Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Koudouna Smaragda
Dissertation committee:
Δοντά Ισμήνη – Νίκη, Ομότιμη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Πνευματικός Σπυρίδων, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χρονόπουλος Ευστάθιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βλάμης Ιωάννης, Αν. Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικολάου Βασίλειος, Αν. Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βασιλειάδης Ηλίας, Επ. Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευαγγελόπουλος Στέργιος-Δημήτριος Επ. Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Προοπτική μελέτη παρατήρησης: προγνωστικοί παράγοντες λειτουργικής αποκατάστασης καταγμάτων ισχίου συσχετιζόμενοι με την προ-καταγματική κινητική και λειτουργική ικανότητα του ασθενούς
Translated title:
A prospective observation study: prognostic factors of functional hip fracture rehabilitation associated with patient’s pre-fracture mobility and functional ability
Summary:
Introduction: Hip fractures in the elderly have become a major public health concern as the population ages. Post-operative rehabilitation is associated with improved outcomes and a greater likelihood of returning to pre-operative functional capacity. Low pre-fracture physical function is associated with poor outcomes in the elderly population, following hip fracture. Several studies have been conducted to investigate various post-operative recovery pathways. However, little is known about which post-operative rehabilitation pathways are most effective in improving patient outcomes, and no clear evidence-based guidelines for a standard mobilization protocol for patients are currently available. Measuring pre-operative activity and comparing it to post-operative follow-up values can help predict post-operative rehabilitation functional outcomes.
Aim of study: The present study aims to evaluate prognostic tools for predicting patient recovery after hip fractures and investigate the possible correlation with the pre-fracture motor and functional status. In addition, we aim to investigate post-operative recovery pathways to help patients return to pre-fracture condition and to quantify pre-operative and post-operative scores for objective rehabilitation evaluation.
Material and Methods: A prospective study was performed (a literature review was conducted to investigate the postoperative rehabilitation pathways and its scoring systems), including 80 patients (mean age 82.9 years, female 81.3%) suffering from hip fracture. Patient history, previous falls, type of fracture and overall survival were evaluated. Patient-reported outcome measures (SF-36 and EQ-5D/EQ-VAS, CCI), Short physical performance battery (SPPB), Time Up and Go test (TUG) and Harris Hip score (HHS) were monitored before hospital discharge and at 6 weeks, 3 months, 6 months and 12 months postoperatively.
Results: Many studies of postoperative rehabilitation are reported in the literature. Due to different research methodologies it is not clear which routes are most effective in improving patients. Early mobilization, multidisciplinary (orthopedic, geriatric, physical therapy, psychological) approach, long-term, intensive and individualized physical therapy exercise programs (strengthening, balance, fall prevention) contribute significantly to postoperative improvement. Scoring systems for quality of life (SF-36, EQ5/VAS), comorbidities (CCI), physical condition (SPPB, TUG) and hip pathologies (HHS) contribute to the prediction of postoperative rehabilitation outcomes and effectiveness of treatment protocols, to improve mobility and functionality of patients after hip fracture surgery and furthermore they can be monitored continuously (before and after discharge).
In our study, 55% of the patients experienced at least one fall and 46% of them used crutches before the fracture. The average Charlson Comorbidity Index was 6.9 (range 2-13). SPPB score improved from 1.4±1.3 at 1 week to 4.4±2.1 at 48 weeks. One-year age rise, female sex and prior history of falls lead to 0.1 (p=0.001), 0.92 (p=0.071) and 0.56 (p=0.04) respectively lower SPPB scores at 12 months. HHS recorded the greatest improvement between 6 to 12 weeks (52.1±14.6, p<0.0005), whereas TUG score continued to improve significantly from 139.1±52.6 sec at 6 weeks to 66.4±54 sec at 48 weeks follow up (p<0.0005).
Conclusion: SPPB score and performance test can be routinely used in patients with hip fragility fractures as a prognostic tool to predict function recovery after hospital discharge. Postoperative rehabilitation can improve clinical outcomes and quality of life in patients after hip fracture. Measuring preoperative activity and comparing it with postoperative values can help predict the functional outcomes of postoperative rehabilitation. It is important for orthopedists and physical therapists to adopt individualized rehabilitation approaches and to understand the strengths and weaknesses of various alternatives.
Main subject category:
Health Sciences
Keywords:
Hip fracture rehailitation, Prognostic factors, Sppb, Hhs, Charlson comorbidity index
Number of references:
212
