Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

Al-Ani, Amer N.; Flodin, Lena; Söderqvist, Anita; Ackermann, Paul W.; Samnegård, Eva; Dalén, Nils; Sääf, Maria; Cederholm, Tommy; Hedström, Margareta

doi:10.1016/j.apmr.2009.09.005

Cited by 57 publications

(63 citation statements)

References 143 publications

(190 reference statements)

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“…Of these 26 articles, 13 met the inclusion criteria: five randomized clinical trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Articles carried forward to full-text review were excluded for having unclear methods, 17,21,30,31 using heterogeneous populations, 21,30-32 not reporting data specifically for dementia patients, [33][34][35] not describing a rehabilitation intervention, [36][37][38] or not reporting sufficient outcome data related to our patient population of interest. 39 Agreement between reviewers at the abstract level was moderate for pair 1 (k ¼ 0.53) and fair for pair 2 (k ¼ 0.31).…”

Section: Resultsmentioning

confidence: 99%

Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review

Allen

Koziak

Buddingh

et al. 2012

Physiotherapy Canada

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Purpose: Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Methods: Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle-Ottawa Scale was used to assess validity. Results: A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. Conclusions: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.Key Words: dementia; geriatrics; hip fractures; rehabilitation. RÉ SUMÉObjectif : Il n'y a pas de pratiques exemplaires d'é tablies pour la ré adaptation aprè s une fracture de la hanche chez les personnes aux prises avec la dé mence. Nous avons procé dé à une revue systé matique en vue de recueillir les faits cliniques relatifs à la ré adaptation chez ce segment de la population, y compris les personnes en soins prolongé s. Mé thode : Une mé thodologie d'examen de documents normalisé e a é té utilisé e pour effectuer une recherche dans huit bases de donné es afin de recueillir de la documentation sur la ré adaptation aprè s une fracture de la hanche chez les personnes souffrant de dé mence. Les é tudes admissibles traitaient de patients avec dé mence qui avaient subi une fracture de la hanche; auprè s de qui on avait procé dé à une intervention en ré adaptation; et où au moins une fonction, la marche, le site du congé ou les risques de chutes avaient é té é valué s. L'é chelle de Newcastle-Ottawa a é té utilisé e aux fins d'é valuation de la validité de ces é tudes. Ré sultats : Au total, 13 é tudes ont é té ré pertorié es; cinq essais contrô lé s randomisé s (ECR), sept é tudes de cohorte prospective et une é tude de cohorte ré trospective. La qualité moyenne des ECR et des é tudes de cohortes é taient respectivement bonne à moyenne. Les participants avec dé mence lé gè re à modé ré e qui recevaient des traitements de ré adaptation ont dé montré des gains relatifs de fonction similaires à ceux qui ne souffraient pas de dé mence. Un...

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Section: Resultsmentioning

confidence: 99%

Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review

Allen

Koziak

Buddingh

et al. 2012

Physiotherapy Canada

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“…The review included a total of 22,443 patients and 97 health professionals. In total, 6282 (range 90-401) patients participated in RCTs, 12,69,78,80,87,[128][129][130]197,199 276 (range 24-95) patients participated in quasi-RCTs, 83,[131][132][133] 116 (range 20-30) patients participated in non-RCTs, 79,[134][135][136][137] 3044 (range 1-919) patients participated in historical cohort studies, 13,[157][158][159][160][161][162][163][164][165]170,173,178 7136 (range 18-946) patients participated in concurrent cohort studies, 81,[138][139][140][141][142][143][144][145][146][147][148][149][150][151][152]169,177,179,…”

Section: Summary Of Participant Characteristicsmentioning

confidence: 99%

“…171,172 The majority of the studies included patients aged ≥ 65 years. 79,80,[82][83][84][85][86]88,[90][91][92][93]95,97,[99][100][101][102]105,107,109,111,113,115,116,120,121,[124][125][126][127]131,135,[138][139][140][141][142][143][144][145][146][147][148]151,153,[155][156][157]160,162,163,165,166,175,…”

Section: Summary Of Participant Characteristicsmentioning

confidence: 99%

“…119 The majority of the studies included participants who were mobile and living independently in their own home or in a care home before their hip fracture. 12 [183][184][185][186]191,193,194,196,197,199,201 Only seven studies included patients with a medical or psychological comorbidity; 123,139,145,157,158,184,193 the majority of studies excluded such patients, especially when exercise would have been contraindicated. Only two studies included patients who had a history of a previous fracture.…”

Section: A Community-based Multidisciplinary Rehabilitation Package Fmentioning

confidence: 99%

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Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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“…However, it remains undecided whether lower hemoglobin levels in older people are necessarily an indicator of underlying comorbidities, or just an aspect of natural aging [7]. A large number of research has been done to investigate the impact of different variables on recovery after hip fracture surgery [8][9][10]. The effect of perioperative anemia on surgical mortality and morbidity in hip fracture patients has also been addressed in literature [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Is anemia at admission related to short-term outcomes of elderly hip fracture patients?

Dubljanin-Raspopovic¹,

Marković-Denić

Nikolić

et al. 2011

Open Medicine

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AbstractHip fracture in elderly people is associated with high morbidity and mortality. Therefore, it is important to identify risk factors that potentially influence outcomes after hip surgery. The main purpose of this study was to evaluate the relationship of anemia at admission and short-term outcomes after hip fracture. We studied 343 community-dwelling patients who underwent surgery for hip fracture from March 2009 to March 2010. Functional mobility at discharge, postoperative complications, hospital length of stay and in-hospital mortality were analyzed in respect to presence and severity of anemia at admission. Anemia (defined as hemoglobin levels < 13.0 g/dl for men and < 12.0g/dl for women) was present in 185 (53.9%) patients, of whom 54 (29.2%) were severely anemic (defined as hemoglobin level 10.0g/dl or below). In multivariate analysis anemia was associated with age, gender (female), type of fracture (intertrochanteric) and American Society of Anesthesiologists (ASA) classification (3 or 4), while severity of anemia was associated with recovery of ambulatory ability at discharge. There was no difference in the incidence of postoperative complication, in-hospital mortality and length of hospital stay between the groups at discharge. Overall anemia at admission is an indicator of poor general health status. Ambulatory recovery in hip fracture patients is independently related to severity of anemia at admission.

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Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

Cited by 57 publications

References 143 publications

Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review

Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Is anemia at admission related to short-term outcomes of elderly hip fracture patients?

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