scholarly journals Outpatient and Home-Based Treatment: Effective Settings for Hip Fracture Rehabilitation in Elderly Patients

Geriatrics ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 83
Author(s):  
Margarida Mota Freitas ◽  
Sara Antunes ◽  
Diana Ascenso ◽  
Alda Silveira
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Outcome Measures ◽  
Group Analysis ◽  
Inpatient Rehabilitation ◽  
The Elderly ◽  
Knee Extension ◽  
Outpatient Rehabilitation ◽  
Home Based ◽  
Hip Flexion

Femoral neck fractures are a major source of disability in the elderly. Rehabilitation is fundamental to recover pre-fracture functionality. We conducted an observational cohort study with the aim of comparing the efficacy of rehabilitation programs in different therapeutic settings. We included elderly patients who had undergone surgical stabilization of a hip fracture. The participants were divided into 3 groups: group 1, outpatient rehabilitation; group 2, inpatient rehabilitation; group 3, home-based rehabilitation. Patients were evaluated at baseline, at three months, and at six months after fracture. Our outcome measures were the Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, and muscle strength in hip flexion, abduction, and knee extension. At six months, all three groups showed an average statistically significant improvement (p < 0.05) in all outcome measures compared to the baseline. Considering the between-group analysis, final BI was significantly higher in outpatient than inpatient-treated patients (p = 0.018), but no statistical difference was found between outpatient and home-based patients. Our findings suggest that rehabilitation leads to significant functional recovery after hip fracture in elderly patients. Both outpatient and home-based rehabilitation seem to be reasonable options for hip fracture rehabilitation.

scholarly journals Functional Recovery in Hip Fracture Patients: a Real-practice Pilot Study Comparing Different Rehabilitation Settings

2020 ◽  
Author(s):  
Margarida Mota Freitas ◽  
Claudio Curci ◽  
Diana Ascenso ◽  
Alda Silveira ◽  
Alessandro de Sire
Keyword(s):  
Hip Fracture ◽  
Pilot Study ◽  
Functional Recovery ◽  
Knee Extension ◽  
Outpatient Rehabilitation ◽  
Group 3 ◽  
Group 2 ◽  
Hip Flexion ◽  
Real Practice ◽  
Group 1

Abstract Background: Hip fractures are a major source of disability in the elderly and rehabilitation is mandatory to recover pre-fracture functioning. To date, there is a big heterogeneity not only in terms of frequency and timing but also of choosing the most appropriate setting for hip fracture rehabilitation. In this real-practice pilot study we aimed at evaluating the long-term effects of rehabilitative intervention on disability status and functional outcomes in post-hip fracture elderly people.Methods: We included patients aged 65 years or older who had undergone surgical stabilization of a hip fracture. Exclusion criteria: pathological fractures or whose comorbidities could have an impact on motor, cognitive or sensory function. The sample was divided into 3 groups according to their destination after hospital discharge: Group 1, outpatient rehabilitation; Group 2, inpatient rehabilitation; Group 3, home-based rehabilitation. All three groups underwent a specific rehabilitation protocol for 3 times/week for 2 months. At the baseline (T0), at 3 months (T1), and at 6 months after fracture (T2), we assessed as outcome measures: Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, Medical Research Council scale (MRC) to assess muscle strength in hip flexion, hip abduction, and knee extension.Results: All three groups showed an average statistically significant improvement (p<0.05) in all the outcome measures compared to baseline, except for MRC of knee extension in group 3 at T1. Considering the between-group analysis, BI was significantly higher in Group 1 than in Group 2 at T2 (p=0.018).Conclusions: Taken together, our findings show that rehabilitation could lead to a significant improvement in functional recovery, independently from the settings, albeit outpatient rehabilitation seems to be the best option for hip fracture patients.

scholarly journals Comparison Between Classic and Light Touch Massage on Psychological and Physical Functional Variables in Athletes: a Randomized Pilot Trial

2020 ◽  
pp. 30-37
Author(s):  
Gemma Victoria Espí-López, PT, PhD ◽  
Pilar Serra-Añó, PT, PhD ◽  
Ferran Cuenca-Martínez , PT, MSc ◽  
Luis Suso-Martí, PT, MSc ◽  
Marta Inglés, PT, PhD
Keyword(s):  
Outcome Measures ◽  
Mood State ◽  
Pilot Trial ◽  
Knee Extension ◽  
Control Group ◽  
Light Touch ◽  
General Belief ◽  
Massage Group ◽  
Physical Variables ◽  
Hip Flexion

Background: Despite the general belief of the benefits and the widespread use of massage in sport field, there are limited empirical data on possible effectiveness of massage on psychological and physical functional variables. Purpose: The main objective of the present study was to compare the effectiveness of classical and light touch massage on psychological and physical functional variables in athletes. Setting: Athletic club of Valencia Participants: 20 amateur athletes were recruited from two athletic clubs. Research Design: A single-blind, randomized, pilot-placebo trial. Intervention: The subjects were randomly allocated to two different groups: a) Massage group (MG) (n=10); b) Control group (CG) (n=10). The intervention period lasted one month (one session per week). Main Outcome Measures: Assessment of the participants was performed at baseline and 24 hours following the completion of the intervention. Outcome measures included hip flexion, knee extension, and mood state. Results: The results suggest that MG obtained better results on physical variables (p < .05). However, for both groups, trends suggest significant improvements in the overall mood state of the participants (p < .05). Conclusion: Our results suggest that classic massage could be an effective intervention to improve functional physical variables in athletes. However, trends suggest that a light touch intervention could provoke improvements in physiological measures.

scholarly journals Evaluation of the health pathway through the patient-experience in the French program PAERPA

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
V Donio ◽  
M M Defebvre ◽  
R Pamart ◽  
B Caron ◽  
C Delval-Bugny ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Patient Experience ◽  
Social Action ◽  
Frail Elderly ◽  
Elderly Subject ◽  
The Elderly ◽  
Face To Face ◽  
Individual Interviews ◽  
Home Based ◽  
Human Connection

Abstract The patient-experience is an emerging concept in research and medico-social action, and its consideration in the development of care pathways is encouraged (e.g. ’Ma Santé 2020’ national plan in France). In addition, the patient-experience of the elderly subject has specific dimensions and his collection presents difficulties insufficiently explored. PAERPA (elderly people at risk of loss of autonomy), French national experiment for the care of frail elderly patients, offers an opportunity to return to these issues. The objective of this study, mandated by the ARS of Hauts-de-France, was to collect the experience of the elderly PAERPA. Faced with the difficulties of current methodologies, several methodological approaches have been combined: semi-structured individual interviews face-to-face or by telephone, dedicated questionnaire. In addition, a specific grid was developed to explore the home-based patient experience, including seven dimensions of the patient-experience identified in the literature. This study was conducted in the second half of 2018 (3 years and a half of the start of the project). The experience of 43 seniors and / or caregivers was collected. Patients PAERPA are generally satisfied with their care but they have difficulties in making the link between their care and the actors and devices specific to PAEPRA experimentation. Human connection and listening seem essential for the elderly patients included. Other dimensions, such as stakeholder coordination, remain controversial and more difficult to grasp. Methodologically, the particular situation of seniors, such as sensory or memory disorders, requires a major adaptation of the survey tools. In PAERPA, the patient-experience of the frail elderly subject passes mainly through the feeling of a human connection. Current methodologies do not seem fully adapted to collectively capture the experience of frail elderly patients. Key messages Evaluating the patient-experience to improve the health pathway is possible and necessary through a qualitative collection, regularly, in itinere. The peculiarities of older people often require the participation of carers, who need to be involved in the assessment of the patient-experience and raised awareness.

scholarly journals Incidence and risk factors of postoperative delirium in the elderly patients with hip fracture

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Chen-guang Wang ◽  
Ya-fei Qin ◽  
Xin Wan ◽  
Li-cheng Song ◽  
Zhi-jun Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
The Elderly

scholarly journals Preferred rehabilitation setting among stroke survivors in Nigeria and associated personal factors

2018 ◽  
Vol 7 ◽  
Author(s):  
Grace Vincent-Onabajo ◽  
Zulaiha Mohammed
Keyword(s):  
Inpatient Rehabilitation ◽  
Outpatient Setting ◽  
Outpatient Rehabilitation ◽  
Personal Factors ◽  
Stroke Patients ◽  
Community Based ◽  
Cross Sectional ◽  
Home Based ◽  
Community Based Rehabilitation ◽  
Cross Sectional Design

Background: Incorporating patients’ preferences in the care they receive is an important component of evidence-based practice and patient-centred care.Objective: This study assessed stroke patients’ preferences regarding rehabilitation settings.Methods: A cross-sectional design was used to examine preferences of stroke patients receiving physiotherapy at three hospitals in Northern Nigeria. Personal factors and preferred rehabilitation setting data were obtained using the Modified Rankin Scale (to assess global disability) and a researcher-developed questionnaire. Associations between preferences and personal factors were explored using bivariate statistics.Results: Sixty stroke patients whose mean age was 53.6 ± 14.8 years participated in the study. Most of the participants (38.3%) preferred an outpatient setting, 19 (31.7%) preferred rehabilitation in their homes, 14 chose inpatient rehabilitation (23.3%), while 4 (6.7%) preferred the community. Age and source of finance were significantly associated with preferences. The majority (66.7%) of those aged ≥ 65 years expressed a preference for rehabilitation in the home or community (X2 = 6.80; p = 0.03). Similarly, most of the participants (53.3%) who depended on family finances preferred home- or community-based rehabilitation, while most of those who depended on employment income for finances preferred an outpatient rehabilitation setting (X2 = 16.80; p = 0.01).Conclusion: A preference for rehabilitation in outpatient facilities predominated followed by home-based rehabilitation, and preferences varied based on age and source of finance. These variations in preferences have implications for making rehabilitation decisions.

scholarly journals Assessment of HIT Antibody Complex in Hip Fracture Patients Receiving Enoxaparin or Unfractionated Heparin

2011 ◽  
Vol 17 (6) ◽  
pp. 567-571
Author(s):  
Justin W. Griffin ◽  
William J. Hopkinson ◽  
Michael R. Lassen ◽  
Indermohan Thethi ◽  
Evangelos Litinas ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Unfractionated Heparin ◽  
Standard Of Care ◽  
The Elderly ◽  
Enzyme Linked Immunosorbent Assay ◽  
Platelet Factor ◽  
Surgical Fixation ◽  
Thrombotic Complications ◽  
Antibody Complex

Thromboembolic disease is a common complication of hip fracture in the elderly. Anticoagulants represent a standard of care in preventing postoperative thrombotic complications following surgical fixation. We asked whether levels of antibody to heparin–platelet factor 4 (PF4) complex were differentially present in unfractionated heparin (UFH) versus Enoxaparin, following hip fracture and whether one particular subtype of antibodies was more prevalent. Plasma samples from elderly patients sustaining a hip fracture treated with either enoxaparin or UFH were collected pre- and postoperatively and analyzed using enzyme-linked immunosorbent assay (ELISA) sandwich method for the prevalence of antiheparin-PF4 antibodies and later subtyped. The prevalence of antiheparin-PF4 antibodies was higher in the UFH group especially on postoperative day 7. Patients treated with UFH showed a greater prevalence of antiheparin-PF4 antibodies and a greater prevalence of immunoglobulin G (IgG) subtype. Heparin and enoxaparin are capable of generating heparin-induced thrombocytopenia (HIT) antibodies in elderly patients undergoing orthopedic surgery but perhaps not to the same extent. When comparing low-molecular-weight heparin (LMWH) with UFH, the incidence of new antiheparin-PF4 antibody production is higher in patients treated with UFH.

scholarly journals Factors which influence postoperative mortality after hip fracture

2006 ◽  
Vol 63 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Branko Ristic ◽  
Dragana Ristic-Ignjatovic ◽  
Biljana Milicic ◽  
Zdravko Obradovic
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Health Assessment ◽  
Postoperative Mortality ◽  
The Elderly ◽  
Physical And Mental Health ◽  
Mental Health Assessment ◽  
A Prospective Study ◽  
Type Of Fracture

Background/Aim. One of the most significant predictors of mortality after hip fractures is cognitive impairment (dementia). The aim of this study was to report the results of a prospective study of the influence of some factors on sixmonth mortality in elderly patients with hip fractures. Method. The elderly patients with hip fracture were assessed on admission to the hospital using the measures of cognitive function, the mobility before the fracture, and physical comorbidity, the type of fracture and the place of the injury. Six months later, we checked how many of them were still alive. Results. We performed univariate and multivariate analyses in 132 patients and found that the most significant predictors of six-month mortality were dementia, comorbidity, and prefacture mobility. Conclusions. A comprehensive physical and mental health assessment of an elderly patient after hip fracture could predict mortality. A good examination of cognitive functioning could be very useful in choosing the optimal treatment for this type of patients.

scholarly journals Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review

Pain medicine ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 42-49
Author(s):  
Anastasiia Romanenko ◽  
Юрій Кучин ◽  
Катерина Бєлка ◽  
Ігор Токар
Keyword(s):  
Hip Fracture ◽  
Pain Management ◽  
Elderly Patients ◽  
Femoral Fracture ◽  
Adverse Drug Events ◽  
Perioperative Period ◽  
The Elderly ◽  
Proximal Femoral Fracture ◽  
Nerve Blocks ◽  
Number Of Patients

The purpose of this article is to compare different methods of analgesia during perioperative period in elderly patients with а proximal femoral fracture. The incidence of hip fracture is high and also rises with the age, for example, In Great Britain, number of patients with a hip fracture will be approximately 100 000 in 2033, and it’s also associated with significant healthcare financing. Nevertheless, effective pain management is a big challenge for clinicians because of considerable problems in geriatric patients, including age, physiological changes in the elderly, preexisting comorbidities, cognitive impairment, high risk of delirium, problems with rehabilitation and probability of an independent life [12].   Opioids are still the main option for hip fracture pain management, despite differences in pharmacokinetics and pharmacodynamics in elderly patients, which are correlated with high frequency of side effects. Opioid-related adverse drug events are associated with worse patient outcomes such as morbidity, mortality and length of stay increase. Therefore, peripheral nerve blocks as part of multimodal analgesic technique can provide more effective pain control after hip fracture. Comprehensive literature searches focus on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anesthesia for hip fracture surgery.

scholarly journals Activity Classification Feasibility Using Wearables: Considerations for Hip Fracture

2018 ◽  
Vol 7 (4) ◽  
pp. 54 ◽  
Author(s):  
Akash Gupta ◽  
Adnan Al-Anbuky ◽  
Peter McNair
Keyword(s):  
Hip Fracture ◽  
The Elderly ◽  
Physical Activities ◽  
Medical Attention ◽  
Severe Injuries ◽  
Acceleration Signal ◽  
Home Based ◽  
Research Findings ◽  
Ambulatory Activities

Falls in the elderly are a common health issue that can involve severe injuries like hip fractures, requiring considerable medical attention, and subsequent care. Following surgery, physiotherapy is essential for strengthening muscles, mobilizing joints and fostering the return to physical activities. Ideally, physiotherapy programmes would benefit from active home-based monitoring of the elderly patients’ daily activities and exercises. This paper aims at providing a preliminary analysis addressing three key research questions. First, what are the key involved activities (at-hospital, home exercises, and activities of daily living) during the post-operative hip fracture rehabilitation process? Second, how can one monitor and identify a range of leg exercises accurately? Last, what is the most suitable sensor location that can categorize the majority of the physical activities thought to be important during the rehabilitation programme? During preliminary testing, it was noted that a standard deviation of the acceleration signal was suitable for classification of static activities like sitting, whereas classification of the ambulatory activities like walking, both the frequency content and related amplitude of the acceleration signal, plays a significant role. The research findings suggest that the ankle is an appropriate location for monitoring most of the leg movement physical activities.

scholarly journals Orthogeriatrics in Italy: the Gruppo Italiano di Ortogeriatria (GIOG) audit on hip fractures in the elderly

2018 ◽  
Vol 4 (2) ◽  
Author(s):  
Amedeo Zurlo ◽  
Giuseppe Bellelli
Keyword(s):  
Hip Fracture ◽  
Observational Study ◽  
Elderly Patients ◽  
The Elderly ◽  
Study Group ◽  
Web Based ◽  
Italian Study ◽  
Multicenter Observational Study ◽  
Functional Deficit ◽  
High Prevalence

The Gruppo Italiano di Ortogeriatria (GIOG) is an Italian study group promoted by three Italian Scientific Geriatric Societies with the aim of disseminating orthogeriatric methodology in Italy. In 2015 it has supported a multicenter web-based audit to collect data on functioning of Italian orthogeriatrics. The study, still ongoing, has enrolled until now 2577 cases of elderly patients undergoing surgery for hip fracture from 14 Italian orthogeriatric units. The population in question consists of markedly elderly and frail subjects, due to high prevalence of pre-existing functional deficit conditions, but it is also clinically complex; the most frequent fracture is intertrochanteric and the most performed surgery approach is intramedullary nail. This is the largest multicenter observational study conducted so far in Italy on elderly patients with hip fracture.

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