RESUMEN
BACKGROUND: Providing adequate care for the person with a fragility fracture is essential to prevent recurrences. A key strategy involves training by improving nursing care in the fields of osteoporosis and fragility fractures. However, in Portugal, there is no report on the level of knowledge of nurses, nor experimental studies on how to improve it. OBJECTIVE: The study aimed to assess the knowledge of Rehabilitation Nurses in Portugal on osteoporosis and fragility fractures. Additionally, it sought to evaluate the impact of a specific educational programme on nurses' knowledge. METHODS: In Phase I, a cross-sectional study involved 452 participants, utilizing a 26-question knowledge test. In Phase II, a quasi-experimental study included 42 nurses from 28 hospitals, subjected to a 30-h hybrid educational programme. The program comprised 9 online (2 h 30 min each) and 2 live sessions, covering assessment, pharmacological and non-pharmacological treatment, monitoring, project planning, consultations, and outcome indicators measurement. A before-and-after programme knowledge test was administered. RESULTS: Phase I revealed an average knowledge score of 69.6%. In Phase II, there was a significant improvement with programme (70.4% vs. 85.8%, p < 0.01). Specialized nurses performed better than non-specialized nurses (80% vs. 75%, p = 0.011), and those from orthopaedic services showed the greatest improvement (92% vs. 83%, p = 0.014). CONCLUSIONS: Rehabilitation Nurses in Portugal have room to improve their knowledge of osteoporosis and fragility fractures. The hybrid educational programme proved effective in improving nurses' knowledge, especially among specialist and orthopaedic service nurses. We hope that this knowledge can be translated into continuous improvement in healthcare provision.
Asunto(s)
Competencia Clínica , Osteoporosis , Humanos , Estudios Transversales , Portugal , Femenino , Osteoporosis/enfermería , Masculino , Competencia Clínica/estadística & datos numéricos , Adulto , Enfermería en Rehabilitación/educación , Enfermería en Rehabilitación/métodos , Fracturas Osteoporóticas/enfermería , Fracturas Osteoporóticas/rehabilitación , Fracturas Osteoporóticas/prevención & control , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , Educación Continua en EnfermeríaAsunto(s)
Terapia por Ejercicio , Fracturas de Cadera , Humanos , Fracturas de Cadera/rehabilitación , Terapia por Ejercicio/métodos , Depresión/rehabilitación , Depresión/etiología , Anciano , Fracturas Osteoporóticas/rehabilitación , Fracturas Osteoporóticas/prevención & control , Fracturas Osteoporóticas/psicología , Metaanálisis como AsuntoAsunto(s)
Terapia por Ejercicio , Fracturas de Cadera , Anciano , Humanos , Depresión/rehabilitación , Depresión/etiología , Terapia por Ejercicio/métodos , Fracturas de Cadera/rehabilitación , Metaanálisis como Asunto , Fracturas Osteoporóticas/rehabilitación , Fracturas Osteoporóticas/prevención & control , Fracturas Osteoporóticas/psicología , Resultado del Tratamiento , Revisiones Sistemáticas como AsuntoRESUMEN
BACKGROUND: This study aimed to determine whether changes in phase angle during rehabilitation are associated with clinical outcomes such as activities of daily living (ADL), skeletal muscle mass index (SMI), and strength in patients with osteoporotic fractures. METHODS: This retrospective observational study included patients with osteoporotic fractures admitted to convalescent rehabilitation wards. Changes in phase angle were defined as the difference between the phase angle values at discharge and on admission. The primary outcome was the Functional Independence Measure motor (FIM-motor) score at discharge. The secondary outcomes were SMI and handgrip strength at discharge. We used multivariate analysis to adjust for confounding factors and examine the association between changes in the phase angle and outcomes. RESULTS: We analyzed a total of 115 patients (97 women, mean age of 81.0±10.0 years), with a median change in phase angle of 0° during hospitalization. We observed increased phase angles in 49 patients (43%), with a median increase of 0.2°. Multiple regression analysis showed that changes in phase angle were independently associated with FIM-motor score at discharge (ß=0.238, p=0.027). Changes in phase angle were not significantly associated with SMI (ß=0.059, p=0.599) or handgrip strength (ß=-0.032, p=0.773) at discharge. CONCLUSION: An increased phase angle during rehabilitation was positively associated with ADL improvement in patients with osteoporotic fractures. These findings may help clinicians make informed decisions regarding patient care and treatment strategies for better outcomes.
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Actividades Cotidianas , Fuerza de la Mano , Fracturas Osteoporóticas , Sarcopenia , Humanos , Femenino , Masculino , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/rehabilitación , Estudios Retrospectivos , Anciano , Sarcopenia/fisiopatología , Anciano de 80 o más Años , Fuerza de la Mano/fisiología , Músculo Esquelético/fisiopatologíaRESUMEN
Long-term physical functioning trajectories following distal forearm fracture are unknown. We found that women with versus those without distal forearm fracture were more likely to experience a 5-year decline in physical functioning, independent of initial physical functioning level. This association was most evident among women 80 years and older. INTRODUCTION: Physical functioning trajectory following lower arm or wrist fracture is not well understood. PURPOSE: This study is to evaluate physical functioning trajectory before vs. after lower arm or wrist fracture, stratified by age. METHODS: We performed a nested case-control study of prospective data from the Women's Health Initiative Study (n = 2097 cases with lower arm or wrist fracture, 20,970 controls). Self-reported fractures and the physical functioning subscale of the RAND 36-item Short-Form Health Survey were assessed annually. We examined three physical functioning trajectory groups: stable, improving, and declining. RESULTS: Mean (SD) number of physical functioning measurements was 5.2 (1.5) for cases and 5.0 (1.4) for controls. Declining physical functioning was observed among 20.4% of cases and 16.0% of controls. Compared to women without lower arm or wrist fracture, women with lower arm or wrist fracture were 33% more likely to experience declining physical functioning (adjusted odds ratio [aOR] 1.33 95% confidence interval [CI] 1.19-1.49, reference group stable or improving physical functioning trajectory). Associations varied by age: age ≥ 80 years aOR 1.56 (95% CI 1.29-1.88); age 70-79 years aOR 1.29 (95% CI 1.09-1.52); age < 70 years aOR 1.15 (95% CI 0.86-1.53) (pinteraction = 0.06). Associations between lower arm or wrist fracture and odds of declining physical functioning did not vary by baseline physical functioning or physical activity level. CONCLUSIONS: Women with lower arm or wrist fracture, particularly those aged 80 and older, were more likely to experience declines in physical functioning than women without such fractures, independent of baseline physical functioning level.
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Fracturas Osteoporóticas , Traumatismos de la Muñeca , Humanos , Femenino , Anciano , Traumatismos de la Muñeca/fisiopatología , Traumatismos de la Muñeca/epidemiología , Anciano de 80 o más Años , Estudios de Casos y Controles , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/rehabilitación , Persona de Mediana Edad , Estudios Prospectivos , Posmenopausia/fisiología , Factores de Edad , Fracturas del Radio/fisiopatología , Fracturas del Radio/epidemiología , Estados Unidos/epidemiología , Osteoporosis Posmenopáusica/fisiopatología , Osteoporosis Posmenopáusica/complicacionesRESUMEN
BACKGROUND: Vertebral fragility fractures (VFFs) commonly result from low bone mass and microarchitecture deterioration of bone tissue. spinal orthoses are common non-pharmacological options for managing vertebral fracture pain. However, the effects of spinal orthoses on pain, physical functioning, and quality of life (QoL) are still debated. OBJECTIVE: This survey aimed to investigate the patients-reported outcomes of a dynamic spinal orthosis prescribed in the routine clinical practice of VFFs management. METHODS: This multi-center national-wide prospective cohort study assessed older patients (aged > 60 years) diagnosed with acute VFFs and prescribed with a dynamic spinal orthosis (Spinfast®). A survey questionnaire was realized and included sections on patient characterization, osteoporosis characterization, spinal orthosis, clinical outcomes, pain medications, and osteoporosis medications. The questionnaire was administered at baseline and after three months. A total of 68 patients completed the questionnaire at three months. Most patients had one or two VFFs and were treated with pain medications and osteoporosis medications. Compliance and tolerability of the spinal orthosis were assessed, and clinical outcomes such as pain intensity, physical functioning, and QoL were measured. RESULTS: The results showed no significant differences in outcomes between age subgroups. Italian physical medicine and rehabilitation physicians were commonly involved in the management of VFFs patients. Sixty-six patients completed the questionnaire. The results showed that pain intensity, physical functioning and QoL improved after three months of spinal orthosis wearing (p< 0.0001). CONCLUSION: The correct management of VFFs is mandatory to improve pain and reduce disability, and our findings suggested a positive role of dynamic spinal orthosis to improve the comprehensive management of VFFs patients. However, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.
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Aparatos Ortopédicos , Fracturas Osteoporóticas , Calidad de Vida , Fracturas de la Columna Vertebral , Humanos , Femenino , Anciano , Masculino , Estudios Prospectivos , Fracturas de la Columna Vertebral/rehabilitación , Persona de Mediana Edad , Fracturas Osteoporóticas/rehabilitación , Dolor de Espalda/rehabilitación , Dolor de Espalda/terapia , Anciano de 80 o más Años , Autoinforme , Dimensión del Dolor , Medición de Resultados Informados por el PacienteRESUMEN
Osteoporosis is a silent, asymptomatic disease until a fragility fracture is sustained. Fractures greatly affect the physical functioning and health-related quality of life and are associated with increased mortality and morbidity rates. Furthermore, once a fragility fracture occurs, the patient is more susceptible to sustain further fractures. Repeated falls are the main causes of fractures in patients with osteoporosis. The management of osteoporosis postfracture is a combination of medical treatment, nutritional interventions, and rehabilitation in order to improve activities of daily living to prevent falls and increase safety while reducing the loss of bone mass. In this article the principles of fracture prevention and physical rehabilitation of patients with osteoporosis postvertebral and hip fragility fractures will be discussed, as well as the rehabilitation management to prevent further falls and fractures.
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Fracturas Osteoporóticas/rehabilitación , Accidentes por Caídas/prevención & control , Fracturas de Cadera/rehabilitación , Humanos , Fracturas Osteoporóticas/prevención & control , Factores de Riesgo , Fracturas de la Columna Vertebral/rehabilitaciónRESUMEN
Fractures in the elderly population are increasing in incidence and represent a rising burden of disease. It is difficult for the elderly population to adhere to restricted weight bearing, and immobility poses significant risks and increased morbidity. Therefore, a primary goal of fracture management in the elderly population is early post-operative weight bearing. This review examines published literature regarding lower extremity fracture management in the elderly, with a focus on post-operative rehabilitation. While extensive literature supports early weight bearing after hip fractures in the elderly, further research is warranted to provide guidelines for management of other lower extremity fractures in this population.
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Fracturas de Cadera/rehabilitación , Traumatismos de la Pierna/rehabilitación , Fracturas Osteoporóticas/rehabilitación , Soporte de Peso/fisiología , Anciano , Fracturas de Cadera/fisiopatología , Fracturas de Cadera/cirugía , Humanos , Traumatismos de la Pierna/fisiopatología , Traumatismos de la Pierna/cirugía , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/cirugía , Rango del Movimiento Articular , Recuperación de la Función , Resultado del TratamientoAsunto(s)
Fracturas Osteoporóticas/rehabilitación , Soporte de Peso/fisiología , Anciano , Fracturas Óseas/fisiopatología , Fracturas Óseas/rehabilitación , Fracturas Óseas/cirugía , Anciano Frágil , Humanos , Inmovilización/efectos adversos , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/cirugíaRESUMEN
BACKGROUND: Osteoporotic fractures are associated with increased morbidity, mortality, and increased health care use. As the number of older adults increases, identifying those at increased risk for osteoporotic fractures has become of utmost importance to providing them with preventive and therapeutic interventions. AIMS: To determine the prevalence of unknown clinical and densitometric osteoporosis and to investigate the performance of different diagnostic strategies for osteoporosis in elderly patients admitted to rehabilitation. METHOD: This is an observational study. Eligible participants were older adults admitted to rehabilitation in an academic hospital in Switzerland over an 11-month period. Patients with previously unknown osteoporosis underwent dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA), and history review for past fractures. RESULTS: Complete assessment was available for 252 patients. Previously undiagnosed osteoporosis was identified in 62.3% of these patients, a proportion that was higher among women (71.5%) than men (44.8%). DXA proved most sensitive, followed by VFA and history review. Results differed across gender: DXA remained the most sensitive single test among women, but VFA proved most sensitive in men. The best test to combine with history review was DXA in women (detection increasing from 47.5 to 93.2%) and VFA in men (detection increasing from 35.9 to 84.6%). CONCLUSIONS: Prevalence of previously unknown osteoporosis appears very high in elderly patients admitted to post-acute rehabilitation. The combination of history review of previous fractures with DXA in women and with VFA in men appears the best two-step strategy to improving detection of osteoporosis in this population.
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Osteoporosis , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Absorciometría de Fotón/métodos , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización , Humanos , Masculino , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/rehabilitación , Prevalencia , Fracturas de la Columna Vertebral/epidemiología , Fracturas de la Columna Vertebral/rehabilitaciónRESUMEN
PURPOSE: This qualitative study was conducted as part of a feasibility study for TrAFFix, (ISRCTN92089567), a randomised controlled trial that will compare two surgical interventions used to fix distal femoral fractures. Our aim was to understand patients' experiences of treatment and the early phase of recovery after a distal femoral fracture. While, much is known about the experience of recovery from hip fracture, little is known about whether patients with other lower limb fragility fractures experience the same concerns and challenges. MATERIALS AND METHODS: Semi-structured interviews were conducted with 11 patients participating in TrAFFix or their relative. Interviews were conducted face to face or by telephone. With agreement from participants, interviews were audio recorded and transcribed. Transcripts were analysed inductively using thematic analysis. As part of the user involvement for TrAFFix, we held a focus group with PPI representatives who had experience or knowledge of lower limb fractures, to learn about factors that might influence patients' recovery after a fragility facture. Data from the focus group relevant to themes from our thematic analysis are also presented. RESULTS: Three themes were identified within patients' accounts of their experience. Our data revealed that: i) being informed about treatment and recovery was important to patients; ii) patients muddled through and found ways to manage at home, often needing the support of others; and iii) rehabilitation was arduous for patients who received limited rehabilitative support and at times lacked confidence to follow the instructions that they were given. CONCLUSIONS: Our findings highlight the struggle patients endure while recovering after a distal femoral fracture and the limited rehabilitative support they receive after discharge from hospital. They reinforce the need to ensure a patient feels informed about their treatment and recovery and the need for greater support for patients to manage at home and move with confidence.
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Fracturas del Fémur/cirugía , Fracturas Osteoporóticas/cirugía , Satisfacción del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/fisiopatología , Fracturas del Fémur/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/rehabilitación , Evaluación de Procesos y Resultados en Atención de Salud , Alta del Paciente , Cuidados Posoperatorios , Investigación Cualitativa , Calidad de VidaRESUMEN
This study explores the effect of supervised back extensor strength training on spinal pain, back extensor muscle strength, trunk-arm endurance, kyphosis, functional mobility, and quality of life (QoL) among sixty postmenopausal women with vertebral osteoporotic fractures. PURPOSE: To compare the effects of a 6-week supervised or home-based program of back-strengthening exercise on spinal pain, back extensor strength, trunk-arm endurance, kyphosis, functional mobility, and QoL in osteoporotic postmenopausal women with vertebral fractures. METHODS: The study was designed as a randomized controlled clinical trial. Sixty osteoporotic postmenopausal women with vertebral fracture (mean age 60.3 ± 9.3 years) were included in the study. Subjects were randomly assigned into three groups (supervised program, home-based program, or control), each consisting of 20 subjects. The subjects underwent the 6-week exercise program which included strengthening exercise for the back extensor muscles. They performed three sets of 8, 10, or 12 repetitions for each of the exercises, biweekly ascending, three times per week. Spinal pain, back extensor strength, trunk and arm endurance, kyphosis, functional mobility, and QoL were measured at baseline and at the end of the exercise program. RESULTS: Statistically significant improvements were demonstrated on spinal pain, muscle strength and endurance, functional mobility, and QoL for the supervised exercise program compared with control and home-based exercise groups (p < 0.01). Home-based exercise program did not provide a significant improvement compared with the control group except for mobility parameters of QoL. CONCLUSIONS: Six-week supervised back extensor strengthening training is superior to home-based program in terms of spinal pain, back extensor muscle strength, trunk endurance, functional mobility, and QoL for postmenopausal osteoporotic women with vertebral fractures.
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Terapia por Ejercicio/métodos , Osteoporosis Posmenopáusica/complicaciones , Fracturas Osteoporóticas/rehabilitación , Entrenamiento de Fuerza/métodos , Fracturas de la Columna Vertebral/rehabilitación , Anciano , Femenino , Humanos , Persona de Mediana Edad , Fuerza Muscular/fisiología , Músculo Esquelético/fisiopatología , Fracturas Osteoporóticas/fisiopatología , Posmenopausia , Calidad de Vida , Rango del Movimiento Articular , Fracturas de la Columna Vertebral/fisiopatología , Columna Vertebral/fisiopatología , Resultado del TratamientoRESUMEN
In a population-based study of older Swedish women, we investigated if clinical vertebral fracture was associated with lower health-related quality of life (HRQoL) and determined whether the association remained over time. Clinical vertebral fracture was associated with lower HRQoL and the effect persisted for up to 18.9 years. INTRODUCTION: Vertebral fractures are often associated with back pain and reduced physical function, which might result in isolation and depression. As a result, women with vertebral fractures often have lower health-related quality of life (HRQoL), but during what time frame the decrease lingers is unclear. Therefore, the aim of this study was to investigate if clinical vertebral fracture and hip fracture were associated with lower HRQoL and to determine whether the associations remained over time. METHODS: Vertebral fracture assessments (VFA) were performed using dual-energy X-ray absorptiometry. Data regarding prior fractures, medications, medical history, and physical activity was collected using a questionnaire. Self-rated physical HRQoL was assessed using the 12-Item Short-Form Health Survey (SF-12). Women with clinical vertebral fractures were divided into tertiles according to time since fracture onset and their HRQoL was compared with non-fractured women. RESULTS: In a population-based cross-sectional study of 3028 women aged 77.8 ± 1.63 (mean ± SD), a total of 130 (4.3%) women reported at least one clinical vertebral fracture. Women with a clinical vertebral fracture, divided into tertiles (T1-T3) depending on time since the fracture occurred, had lower HRQoL (T1: 36.3 ± 10.8; T2: 41.0 ± 9.94; and T3:41.6 ± 11.4) than women without fracture (46.2 ± 10.6; p < 0.001). Using linear regression analysis, clinical vertebral fracture was associated with reduced physical HRQoL for up to 18.9 years, independently of covariates (age, height, weight, smoking, prior stroke, mental HRQoL, grip strength, and lumbar spine BMD). CONCLUSIONS: Clinical vertebral fracture was associated with lower self-rated physical HRQoL, for up to 18.9 years after time of fracture.
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Fracturas Osteoporóticas/rehabilitación , Calidad de Vida , Fracturas de la Columna Vertebral/rehabilitación , Absorciometría de Fotón , Anciano , Anciano de 80 o más Años , Antropometría/métodos , Densidad Ósea/fisiología , Estudios Transversales , Ejercicio Físico/fisiología , Femenino , Fracturas de Cadera/epidemiología , Fracturas de Cadera/fisiopatología , Fracturas de Cadera/rehabilitación , Humanos , Vértebras Lumbares/fisiopatología , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/fisiopatología , Aptitud Física/fisiología , Psicometría , Sistema de Registros , Autoinforme , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/epidemiología , Fracturas de la Columna Vertebral/fisiopatología , Suecia/epidemiología , Factores de TiempoAsunto(s)
Ejercicio Físico , Fracturas Osteoporóticas/rehabilitación , Fracturas de la Columna Vertebral/rehabilitación , Actividades Cotidianas , Densidad Ósea , Consenso , Guías como Asunto , Humanos , Fracturas Osteoporóticas/fisiopatología , Educación del Paciente como Asunto , Calidad de Vida , Medición de Riesgo , Fracturas de la Columna Vertebral/fisiopatologíaRESUMEN
Little is known about the association between health-related quality of life (HRQOL) and osteoporosis in the absence of fracture, and how HRQOL may change over time. This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. INTRODUCTION: Fragility fractures have a detrimental effect on the health-related quality of life (HRQOL) of those with osteoporosis. Less is known about the association between HRQOL and osteoporosis in the absence of fracture. METHODS: Canadian Multicentre Osteoporosis Study participants completed the SF-36, a detailed health questionnaire and measures of bone mineral density (BMD) at baseline and follow-up. We report the results of participants ≥ 50 years with 10-year follow-up. Self-reported osteoporosis at baseline and BMD-based osteoporosis at follow-up were ascertained. Multivariable linear regression models were developed for baseline SF-36 domains, component summaries, and change over time, adjusting for relevant baseline information. RESULTS: Baseline data were available for 5266 women and 2112 men. Women in the osteoporosis group had substantially lower SF-36 baseline scores, particularly in the physically oriented domains, than those without osteoporosis. A similar but attenuated pattern was evident for the men. After 10-year follow-up (2797 women and 1023 men), most domain scores dropped for women and men regardless of osteoporosis status, with the exception of mentally-oriented ones. In general, a fragility fracture was associated with lower SF-36 scores and larger declines over time. CONCLUSIONS: This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. HRQOL should be thoroughly investigated even prior to fracture, to develop appropriate interventions for all stages of the disease.
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Osteoporosis/rehabilitación , Calidad de Vida , Anciano , Anciano de 80 o más Años , Densidad Ósea/fisiología , Canadá , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Osteoporosis/fisiopatología , Osteoporosis Posmenopáusica/fisiopatología , Osteoporosis Posmenopáusica/rehabilitación , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/rehabilitación , Psicometría , Autoinforme , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home. INTRODUCTION: Fall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture. METHODS: Data was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied. RESULTS: Crude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture. CONCLUSIONS: The risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.
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Institucionalización/estadística & datos numéricos , Fracturas Osteoporóticas/rehabilitación , Accidentes por Caídas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Fracturas de Cadera/mortalidad , Fracturas de Cadera/rehabilitación , Hogares para Ancianos/estadística & datos numéricos , Mortalidad Hospitalaria , Humanos , Vida Independiente/estadística & datos numéricos , Masculino , Casas de Salud/estadística & datos numéricos , Fracturas Osteoporóticas/mortalidad , Medición de Riesgo/métodosRESUMEN
OBJECTIVE: A fracture liaison service (FLS) for patients with fractures is a promising approach for improving outcomes, but barriers to the successful implementation of an FLS remain. The factors influencing the outcomes of patients already receiving FLS care are unclear. DESIGN: A prospective multicenter cohort study. SETTINGS AND PARTICIPANTS: Patients with incident hip and clinical vertebral fractures treated at 2 institutions between January 2014 and June 2016 were prospectively enrolled. Demographic profiles, comorbidities, prior fracture experiences, T scores, Fracture Risk Assessment Tool (FRAX) scores, and serum markers were examined. MEASURES: Self-reported functional status (at the 4th month), mortality, recurrent fractures, and falls (at the 2-year follow-up). RESULTS: Of 712 patients screened for eligibility, 600 (84%) participants (age 78 ± 10 years) were enrolled in the FLS program. At 4 months, 58%, 53%, and 60% of the participants reported improved mobility, self-care, and daily activities after FLS care, respectively. After 2 years, 85 (14%) died, 36 (6%) developed recurrent fractures, and 199 (33%) had 1 or more fall episodes. Multivariate logistic regression showed that neurologic disorders, heart disease, and diabetes were associated with a decreased probability of functional recovery. Cox regression showed that older age and chronic kidney disease (CKD) were predictive of increased mortality, whereas heart disease was correlated with an increased refracture risk. Older age and cancer or osteoarthritis were associated with a higher risk of falls. Importantly, a higher body mass index predicted a lower risk of mortality and a higher probability of improved self-care but a higher risk of fall at follow-up. CONCLUSIONS/IMPLICATIONS: We discovered that comorbidities including CKD, heart disease, cancer, and osteoarthritis could influence short-term functional changes, survival, and the risk of refractures or falls among patients participating in FLSs. These factors are expected to aid in prognosis estimation and management planning for those with fractures.
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Accidentes por Caídas/mortalidad , Fracturas Osteoporóticas/mortalidad , Fracturas Osteoporóticas/rehabilitación , Recuperación de la Función/fisiología , Recurrencia , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Humanos , Masculino , Fracturas Osteoporóticas/epidemiología , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Insuficiencia Renal Crónica , Factores de Riesgo , AutoinformeRESUMEN
BACKGROUND AND PURPOSE: As patients who were afflicted with poliomyelitis during the outbreaks in the past are aging, lower extremity osteoporotic fractures are becoming more frequent. Fixation in deformed, porotic bone, coupled with muscle weakness and imbalance creates a unique challenge when treating these fractures as does their reduced rehabilitation potential. The aim of this study was to investigate the outcome of femoral fractures in surviving poliomyelitis patients. PATIENTS AND METHODS: Sixty-five patients with 74 femoral fractures were treated between 1990 and 2014. Clinical outcome was assessed using the Parkland and Palmer mobility score, and quality-of-life was assessed using the SF-12® score. RESULTS: Some 84% of the fractures were a result of low-energy mechanisms and occurred in the polio-affected limbs, but nonaffected limbs were also injured owing to low-energy mechanisms in all cases. Fifty-seven fractures were treated operatively. There were nine re-operations (16%), including implant removals, nonunion, peri-implant fractures, and malunion. Some 60% of the patients did not regain their previous ambulatory capacity. Post-operative weight-bearing status did not correlate with the final functional outcome. CONCLUSIONS: Polio patients with femoral fractures have a guarded prognosis for regaining their pre-injury ambulatory capacity. A higher re-operation rate than that with "normal" osteoporotic fractures is expected.
Asunto(s)
Fracturas del Fémur/cirugía , Limitación de la Movilidad , Fracturas Osteoporóticas/cirugía , Poliomielitis/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Fracturas del Fémur/etiología , Fracturas del Fémur/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/etiología , Fracturas Osteoporóticas/rehabilitación , Pronóstico , Recuperación de la Función , Reoperación , Estudios Retrospectivos , Sobrevivientes , Resultado del Tratamiento , Caminata , Soporte de Peso , Adulto JovenRESUMEN
As more patients live longer, it is probable that an increasing number of geriatric patients will require surgery. An organized, systematic, coordinated, multidisciplinary approach to the perioperative management of these patients will result in fewer complications, improved outcomes, and reduced cost of care. Details are herein provided on the preoperative diagnostic evaluation and assessment as well as perioperative care provided to optimize outcomes. The diagnosis, workup, and treatment of osteoporosis and fragility fractures are presented. The article concludes with a review of the care of the geriatric orthopedic patient in the posthospital time period.
Asunto(s)
Fracturas de Cadera , Ortopedia , Fracturas Osteoporóticas , Atención Perioperativa , Anciano , Evaluación Geriátrica/métodos , Fracturas de Cadera/rehabilitación , Fracturas de Cadera/cirugía , Humanos , Ortopedia/métodos , Ortopedia/organización & administración , Fracturas Osteoporóticas/rehabilitación , Fracturas Osteoporóticas/cirugía , Grupo de Atención al Paciente/organización & administración , Atención Perioperativa/métodos , Atención Perioperativa/normas , Ajuste de Riesgo/métodosRESUMEN
In this large-sample study, we demonstrated that osteogenesis imperfecta (OI) significantly impaired the quality of life (QoL) in children. Moderate/severe OI patients had worse QoL scores than patients with mild OI. Furthermore, the QoL for OI patients was correlated with the presence of pathogenic gene mutations. INTRODUCTION: Osteogenesis imperfecta (OI) is a hereditary disease characterized by multiple fragility fractures and progressive skeletal deformities. No detailed investigations about the quality of life (QoL) have been carried out in a large sample of patients with OI. We evaluated the QoL and its influencing factors in a large and well-characterized OI cohort. METHODS: We used a validated questionnaire of PedsQL 4.0 to evaluate the health-related quality of life (HRQoL) of children and adolescents with OI. We compared HRQoL among patients with OI types I, III, and IV. The relationship between HRQoL and pathogenic mutations in candidate OI genes was investigated. We also evaluated the influencing factors of HRQoL in OI patients. RESULTS: A total of 138 children with OI and 138 healthy controls were enrolled in this study. The HRQoL scores of OI patients were 64.4 ± 30.0, 71.9 ± 22.2, 75.7 ± 24.8, 63.7 ± 24.5, and 68.9 ± 22.0 in physical, emotional, social, school functioning, and total score, respectively, which were significantly lower than those of healthy children (86.5 ± 12.7, 83.3 ± 16.0, 92.1 ± 11.8, 87.5 ± 11.8, and 87.3 ± 10.7, all p < 0.01). Moderate and severe OI (type III/IV) patients had poorer HRQoL scores than patients with mild OI (type I). Gene mutations inducing qualitative defects in type I collagen led to worse HRQoL scores than those with quantitative defects in type I collagen, except in emotional functioning. The total HRQoL score was positively correlated with family income, lumbar, and femoral bone mineral density (BMD) Z-scores and negatively correlated with disease severity and fracture frequency. CONCLUSION: HRQoL was significantly impaired in OI patients, and patients with more severe OI had poorer HRQoL scores. For the first time, we found that children with qualitative defects in type I collagen had poorer HRQoL scores than those with quantitative defects in type I collagen.