Dissertation committee:
Ανδρέας Φ. Μαυρογένης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Παναγιώτης Κουλουβάρης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Παναγιώτης Ι. Παπαγγελόπουλος, Καθηγητής, Ιατρική, ΕΚΠΑ
Όλγα Σαββίδου, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Δημήτριος Φιλιππιάδης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Ολυμπία Παπακωνσταντίνου, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Βασίλειος Κοντογεωργάκος, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Introduction: Hip fractures are probably the most common surgical injury among elderly individuals and, apart from the fact that they present high mortality rates, they should also be considered as a debilitating injury. At the same time, they provide a clear challenge for the orthopedic surgeon and they stand as a serious economic burden for health systems worldwide. Given the above, any kind of improvement in the means of postoperative rehabilitation process should be considered as a significant evolutionary goal.
Aim: In the present study, we aim to evaluate postoperative physical activity of hip fracture patients, using both subjective and objective methods. By asking patients to answer questionnaires pre- and postoperatively and undergo functional tests, we try to identify the level of their postoperative functionality at successive follow-up periods and, hopefully, highlight those aspects of the rehabilitation process that may require improvements of any kind.
Material and Methods: The sample of the study has been created by patients over 65 years of age administered in the 1st Department of Orthopedics, National and Kapodistrian University of Athens (NKUA), University General Hospital “ATTIKON”, Athens, Greece because of hip fracture, both peritrochanteric and femoral neck, between January 2015 and June 2017. Exclusion criteria were final stage cancer, neurological disease, pathological fractures, dementia, clinical depression, symptomatic arthritis of the contralateral leg and significant walking compromise requiring any means of walking aid before the fracture. Patients of the final study sample completed a series of questionnaires evaluating physical performance at time of hospitalization, 2 months and 1 year postoperatively. They also underwent functional tests at the same follow-up points. Finally, each individual patient was handed a portable pedometer, which calculated the overall count of steps made during the course of 48 hours. For the statistical analysis, the paired sample t-test was applied.
Results: The final study sample consisted of 147 patients (50 men and 97 women) of middle age of 79.2 years, range, 65 – 102. The mean duration of hospitalization was 13.7 days, range, 3 – 29, divided into a mean of 8.1 days, range, 0 – 19 preoperatively and 5.5 days, range, 2 – 17 postoperatively. The results of the WHOQOL-Bref, IPAQ and ABC questionnaires presented a significant deterioration at first follow-up followed by a slight improvement at one year postoperatively. The grade of improvement varied depending on the questionnaire. Similar results were obtained by the Tinetti, Timed-Up-and-Go and Sit-to-Stand tests as well. The overall pace count was significantly low at both follow-up periods, with the last number being significantly higher as anticipated. The mean values obtained at both follow-ups however resemble to those of patients of serious neurological or functional compromise, a fact that proves the debilitating nature of hip fractures.
Conclusion: This study proves and further enhances existing knowledge that hip fractures represent a serious debilitating injury, resulting to significant deterioration of quality of life, despite the improvement that should be anticipated at one year postoperatively. Appropriate physiotherapeutic interventions can facilitate the overall rehabilitation process and significantly improve final functional results. Pace count by the means of a portable pedometer provides an easily applicable, fast, directly comparable and reliable method of evaluating physical activity in these patients.
Keywords:
Hip fracture, Physical activity, Pace count, Postoperative rehabilitation
