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Sie haben zu viele Anfragen gesendet, sodass Linguee Ihren Computer ausgesperrt hat.Studies steroid anabolic rating chart shown that patients with hip fracture treated in a Comprehensive Geriatric Care CGC unit report better results in comparison ratiny orthopaedic care. Furthermore, involving patients in their healthcare by encouraging stsroid participation testosteron mann tabelle aus result in better quality of care and improved outcomes. A prospective, controlled, intervention performed in a CGC unit and compared with standard care. A total of patients with steroid anabolic rating chart fracture were recruited who were prior to fracture; community dwelling, mobile indoors and independent in personal care. The primary outcome measure was self-reported patient participation at discharge. Secondary outcome measures were: The online version of this article
Studies have shown that patients with hip fracture treated in a Comprehensive Geriatric Care CGC unit report better results in comparison to orthopaedic care. Furthermore, involving patients in their healthcare by encouraging patient participation can result in better quality of care and improved outcomes.
A prospective, controlled, intervention performed in a CGC unit and compared with standard care. A total of patients with hip fracture were recruited who were prior to fracture; community dwelling, mobile indoors and independent in personal care.
The primary outcome measure was self-reported patient participation at discharge. Secondary outcome measures were: The online version of this article Hip fractures are associated with high mortality rates, substantial functional decline and the consequences have been identified as one of the most serious health care problems in elderly people [ 1 ]. However, due to demographic changes over the coming decades these numbers are expected to increase [ 2 ]. A wealth of research to improve outcomes for patients with hip fracture has been performed.
Studies include investigating pre-disposing factors affecting recovery [ 3 , 4 ]; factors associated with increased risk of mortality [ 4 ]; effect of lower limb training [ 5 ]; recovery of walking ability [ 6 , 7 ]; predicting risk for future falls [ 8 , 9 ]; and comparison of orthopaedic versus comprehensive geriatric care CGC [ 10 — 12 ]. CGC is however not without its limitations. Two recent reviews described how the heterogenous way models of CGC have been organized and put into practice make it difficult to interpret results, compare studies and determine best practice [ 16 , 17 ].
Rehabilitation research generally includes multiple outcomes, addressing ICF classifications of body function, body structures and activities, however the aspect of patient participation is less commonly studied despite being described as the outcome most important to people with disabilities, their families and society [ 18 ]. Encouraging patients with complex health care needs to take a more active role in their health care has shown patients reporting increased motivation and improved outcomes [ 19 ], experiencing higher quality of care, with fewer mistakes, and a more positive impression of the health care system [ 20 ].
Secondary aims were to investigate effect on activities of daily living, functional balance and confidence and physical performance. A prospective, controlled, intervention study. During September and May , a convenience sample of patients with hip fracture was recruited. Patients were admitted to one of the three wards depending on available beds. One ward was allocated as the intervention ward and the other two as controls.
All three geriatric wards follow a structured, systematic interdisciplinary geriatric care pathway for hip fracture patients, commencing at admission pre-operatively through to discharge. The control group received standard rehabilitation from occupational therapists OT and physiotherapists PT Monday to Friday , planned individually and gradually progressed for each patient. Patients were provided with a booklet with information about the fracture, operation method, exercise regime and assistive walking and ADL aid available.
Interdisciplinary team meetings were held twice weekly to discuss progress and future planning. For those patients returning to their own homes, an OT instructed them in the use of ADL aids, and assessed the need for aids in the home environment prior to discharge. All patients received both written and verbal information regarding prevention of falls prior to discharge. In addition to standard rehabilitation, focus was placed on promoting patient participation through closer collaboration between the OT, the PT and the patient.
Patients were encouraged to take a more active part in and personal responsibility for their training and setting of rehabilitation goals. They explained their roles in the inpatient rehabilitation process as facilitators to guide the patients in their recovery process whilst making it clear that it was important that the patient felt involved and part of the team.
Patients were encouraged, using the TLS-BasicADL protocol, to consider activities that were important to them to be able to perform at discharge. This was done under supervision of OT and PT with the aim that patients would gain confidence to take increased responsibility. Written and photographic instructions were included in the kit.
All patients were given self-training exercises to perform daily to suit their level of dependence, adapted and intensified as the patient progressed. OT and PT filled in a training protocol showing when and how often patients received treatment. In addition the patients were encouraged to fill in an exercise diary.
Over and above the twice weekly interdisciplinary meetings, the OT and PT met on a daily basis to plan daily training schedules to avoid collision. An additional meeting was held once a week, to further discuss routines concerning collaboration and treatment plans for individual patients. Patients were asked daily about adverse reactions to treatment such as increased pain or fatigue. Adverse events were documented in the patient records and treatment was adapted as required.
The OT and PT staffing levels were similar on all three wards, with approximately 0. Staff working on the two control wards were informed that the study was in progress, but no information was given regarding the content of the intervention, nor did they treat patients included in the intervention.
The two OTs and three PTs who assessed the patients at discharge and one month were not blinded to the intervention but had no treatment association with the study patients. Data concerning the fracture and other medical conditions were collected from medical records. Self-rated degree of participation in rehabilitation was measured at discharge from hospital.
Patients answered 4 questions, specifically formulated for this study, regarding perceived level of participation in their rehabilitation; working together with OT and PT in goal-setting; personal responsibility for their training, and making decisions regarding care and treatment as much as they liked. The questions were answered using a four level scale very high degree, moderate degree, small degree or not at all. This is done in collaboration with the patient with the aim of promoting increased participation.
TLS-BasicADL has been shown to have high inter-rater and fair intra-rater reliability [ 26 ] and moderate to excellent validity and responsiveness submitted and under peer review.
The ADL-staircase has shown good validity and reliability [ 27 ], and is considered a stable and clinically relevant tool when used in studies of older people [ 29 , 30 ].
BBS assesses 14 activities of varying difficulty with a scoring range from 0 to 4 0 unable to perform to 4 able to perform completely [ 31 ]. The item scores are summed giving a score of 0—56, with 56 showing indicating normal functional balance. BBS has shown excellent test-retest reliability and validity [ 31 , 33 ].
To discriminate those at risk for falls, a cut-off score of 47 was defined [ 32 ]. For the purpose of this study the aspect of confidence rather than fear has been assessed. FES-S includes 13 items, comprising three parts, six items measuring self-care, one item stair walking, and six items instrumental activities.
The maximum score is Test—retest reliability of the Swedish version of the scale was found to be acceptable by Hellstrom et al. The sum of the three components comprises the final SPPB score with a possible range from 0 to 12 12 indicating the highest degree of lower extremity functioning. According to Perera et al.
According to recommendations by Podsiadlo and Richardson [ 38 ], TUG was performed twice in each test session, one trial and one timed performance, with a brief seated rest in between.
The participants were instructed to walk at a comfortable, safe speed. TUG has good inter-rater and intra-rater reliability and is a reliable and valid measure of functional mobility [ 38 ]. Descriptive statistics are reported as means and standard deviations SD or median min-max as appropriate. Analyses were performed using SPSS The patients in the intervention group IG had an average age of No statistically significant differences were found between the groups at baseline apart from type of surgery, with a higher proportion of patients with a hemiarthroplasty in the IG and I-ADL activity of cooking in which the CG was more independent than the IG.
Of the patients admitted to the unit, patients fulfilled the inclusion criteria. The main reason for exclusion was cognitive impairment and dependency in more ADL activities than just bathing. Eighteen patients declined participation giving a total of patients. Reasons for drop-out prior to discharge included: Prior to one month follow-up; declined 6 , deceased 5 , and admitted to hospital 1.
Two patients in the IG and one patient in the CG did not complete the questionnaire, leaving a total of 58 and 57 patients in the IG and CG, respectively. Activities where no statistically significant changes were reported included the three activities involving the upper body: A total of ten patients reported having fallen since discharge, two patients in the IG and eight in the CG, these results were however not statistically significant.
No adverse side effects from the intervention were reported, suggesting that older persons following hip fracture surgery both tolerate and benefit from a more coordinated and intensive rehabilitation compared to standard care. This study shows that by modifying existing CGC in-patient rehabilitation routines and intensity, whilst retaining existing staffing levels, positive results concerning patient participation and recovery of ADL can be obtained.
There is a lack of studies investigating patient participation during acute phase after hip fracture. However, our physical performance outcomes are similar to those reported by Prestmo et al. The difficulties in comparing studies due to the varying models of orthogeriatric care in practice and the heterogeneity of patients with hip fracture are well-known [ 41 ].
However, a strength of this particular study is that we have compared rehabilitation models of care within a well-established geriatric unit, specialized in care of older persons with hip fracture.
To decrease the heterogeneity of the study population, we chose to examine previously relatively high functioning older adults. No changes were made in the levels of OT or PT staffing on the 3 wards and were comparable to staffing levels in the orthogeriatric unit described in the study performed by Prestmo et al.
A further strength is the use of recommended and recognized outcomes to measure balance and physical function, which could facilitate comparisons of results with future studies. BBS has recently been recommended as one of two outcomes to measure standing balance for research and practice in adult populations [ 42 ].
SPPB and TUG are also commonly used in studies of patients with a hip fracture and community dwelling older adults [ 11 , 32 , 43 — 47 ]. There was to our knowledge, no established questionnaire evaluating perceived patient participation for this patient group, and for this purpose questions were therefore constructed by the authors of the study.
These questions were tested in 10 patients prior to starting inclusion in the study, and according to patient feedback minor revisions were made. Although a randomized controlled study would have strengthened this trial, it was not possible due to different admission routines depending on day of the week and time of admission.
Our power calculation initially showed that we needed 92 patients. However we did not stratify for gender, which resulted in a maldistribution towards the end of the inclusion process.
We therefore chose to continue to include participants until a balance was reached between women and men, which resulted in a total of participants. We recognise that there were more patients with cervical fractures and ASA 1—2 in IG which in theory should mean they be less compromised early post-operatively. However our clinical observation was that patients in the IG were in fact less able than those in the CG.
This may have contributed to more IG patients being discharged to an intermediary rehab unit and not directly home. Even if there were no statistically significant differences, the IG was 1. While we need to be cautious, this could partly explain a higher proportion of CG being discharged to own home. The differences found in patient participation we believe, are a result of the more coordinated approach by OT and PT, which incorporated recommendations described by Sahlsten et al.
The IG was also encouraged to be more actively involved in their rehabilitation, both during, and between, treatment sessions. Two activities were however shown to be statistically significantly better in the IG:
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