改善虚弱者髋骨骨折后的情况


  【24drs.com】根据在线发表于2012年1月American Medical Directors Association期刊的报告,髋骨骨折之后一年,护理之家住院率和死亡风险大幅增加,强化耐力训练和多元介入方式可改善整体健康,减少这些负面结果。
  
  悉尼大学的Nalin A. Singh等人探讨了有关虚弱者发生髋骨骨折的议题,假设增加耐力强度可以比现有的复健治疗更能影响日常生活能力(ADLs)。他们写道,减少髋骨骨折后的发病率和死亡率,需要的不只是治疗骨折,还包括虚弱者本身的议题。
  
  研究者的「Hip Fracture Intervention Trial (HIPFIT)」这篇试验探讨了一个新的、实证基础的治疗策略,目的在改善髋骨骨折后的长期结果,方法是藉由高强度耐力训练12个月,以免肌肉减少。研究计画也探讨了之前定义的虚弱、死亡率与护理之家住院,采用跨科介入方式处理平衡问题、骨质疏松、营养不佳、维他命D/钙质缺乏、忧郁、认知不佳、视力不佳、不安全的居家环境、服用多种药物、使用髋骨保护器、自我照护与社会支持。
  
  这是篇随机、控制、平行组别研究,研究对象是124名55岁以上、在2003- 2007年因为手术治疗轻微创伤髋骨骨折住入公立医院的病患。各有62名病患被指定接受介入计划或仅接受一般照护(骨科住院与专职医疗谘商加上6-12周的标准物理治疗),每周监督进行举重训练2天、为期12个月,从物理治疗结束时开始,约是骨折后6-8周。
  
  分析了功能独立性、死亡率资料、护理之家住院资料、ADL情况、以及辅具使用情况。
  
  介入组的62人中,4人死亡,对照组的62人有8人死亡,死亡风险降低81%(年龄校正胜算比0.19;95%信心区间0.04 - 0.91;P < .04),介入组的护理之家住院率降低84%(年龄校正胜算比0.16;95%信心区间0.04 - 0.64;P < .01)。
  
  介入组中,12 个月后的辅具使用率显著降低(P = .01),基本的ADL退化较少,如厕与移动也比较容易。ADL改善和较佳的营养、视力、平衡、认知、自我照护、上半身强度增加等有关。
  
  研究者结论表示,12个月受监督的高强度耐力训练,加上解决其它的虚弱问题,对于减少髋骨骨折后副作用是可行且有效的。HIPFIT介入后有显著改善,死亡率、住护理之家、ADL独立性、辅具使用等都有临床意义的降低。研究限制包括,样本数有限,对介入方式缺乏分类,无法确认特定的改善程度。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6704&x_classno=0&x_chkdelpoint=Y
  

Addressing Frailty Improves Post-Hip-Fracture Experience

By Ricki Lewis, PhD
Medscape Medical News

January 5, 2012 — The risks for mortality and nursing home admission rise greatly in the year after hip fracture. High-intensity resistance training coupled with multiple interventions to improve general health and well-being can minimize these negative outcomes, according to a report published in the January 2012 issue of the Journal of the American Medical Directors Association.

Nalin A. Singh, MBBS, and colleagues from the University of Sydney, Australia, addressed the frailty of patients sustaining hip fracture, hypothesizing that increasing strength might affect activities of daily living (ADLs) more than the current clinical focus on repair and rehabilitation. "Lowering the burden of excess morbidity and mortality after hip fracture requires treatment of the underlying frailty itself, not just the broken bone," they write.

The researcher's Hip Fracture Intervention Trial (HIPFIT) tests "a novel, evidence-based treatment strategy to improve long-term outcomes after hip fracture by targeting sarcopenia with 12 months of high-intensity progressive resistance training." The protocol also addresses previously identified predictors of frailty, mortality, and nursing home admission with "targeted multidisciplinary intervention" to handle balance problems, osteoporosis, poor nutrition, vitamin D/calcium deficiency, depression, impaired cognition, poor vision, unsafe home conditions, taking multiple drugs, using hip protectors, and self-care and social support.

The study was a randomized, controlled, parallel-group superiority design on 124 patients older than 55 years who were admitted to a public hospital for surgical repair of minimal-trauma hip fracture from 2003 to 2007. Equal numbers of patients (62) were assigned to the intervention protocol or to receive only usual care (inpatient orthogeriatric and allied health consultation plus 6 - 12 weeks of standard physical therapy). The supervised weight-lifting took place 2 days per week for 12 months, beginning after the end of physiotherapy, about 6 to 8 weeks postfracture.

Outcomes assessed functional independence, using data on mortality, nursing home admission, ADL scales, and use of assistive devices.

Of the 62 individuals in the intervention group, 4 died compared with 8 of the 62 patients in the control group, indicating reduction in risk for death of 81% (age-adjusted odds ratio, 0.19; 95% confidence interval, 0.04 - 0.91; P < .04). Nursing home admissions were reduced in the experimental group by 84% (age-adjusted odds ratio, 0.16; 95% confidence interval, 0.04 - 0.64; P < .01).

In the intervention group, assistive device use was significantly lower after 12 months (P = .01), basic ADLs declined less, and toileting and transferring became easier. The ADL improvements were associated with better nutrition, vision, balance, cognition, and self-care, as well as increased upper body strength.

The investigators conclude that 12 months of supervised, high-intensity resistance training, coupled with addressing other problems related to frailty, is a feasible and effective approach for minimizing adverse events after hip fracture. "The HIPFIT intervention resulted in statistically significant and clinically meaningful reductions in mortality, nursing home use, ADL dependency, and assistive device usage," they write. Limitations of the study include the small sample sizes and the lack of stratification of the interventions to identify which were responsible for specific improvements.

This study was funded by the Australian National Health and Medical Research Council. The authors have disclosed no relevant financial relationships.

J Am Med Dir Assoc. 2012;13:24-30.

    
相关报导
自闭症与髋骨骨折风险增加有关
2014/10/17 下午 03:32:08
乳糜泻患者髋骨骨折风险随慢性肠道损伤而增加
2014/1/22 下午 05:10:48
心智健康疾病增加了护理之家的收容风险
2012/11/15 下午 03:34:11

上一页
   1   2   3   4  




回上一页