score; and the revision, complication and mortality rates. The Gamma3 group had a significantly shorter surgical duration than the SHS group (p < 0.0001). Implant-related complications were significantly lower in the Gamma3 group (p > 0.05). The revision rate was significantly lower in the Gamma3 group based on intention-to-treat (p = 0.0336) as well as as-treated (p = 0.0302) analyses. Otherwise, we did not find significant difference between the two groups regarding the EQ-5D Index and VAS scores, the Parker Mobility Score, the Harris Hip Score, the mortality rate, the use of walking aids and the living situation. There were no detectable differences between the groups in terms of quality of life and clinical scores 12 months after surgery. The surgical duration and revision rate were superior for the Gamma3 group.

Inertial measurement units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients: a feasibility study

IntroductionThis study evaluates the gait analysis obtained by Inetial Measurement Units (IMU) before and after surgical management of Spastic Equino Varus Foot (SEVF) in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort.MethodsPatients with post-stroke SEVF, who underwent surgery in a single hospital between November 2019 and December 2021 were included. The follow-up duration was 6 months and included a functional analysis using Goal Attainment Scaling (GAS) and a Gait analysis using an innovative Multidimensional Gait Evaluation using IMU: the semiogram.Results20 patients had a gait analysis preoperatively and at 6 months postoperatively. 90% (18/20) patients had a functional improvement (GAS T score ≥ 50) and 50% (10/20) had an improvement in walking technique as evidenced by the cessation of the use of a walking aid (WA). In patients with functional improvement and modification of WA the change in the semiogram area was + 9.5%, sd = 27.5%, and it was + 15.4%, sd = 28%. In the group with functional improvement without change of WA. For the 3 experiences (two patients) with unfavorable results, the area under the curve changed by + 2.3%, -10.2% and − 9.5%. The measurement of the semiogram area weighted by average speed demonstrated very good reproducibility (ICC(1, 3) = 0.80).DiscussionIMUs appear to be a promising solution for the assessment of post-stroke hemiplegic patients who have undergone SEVF surgery. They can provide a quantified, objective, reliable in individual longitudinal follow up automated gait analysis solution for routine clinical use. Combined with a functional scale such as the GAS, they can provide a global analysis of the effect of surgery.

Balance impairment and associated factors among stroke survivors in public hospitals of Amhara regional state: a multicenter cross-sectional study

IntroductionBalance impairment is one of the common impairments in patients after stroke. It can lead to depression reduced speed of mobility, dependent on assistive device and reduce quality of life. However, evidence on balance impairment and its risk factors among stroke survivors in Ethiopia was lacking particularly in the study area. Therefore, this study aimed to investigate prevalence and associated factors of balance impairment among stroke survivor’s attendee at an outpatient clinic in Amara regional state comprehensive specialized hospital.MethodsAn institutional based cross-sectional study was conducted from April1-June 30, 2022. A total of 400 participants were selected using the systematic random sampling technique. Standard Berg balance scale tool and semi-structure questionnaire was used. Multicollinearity and model fitness were checked. Variables with a p-value of less than 0.25 in the Bivariable regression were entered into a multivariable logistic regression and p value < 0.05 was used as cutoff point for significant variables.ResultThe prevalence of balance impairment was 51.5% (95% CI (46.58, 56.39). Being depressed (AOR = 12.25:95% CI (4.727, 31.779), using walking aids (AOR = 8.76:95%CI3.469, 22.117)), abnormal speed (AOR = 6.73:95%CI (2.671, 16.977)), did not have physiotherapy treatment (AOR = 3.96:95%CI (1.483, 10.586), and unmarried (AOR = 2.71, 95% CI = 1.061, 6.903) were significantly associated with balance impairment.Conclusion and recommendationThe prevalence of balance impairment in the study was high. Being depressed, use walking aids, did not have physiotherapy treatment, abnormal speed of mobility, and unmarried were significantly associated factors. Therefore; it is better to give greater emphasis for those factors.

Reliability of self-measured objective functional impairment using the timed up and go test in patients with diseases of the spine.

Accurate assessment of a patient's functional status is crucial for determining the need for treatment and evaluating outcomes. Objective functional impairment (OFI) measures, alongside patient-reported outcome measures (PROMs), have been proposed for spine diseases. The Timed-Up and Go (TUG) test, typically administered by healthcare professionals, is a well-studied OFI measure. This study investigates whether patient self-measurement of TUG is similarly reliable. In a prospective, observational study, patients with spinal diseases underwent two TUG assessments: one measured by a healthcare professional and one self-measured by the patient. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects model, considered excellent between 0.75 - 1.00. Paired t-tests directly compared both measurements. The impact of variables such as age, sex, disease type, symptom severity (via PROMs), comorbidities, and frailty on reliability was also analysed. Seventy-four patients were included, with a mean age of 62.9years (SD 17.8); 29 (39.2%) were female. The majority (64.9%) were treated for degenerative disc disease. The lumbo-sacral region was most affected (71.6%), and 47.3% had previous surgeries. Patient self-measurement reliability was excellent (ICC 0.8740, p < 0.001), and the difference between healthcare professional (19.3 ± 9.4s) and patient measurements (18.4 ± 9.7s) was insignificant (p = 0.116). Interrater reliability remained high in patients > 65years (ICC 0.8584, p < 0.001), patients with ASA grades 3&4 (ICC 0.7066, p < 0.001), patients considered frail (ICC 0.8799, p < 0.001), and in patients not using any walking aid (ICC 0.8012, p < 0.001). High symptom severity still showed strong reliability (ICC 0.8279, p < 0.001 for Oswestry Disability Index > 40; ICC 0.8607, p = 0.011 for Neck Disability Index > 40). Patients with spine diseases can reliably self-measure OFI using the TUG test. The interrater reliability between self-measurements and those by healthcare professionals was excellent across all conditions. These findings could optimize patient assessments, especially in resource-limited settings.

Longitudinal impact of multi-segment spinal fixation surgery on mobility status and clinical outcomes in adult spinal deformity: a multicenter retrospective study.

To investigate changes in postoperative mobility status in patients with ASD, and the determining factors that influence these changes and their impact on clinical outcomes, including the rate of home discharge and long-term mobility. A total of 299 patients with ASD who underwent multi-segment posterior spinal fusion were registered in a multi-center database were investigated. Patient mobility status was assessed using walking aids and classified into five levels (1: independent, 2: cane, 3: walker, 4: assisted, and 5: wheelchair) preoperatively, at discharge, and after 2years. We determined improvements or declines in the patient's mobility based on changes in the classification levels. The analysis focused on the factors contributing to the deterioration of postoperative mobility. Two years postoperatively, 87% of patients maintained or improved mobility. However, 27% showed decreased mobility status at discharge, associated with a lower rate of home discharge (49% vs. 80% in the maintained mobility group) and limited improvement in mobility status (35% vs. 5%) after 2years. Notably, postoperative increases in thoracic kyphosis (7.0 ± 12.1 vs. 2.0 ± 12.4°, p = 0.002) and lower lumbar lordosis (4.2 ± 13.1 vs. 1.8 ± 12.6°, p = 0.050) were substantial factors in mobility decline. Postoperative mobility often temporarily decreases but generally improves after 2years. However, an overcorrection in sagittal alignment, evidenced by increased TK, could detrimentally affect patients' mobility status. Transient mobility decline associated with overcorrection may require further rehabilitation or hospitalization. Further studies are required to determine the biomechanical effects of surgical correction on mobility.

Risk assessment model used to predict discharge care after total hip and total knee arthroplasty: A population-based study

BackgroundTransfer to a post-acute care facility or hospital readmission after total joint arthroplasty represent additional costs and increased surgical and health care resource utilization. Accurate prediction of post-acute care factors could help providers to plan the patient's discharge destination and have a positive impact on postoperative outcomes and readmission rates. ObjectiveTo develop a risk assessment model to predict discharge care after total hip arthroplasty (THA) and total knee arthroplasty (TKA). DesignA retrospective longitudinal observational study. Settingsand participants: This study included 209 patients who underwent primary unilateral THA or TKA at a major academic medical center in Switzerland from January 2018 to December 2019. MethodsA collection of computerized- and paper-recorded data identified the discharge destination, socio-demographic factors, comorbidities, and other factors related to the patient. Univariate and multivariate analyses were performed to describe the predictors of post-surgical discharge destinations. ResultsThe characteristics associated with post-acute care after primary unilateral THA or TKA were the absence of a caregiver, advanced age, female gender, presence of walking aids, high ASA score, and comorbidity severity. A prediction model demonstrated that these six characteristics were associated 52 % with discharge to a post-acute care destination. ConclusionsThis study allowed us to identify predictors of discharge to a post-surgical destination. Predictive models can be efficiently used to better predict which patients are predisposed to post-acute care after hospital discharge. Further studies are needed to determine the optimal criteria for different destinations.

A Study To Investigate Fear Of Falling On An Age-Related Rehabilitation Unit

Abstract Background Fear of falling (FOF) is a lasting concern about falling that can lead an individual to avoid activities that he/she remains capable of preforming. Due to a FOF many older adults restrict their activities and subsequently increase their risk of falls. The aim of this study was to 1. Obtain a profile of FOF in an age-related inpatient population 2. Determine the severity of their FOF 3. Collect mobility status and falls history. Methods All current inpatients on two age-related rehabilitation units (age &amp;gt;/= 65 years) with sufficient communication were included. Patients were facilitated to complete The Falls Efficacy Scale International (FES-I) which is a 16-point scale that is valid and reliable. A score of 16-19 indicates a low concern, 20-27 moderate concern and 28-64 a high concern about falling. A two-point convenience sampling at summer and winter period was used. Data was anonymized and recorded using Microsoft excel. Results 68 questionnaires were collected. 40% of patients were independently mobile (+/- a walking aid), 16% required supervision, 26% assistance of one and 18% assistance of two. 100% of patients had a FOF (FES-I score &amp;gt;16). 80% (N=54) of patients had a high FOF, 13% (N=9) had a medium FOF, and 7% (N=5) a low FOF. 75% (N=51) of patients had a documented falls history. 80% (N=41) of people with a falls history had a high FOF. 76% (N=13) of those with no falls history had a high FOF. Conclusion This the first profile of FOF in our age-related rehabilitation unit. 93% of patients reported a high or medium FOF with high rates reported independent of a history of falling. Addressing FOF with evidence-based interventions and psychological support may reduce length of stay and increase successful discharges from older person rehabilitation units.

An Audit Of Falls Admissions Documentation To A University Hospital: Cycle 1

Abstract Background 30% of adults aged 65 years and older experience a fall annually which can result in significant disability. The World Falls Guidelines (WFG) 2022 were developed to guide non-specialist clinicians in undertaking a falls assessment for high vs low/medium risk of further fall. Methods The medical admission list from July 2023-October 2023 was reviewed and 165 charts were requested for admissions listed as “fall’, ‘syncope’, ‘collapse’ and ‘pre-syncope’. Of 93 charts reviewed, 60 admissions were included in the audit. Of the 26 criteria listed in the WFG 2022, 10 were included in this audit. The index admission document was assessed for documentation of demographics, description of fall, any falls in preceding year, documentation of syncope, documentation of injury, cardiac and neuro examination, walking aids, comment on the cause of fall, medication review and time to mobility assessment. A pre-morbid Rockwood Clinical Frailty Score (CFS) was assigned on chart review. Results 40% were male and 60% were female. Mean age of patients was 80.25 years (SD=8.4) with a mean CFS of 3.6 (SD=1.89). 91.7% documented some descriptor of the fall, 50% documented asking about syncope, 33.3% documented asking about previous falls. 96.7% had a documented cardiac exam, while only 71.1% documented a neuro exam and 41,7% documenting mobility baseline. 60% had a medication review documented and 41.6% had mobility assessed in under 72 hours. Only 76.7% of admissions had a documented differential for the fall. Conclusion Further education is required to adequately risk stratify patients admitted with falls and help guide appropriate investigation and workup as well as promote thorough documentation. An education session was conducted with Medical SHOs on May 14th, 2024, and Cycle 2 of the audit will commence June 2024.

Continuous Gait Phase Estimation for Multi-Locomotion Tasks Using Ground Reaction Force Data.

Existing studies on gait phase estimation generally involve walking experiments using inertial measurement units under limited walking conditions (WCs). In this study, a gait phase estimation algorithm is proposed that uses data from force sensing resistors (FSRs) and a Bi-LSTM model. The proposed algorithm estimates gait phases in real time under various WCs, e.g., walking on paved/unpaved roads, ascending and descending stairs, and ascending or descending on ramps. The performance of the proposed algorithm is evaluated by performing walking experiments on ten healthy adult participants. An average gait estimation accuracy exceeding 90% is observed with a small error (root mean square error = 0.794, R2 score = 0.906) across various WCs. These results demonstrate the wide applicability of the proposed gait phase estimation algorithm using various insole devices, e.g., in walking aid control, gait disturbance diagnosis in daily life, and motor ability analysis.

Prediction of abnormal gait behavior of lower limbs based on depth vision

Abstract As a kind of lower-limb motor assistance device, the intelligent walking aid robot plays an essential role in helping people with lower-limb diseases to carry out rehabilitation walking training. In order to enhance the safety performance of the lower-limb walking aid robot, this study proposes a deep vision-based abnormal lower-limb gait prediction model construction method for the problem of abnormal gait prediction of patients’ lower limbs. The point cloud depth vision technique is used to acquire lower-limb motion data, and a multi-posture angular prediction model is trained using long and short-term memory networks to build a model of the user’s lower-limb posture characteristics during normal walking as well as a real-time lower-limb motion prediction model. The experimental results indicate that the proposed lower-limb abnormal behavior prediction model is able to achieve a 97.4% prediction rate of abnormal lower-limb movements within 150 ms. Additionally, the model demonstrates strong generalization ability in practical applications. This paper proposes further ideas to enhance the safety performance of lower-limb rehabilitation robot use for patients with lower-limb disabilities.

An observational study of the impact of professional walking aid prescription on gait parameters for individuals with suspected balance impairments

BackgroundThe primary management strategy for gait impairment is the adoption of a walking aid. However, there are no established criteria upon which to base a decision regarding the need for a walking aid. It appears clinicians prescribe aids based on preference, clinical experience and intuition rather than standardised objective rationale. This may contribute to the inconsistent gait response to walking aids reported in the published literature. Understanding gait changes resulting from gait aid usage may have significant impact on clinical practice by improving confidence of prescribing clinicians and compliance of walking aid usage by patients, maximising the benefits of use, and reducing any risks associated with non-use or inappropriate use, of the walking aid. Research questionDo professionally prescribed walking aids improve gait parameters? MethodsThis is a secondary data analysis of a cross-sectional study where participants, identified by healthcare staff requiring a mobility assessment due to potential balance impairment of any cause, walked a 20-m straight walking course under three different walking conditions (no aid, walking stick and 4-wheeled walker). Fifty-eight participants were recruited. Commonly reported spatial and temporal gait parameters were assessed using a validated gait analysis device. Changes in gait parameters across the three conditions were compared, noting the individual's professionally prescribed aid and interpreting changes in parameters towards outcomes of the ‘no aid required group’. Results and significanceGait cycle, cadence, stance, swing and stride length during unaided walking were significantly changed when a walking stick was prescribed (p < 0.05). Stance, swing, double support, stride length, speed, max toe clearance and minimum toe clearance were significantly changed when a 4-wheel walker was prescribed (p < 0.05). Professional walking aid prescription improves some gait parameters. A greater number and magnitude of gait parameter improvements were seen in people requiring a 4-wheel walker than people requiring a walking stick.

Risk Factors and Profiles of Falls Among Inpatients in Vietnam: A Multicenter Nested Case-Control Study.

Falls among inpatients represent a significant global health concern and are among the leading causes of accidental death. However, hospital falls are context- and population dependent. This study aimed to investigate the risk factors contributing to falls and the fall profiles among Vietnamese inpatients. A nested case-control study was conducted at nine public hospitals in Ho Chi Minh City. For every fall identified through the medical fall incident reporting system, four controls (ie, nonfall patients) were also selected from medical records within the same department and timeframe. Medical records were extracted, which included detailed information about the falls. Among 101 fall cases and 404 nonfall controls, several risk factors for falls were found, including reduced strength and mobility (OR=3.08, 95% 1.30-7.30), nocturia (OR=9.08, 95% CI 4.04-20.45), having more than two diseases (OR=2.76, 95% CI 1.53-4.98), using walking aids (OR=23.26, 95% CI 10.20-53.03), using medical devices (OR=3.44, 95% CI 1.92-6.15) and using antiepileptics (OR=3.94, 95% CI 1.22-12.77). About 19.8% of the falls occurred within the first 24 hours from admission and the most common time of falls was from 0:00 am to 5:59 am (44.6%). The patient bed and bathroom were the most frequent locations for falls, accounting for 44.55% and 37.62% of the cases, respectively. More than 40% of the falls occurred when the patients were with their personal caregivers. Although intervention programs can use these risk factors to target those who have a high risk of falling, to optimize resources, such programs should consider the fall patterns found in our study.

240 Does fall prevention also have to hinder physical activity?

Abstract Purpose Physical activity is effective for preventing falls and improves physical and mental health, increase function and quality of life. Regarding people at high risk of falling, such as residents at nursing homes, global guidelines recommend individually adapted exercise programs to prevent falls. These guidelines are not followed. We aimed to map out physical activity among people living at a nursing home. To our knowledge, this is the first study measuring physical activity 24 hours per day among residents at a nursing home. Method In this pilot study, persons who lived at one nursing home and could walk without a walking aid wore an Inertial Measurement Unit for 24 hours per day for 3 months. Main outcome measure was steps per day. For each participant, the mean steps per day during the period was calculated and for the total group, the median value of the mean steps per day was calculated. Results The participants (n = 5), three women and 2 men, 72 to 98 years old, walked in a median of 65 steps per day (10-356). Conclusion In Sweden, instead of following guidelines, technical solutions that monitor if a person tries to move are introduced at nursing homes, often in the form of web cameras. This means that falls are prevented by hindering physical activity and making sure the residents do not move at all. Our study shows that people living in nursing homes can have a very low level of physical activity. We call on all responsible organizations to initiate activities and efforts that enable rather than hinder physical activity. For example, use technology that promotes physical activity, build gyms located in nursing homes, use Virtual Reality to make the bike ride seem to take place outside in a beautiful landscape, and employ physiotherapists who can do balance-training exercises on an everyday basis.

Effect of a digital two-dimensional animation program on attitude toward walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities

The study investigated the impact of a two-dimensional animation program on attitudes towards walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities. A quasi-experimental pretest-posttest control group study was conducted on 128 older adults aged 60 years and above. The intervention group showed more favorable attitudes towards walking aids, improved cane and walker use, and reduced fall concerns. The 2D animation program proved to be an innovative teaching strategy that positively influenced attitudes, performance, and fall-related concerns among elderly residents. Integration into care settings could enhance mobility, reduce fall risks, and contribute to overall well-being.

Sarcopenia and self-reported markers of physical frailty in patients with osteoporosis

SummaryBone and muscle impairment, named osteoporosis and sarcopenia, may co-occur with age, and patients with both disorders might exhibit physical frailty. One-hundred sixty-three patients were included. 14.2% had both disorders and presented more frequent with previous fall, reduced daily activity level, walk/balance challenges, and need of walking aid, indicating overall frailty.PurposeIn older adults, sarcopenia (muscle impairment) and physical frailty may accompany osteoporosis (bone brittleness), yet osteoporosis is typically assessed without evaluating these conditions, even though coexistence may contribute to exacerbated negative health outcomes. We aimed at evaluating the prevalence of sarcopenia and impaired muscle domains in osteoporotic patients and explore the risk of osteosarcopenia from markers of physical frailty.MethodsIn Copenhagen, Denmark, osteoporotic patients aged 65 + were assessed cross-sectionally in 2018–2019. Evaluations included muscle mass, strength, and function; bone mineral density; and self-reported physical activity, fall, balance challenges, dizziness, and the need of walking aid. Low bone mass, low-energy fracture, or treatment with anti-osteoporotic medication defined patient with osteoporosis, and sarcopenia was defined by low muscle strength and mass. Osteosarcopenia was defined from the coexistence of both conditions.ResultsOne-hundred sixty-three patients with osteoporosis were included. Of those, 23 (14.2%) exhibited sarcopenia, hence osteosarcopenia. Hand-grip-strength, 30-s-chair-stand-test, relative-appendicular-lean-muscle-mass, and gait-speed were below cut-off levels in 21.0%, 30.9%, 28.8%, and 23.6% of the patients, respectively.Previous fall, activity level, walk and balance challenges, and need of walking aid were statistically (or borderline) significantly more often affected in the osteosarcopenic group compared with the solely osteoporotic. Logistic regression analysis, however, revealed that only the need for walking aid significantly increased the risk of an osteosarcopenia diagnosis (odds ratio 5.54, 95% CI (1.95–15.76), p < 0.01).ConclusionsSarcopenia and impaired muscle domains were frequent in osteoporotic patients, as were markers of physical frailty, indicating the need of thorough examination of osteoporotic patients.

A comparison of the clinical efficacy of total hip arthroplasty via direct anterior approach and posterior approach: A meta-analysis.

The approach of total hip arthroplasty (THA) has long been controversial, and many studies have compared different approaches. However, there is still a lack of consistent conclusions and comprehensive, systematic comparisons and evaluations. This study retrieved 7 databases: PubMed, Web of Science, Embase, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang Database. The search time ranged from the establishment of each database to November 1, 2023. Data analysis was performed using Review Manager 5.4, and outcome was presented as the weighed mean difference for continuous data and risk/odds ratio for dichotomous data. We used the Mantel-Haneszel method and random effects model to obtain the overall effects of the differences in the impact of 2 surgical methods on clinical outcomes in all included studies. A total of 33 articles were included in this study, including 14478 participants, 4911 participants in DAA group and 9567 participants in PA group. The visual analogue scale scores of the DAA group at 1 day and 2 days after THA were significantly lower than those of the PA group (mean difference [MD] = -0.56, 95% confidence interval [CI]: -0.83 to -0.30, P < .01) at 1 day and (MD = -0.67, 95% CI: -1.16 to -0.17, P = .01) at 2 days. The risk of intraoperative fracture (odds ratio = 2.18, 95% CI: 1.11-4.29, P = .05) and lateral femoral nerve injury (risk ratio = 7.84, 95% CI: 1.69-36.42, P < .01) in the DAA group was significantly higher than that of the PA group. The number of prostheses in the Lewinnek safe zone of the DAA group was significantly higher than that of the PA group (risk ratio = 1.13, 95% CI: 1.00-1.27, P = .05). The results showed no significant difference between the DAA group and the PA group in the time to stop using walking aids, dislocation rate, groin pain, incision complications, heterotopic ossification, intraoperative blood loss, and acetabular anterior (P > .05). Compared with the PA group, patients in the DAA group showed more ideal anatomical and imaging results, shorter hospital stay, and showing advantages in postoperative pain, but with a higher incidence of intraoperative complications.

2151 A retrospective analysis of outcomes in inpatient fallers who sustain a neck of femur fracture

Abstract Introduction Inpatient fallers make up the minority of neck of femur fractures (NOF) in Morriston Hospital but it was observed that outcomes were less favourable than those in patients who sustained their fracture outside of hospital. Method Retrospective analysis was conducted of all NOF patients managed in Morriston Hospital whose injury was the result of an inpatient fall between January 2022 and December 2023. Outcomes were compared to those in all other NOF patients including pathological and occult fractures managed in the centre over the same two-year period. Anonymised data were collected from departmental and electronic patient records. Results A total of 1383 NOF patients were analysed of whom 51 sustained their fracture whilst as inpatients across four hospital sites. Among inpatients 35% were identified as requiring supervision when mobilising, the majority required walking aids (73%) and fell on medical wards (65%). Median length of stay prior to falling was 25 days (range 1–171). Patients who sustained a NOF as an inpatient had a lower initial abbreviated mental test scores (p 0.001) and higher frailty scores (p 0.0001) compared to all others, they also had a longer length of stay post injury (Median 23 days vs 17 days p 0.002). Mortality was significantly higher among inpatient fallers Odds Ratio (OR) 4.0 and they were significantly less likely to be discharged to their own home OR 0.3. Post-operative delirium was also seen more frequently OR 2.1. Conclusion This data demonstrates that morbidity and mortality is significantly greater among those who fall and sustain a NOF fracture as an inpatient compared to all others. Further work, particularly the timing of inpatient falls in relation to staff handover, is being continued to investigate whether there are any modifiable factors to reduce inpatient falls and the burden of their consequences.

Compliance Analysis of Nurses in Implementing Fall Risk Prevention in Post-Op Patients in the Jepun Room of Bali Mandara Hospital: A Case Study

Falling risk is an increased sensitivity to falling that can result in physical injury and health problems. Nurses play a crucial role in reducing the risk of falls among patients in hospitals; therefore, nurses must adhere to established fall prevention protocols. The aim of this study is to assess nurses' compliance in implementing fall prevention measures for post-operative patients in the Jepun Room of Bali Mandara Regional General Hospital. The research design used is descriptive analysis in the form of a case study, with the study population consisting of 3 nurses from the Jepun Room at Bali Mandara Regional General Hospital. This study observes nurses' compliance in implementing fall risk prevention measures for patients. Based on observations, it was found that the implementation of mild fall risk prevention measures by 3 responsible nurses achieved 100% compliance. Specifically, ensuring non-slip footwear was applied 100% on the first day, with the lowest application being 0% on day 2 and 3. Meanwhile, measures such as providing patient orientation, obtaining patient consent to keep night lights on, and ensuring walking aids are within reach (if used) were never implemented, also at 0%. Regarding moderate fall risk prevention measures by these nurses, it was found that implementation was 100%. However, the installation of fall risk signs outside patient rooms had 0% implementation. From these findings, the role of these nurses as care coordinators in implementing fall risk prevention measures for patients is crucial to prevent undesired incidents.