RESUMEN
Different rehabilitation programs after surgery have been presented to improve the outcome for patients with a hip fracture. Empowerment has been suggested as useful, but requires a change in the caring behaviours of health professionals. The aim with this study was to evaluate if training and supervision of the nursing staff could alter caring behaviours. A case-control study of nursing staff treating hip fracture patients was performed at a hospital with two sites. Training and supervision was given to the nursing staff at the intervention site. The intervention focused on creating positive care interaction by using eight guidelines. The evaluation was performed with recordings of a constructed caring situation before training, and observations of care situations at the ward before and after intervention. The results showed no differences at baseline between the two sites in the caring behaviours. After intervention, significant effects of caring behaviours were seen in seven out of eight guidelines, the effect sizes ranged from medium to large. The findings indicate that the nursing staff can change caring behaviours and facilitate the empowerment of patients with a hip fracture.
Asunto(s)
Fracturas de Cadera/rehabilitación , Personal de Enfermería en Hospital/normas , Enfermería Ortopédica/normas , Poder Psicológico , Guías de Práctica Clínica como Asunto/normas , Adulto , Estudios de Casos y Controles , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND AND PURPOSE: Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively. PATIENTS AND METHODS: This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living. RESULTS: Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22-26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2-5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4-5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22-26. INTERPRETATION: In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture.
Asunto(s)
Índice de Masa Corporal , Peso Corporal/fisiología , Fracturas de Cadera/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Fracturas de Cadera/mortalidad , Humanos , Vida Independiente , Masculino , Sobrepeso , Estudios Prospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: The catabolic state that follows hip fracture contributes to loss of muscle mass and strength, that is sarcopenia, which impacts functional ability and health-related quality of life. Measures to prevent such long-term postoperative consequences are of important concern. The aim of this study was to evaluate the combined effects of protein-rich nutritional supplementation and bisphosphonate on body composition, handgrip strength and health-related quality of life following hip fracture. METHODS: The study included 79 men and women with hip fracture, mean age 79 years (SD 9), without severe cognitive impairment, who were ambulatory and living independently before fracture. Patients were randomized postoperatively to receive liquid supplementation that provided 40 g of protein and 600 kcal daily for six months after the fracture, in addition to bisphosphonates once weekly for 12 months (group N, n = 26), or bisphosphonates alone once weekly for 12 months (group B, n = 28). All patients, including the controls (group C, n = 25) received calcium 1 g and vitamin D3 800 IU daily. Body composition as measured by dual-energy X-ray absorptiometry (DXA), handgrip strength (HGS) and health-related quality of life (HRQoL) were registered at baseline, six and 12 months postoperatively. RESULTS: There were no differences among the groups regarding change in fat-free mass index (FFMI), HGS, or HRQoL during the study year. Intra-group analyses showed improvement of HGS between baseline and six months in the N group (P = 0.04). HRQoL decreased during the first year in the C and B groups (P = 0.03 and P = 0.01, respectively) but not in the nutritional supplementation N group (P = 0.22). CONCLUSIONS: Protein-rich nutritional supplementation was unable to preserve FFMI more effectively than vitamin D and calcium alone, or combined with bisphosphonate, in this relatively healthy group of hip fracture patients. However, trends toward positive effects on both HGS and HRQoL were observed following nutritional supplementation. TRIAL REGISTRATION: Clinicaltrials.gov NCT01950169 (Date of registration 23 Sept 2013).
Asunto(s)
Proteínas en la Dieta/administración & dosificación , Difosfonatos/administración & dosificación , Fijación de Fractura , Fracturas de Cadera , Complicaciones Posoperatorias , Calidad de Vida , Sarcopenia , Vitamina D/administración & dosificación , Absorciometría de Fotón/métodos , Actividades Cotidianas , Anciano , Composición Corporal/efectos de los fármacos , Conservadores de la Densidad Ósea/administración & dosificación , Suplementos Dietéticos , Femenino , Fijación de Fractura/efectos adversos , Fijación de Fractura/rehabilitación , Fuerza de la Mano , Fracturas de Cadera/complicaciones , Fracturas de Cadera/rehabilitación , Fracturas de Cadera/cirugía , Humanos , Efectos Adversos a Largo Plazo/diagnóstico , Efectos Adversos a Largo Plazo/etiología , Efectos Adversos a Largo Plazo/prevención & control , Efectos Adversos a Largo Plazo/psicología , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/psicología , Sarcopenia/diagnóstico , Sarcopenia/etiología , Sarcopenia/prevención & control , Sarcopenia/psicologíaRESUMEN
BACKGROUND/AIM: New surgical procedures, early operation and medical optimisation in patients with hip fracture have shown positive results on length of hospital stay. Our aims were to investigate whether patient empowerment along with an individually designed, postoperative rehabilitation programme could reduce length of hospital stay and whether the patients would have better chances to return to their previous living. DESIGN/METHOD: Patients were recruited during a 12-month period 2009-2010, with an intervention group treated with an individually designed, postoperative rehabilitation programme and a control group treated in a traditional way according to the hospitals routines. Final assessment was performed 4 month after surgery. The postoperative programme for the intervention group consisted of four standardised care tracks adapted individually for the patients. Assessments of Activity of Daily Living, American Society of Anesthesiologists classification of medical disease status and Short Portable Mental Status Questionnaire and living conditions were used to determine which care track was most appropriate. The patients were cared for with focus of empowerment in their rehabilitation. RESULTS: The study involved 503 hip fracture patients, 285 patients in the intervention group and 218 patients in the control group. The mean length of stay was 4 days shorter in the intervention group than in the control group (p = 0.04). Varied only to a small extent between the age groups in the intervention group and was greater between the age groups in the control. Patients in the intervention group returned to their previous living in 90% compared with 80% in the control group (p < 0.05). There were no significant differences between the age groups. CONCLUSION: Patient empowerment administrated by specially trained nursing staff and with specialised, tailor-made rehabilitation programme may be of benefit in helping patients to a shorter hospital stay and to return to their previous living.
Asunto(s)
Fracturas de Cadera/psicología , Fracturas de Cadera/rehabilitación , Tiempo de Internación/estadística & datos numéricos , Participación del Paciente/métodos , Participación del Paciente/psicología , Actividades Cotidianas , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Fracturas de Cadera/cirugía , Humanos , Masculino , Enfermeras y Enfermeros , Participación del Paciente/estadística & datos numéricos , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/psicología , Cuidados Posoperatorios/estadística & datos numéricos , Medicina de Precisión/métodos , Medicina de Precisión/psicología , Medicina de Precisión/estadística & datos numéricos , Recuperación de la Función , Análisis de Regresión , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND: After a hip fracture, a catabolic state develops, with increased bone loss during the first year. The aim of this study was to evaluate the effects of postoperative treatment with calcium, vitamin D, and bisphosphonates (alone or together) with nutritional supplementation on total hip and total body bone mineral density (BMD). METHODS: Seventy-nine patients (56 women), with a mean age of 79 years (range, 61-96 years) and with a recent hip fracture, who were ambulatory before fracture and without severe cognitive impairment, were included. Patients were randomized to treatment with bisphosphonates (risedronate 35 mg weekly) for 12 months (B; n=28), treatment with bisphosphonates along with nutritional supplementation (40 g protein, 600 kcal daily) for the first 6 months (BN; n=26), or to controls (C; n=25). All participants received calcium (1,000 mg) and vitamin D3 (800 IU) daily. Total hip and total body BMD were assessed with dual-energy X-ray absorptiometry at baseline, 6, and 12 months. Marker of bone resorption C-terminal telopeptide of collagen I and 25-hydroxy vitamin D were analyzed in serum. RESULTS: Analysis of complete cases (70/79 at 6 months and 67/79 at 12 months) showed an increase in total hip BMD of 0.7% in the BN group, whereas the B and C groups lost 1.1% and 2.4% of BMD, respectively, between baseline and 6 months (P=0.071, between groups). There was no change in total body BMD between baseline and 12 months in the BN group, whereas the B group and C group both lost BMD, with C losing more than B (P=0.009). Intention-to-treat analysis was in concordance with the complete cases analyses. CONCLUSION: Protein-and energy-rich supplementation in addition to calcium, vitamin D, and bisphosphonate therapy had additive effects on total body BMD and total hip BMD among elderly hip fracture patients.
Asunto(s)
Densidad Ósea/efectos de los fármacos , Remodelación Ósea/efectos de los fármacos , Calcio de la Dieta/administración & dosificación , Difosfonatos/administración & dosificación , Fracturas de Cadera/cirugía , Vitamina D/administración & dosificación , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Conservadores de la Densidad Ósea/administración & dosificación , Suplementos Dietéticos , Femenino , Fracturas de Cadera/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Periodo Posoperatorio , Resultado del Tratamiento , Vitaminas/administración & dosificaciónRESUMEN
UNLABELLED: Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients. OBJECTIVE: To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture. DESIGN: Population-based cohort study. SETTING: A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals. PARTICIPANTS: Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Walking ability and ADLs index at 4-month and 12-month follow-up. RESULTS: Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44-19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8-3.5; P<.001), while type of surgery was not (P=.376). CONCLUSIONS: Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.