Effects of Extended Outpatient Rehabilitation After Hip Fracture

Binder, Ellen F.; Brown, Mark G.; Sinacore, David R.; Steger-May, Karen; Yarasheski, Kevin E.; Schechtman, Kenneth B.

doi:10.1001/jama.292.7.837

Cited by 342 publications

(313 citation statements)

References 34 publications

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“…With reference to several previous reports [1][2][3][4][5][6][7], items related to physical function, psychological function, and complications that may affect gait were evaluated (Table 1). Standard items that can be readily measured without a specific instrument were selected based on a consideration of general clinical applicability.…”

Section: Data Collectionmentioning

confidence: 99%

“…As such, an HF both indirectly and directly increases the number of elderly people requiring care, making this condition a major medical and economic problem in an aging society. Major factors that affect the prognosis of HF patients include dementia [1][2][3], delirium [4], extensor muscle strength of the knee joint [5], and complications [6,7], such as cerebral stroke, heart disease, respiratory and circulatory disorders, and arthropathy. Improvements in surgical methods now enable the early initiation of rehabilitation, including physical therapy (PT).…”

Section: Introductionmentioning

confidence: 99%

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Early prediction of gait ability in patients with hip fracture

Tsushima

Hada

Iwata

et al. 2009

Environ Health Prev Med

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Objective Many elderly patients with hip fracture (HF) present with gait deficits. As such, an HF both indirectly and directly increases the number of elderly people requiring care, making it a major medical and economic problem in an aging society. To facilitate the treatment of HF and attempt to resolve the consequences, we have attempted to derive an equation that would predict gait ability. The prediction equation was developed by multivariate analysis using standard evaluation methods, with inclusion of guaranteed objectivity where possible. We attached greater importance to the prediction of gait ability early in the period of hospitalization, since this allows for early determination of an efficient therapeutic strategy. Methods The subjects were 54 HF patients (six men, 48 women; mean age: 78.0 ± 8.4 years) admitted to general hospitals in Hirosaki, Aomori prefecture, between 1998 and 2007. All were aged 60 years or older and were able to walk immediately before injury; physical therapy was initiated for all individuals during hospitalization. Evaluation items related to physical function, psychological function, and complications that may affect gait were evaluated; these included the manual muscle test, motor age test, Katz's index, dementia (HDS-R), consciousness disturbance, among others.Results Based on data for 35 patients who could gait at discharge and 19 patients who could not, a model including MAT, HDS-R, and the New York Heart Association classification of cardiac function scores (P \ 0.001) was obtained using multiple logistic regression analysis (discriminant hitting ratio: 94.4%). Conclusions The effectiveness of the derived model suggests that both physical and psychological functions should be considered for gait prediction.

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Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early prediction of gait ability in patients with hip fracture

Tsushima

Hada

Iwata

et al. 2009

Environ Health Prev Med

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“…During recovery from hip fracture, most patients experience fracture site pain, reduced mobility, and impaired ability to perform routine daily activities, with a large proportion failing to regain their prefracture functional level after 1 year [6,24,25]. Slow recovery after hip fracture has been associated with negative consequences [26,36,39].…”

Section: Introductionmentioning

confidence: 99%

Does Teriparatide Improve Femoral Neck Fracture Healing: Results From A Randomized Placebo-controlled Trial

Bhandari

Jin

See

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background There is a medical need for therapies that improve hip fracture healing. Teriparatide (Forteo 1 / Forsteo 1 , recombinant human parathyroid hormone) is a bone anabolic drug that is approved for treatment of osteoporosis and glucocorticoid-induced osteoporosis in men and postmenopausal women at high fracture risk. Preclinical and preliminary clinical data also suggest that teriparatide may enhance bone healing.Questions/purposes We wished to test the hypotheses that treatment with teriparatide versus placebo would improve femoral neck fracture healing after internal fixation as measured by (1) frequency of revision surgery, (2) radiographic fracture healing, and (3) other outcomes including pain control, gait speed, and safety. Methods We initiated two separate, but identically designed, clinical trials to meet FDA requirements to provide substantial evidence to support approval of a new indication. The two prospective, randomized double-blind, placebo-controlled Phase III studies were designed to evaluate the effect of subcutaneous teriparatide (20 lg/day) for 6 months versus placebo on fracture healing at 24 months. The trials were conducted concurrently with a planned enrollment of 1220 patients per trial. However, enrollment was stopped owing to very slow patient accrual, and an a priori decision was made to pool the results of those studies for statistical analyses before study completion; pooling was specified in both protocols. Randomization was stratified by fixation (sliding hip screw or multiple cancellous screws) and fracture type (displaced or nondisplaced). An independent Central Adjudication Committee reviewed revision surgical procedures and radiographs. A total of 159 patients were randomized in the two trials (81 placebo, 78 teriparatide). The combined program had very low power to detect the originally This study was sponsored by Eli Lilly and Company. The institutions of authors (MB, NG, RW) have received, during the study period, funding from Eli Lilly and Company. One author (MB), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Eli Lilly and Company. One or more of the authors (LJ, KS, RB, KDK, MRW, BM) are employees of Eli Lilly and Company, that provided funding for this study. One of the authors (QIA) was an employee of Eli Lilly and Company at the time of the study but he no longer is employed by them. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This study was conducted at the authors' various institutions. Clinical Orthopaedics and Related Research ®A Publication of The ...

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“…These au thors showed that home-based moderate-to high-intensit y PRT with a portable resistance exercise machine seemed to improve muscle force, endurance and gait, and also physical function, but the improvemen t was signiftcant only for mus cle force (24). Binder et al (25) reported that, among oider hip fracture patients, supervised physical therapy, including not only PRT but also flexibility, balance, coordination and movement speed exercises, enhanced physical performance and reduced physical disability, as measured on the ADL/IADL scale. Again, changes in ADL/IADL were non significant (25).…”

Section: Resultsmentioning

confidence: 99%

“…Binder et al (25) reported that, among oider hip fracture patients, supervised physical therapy, including not only PRT but also flexibility, balance, coordination and movement speed exercises, enhanced physical performance and reduced physical disability, as measured on the ADL/IADL scale. Again, changes in ADL/IADL were non significant (25). ln our study, PRT of the lower Iimbs was ef fective, and improved independenc e in ADL/IADL arnong oider people with hip fracture history.…”

Section: Resultsmentioning

confidence: 99%