Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials

BMC Geriatrics

Leiv Otto Watne¹  Torgeir Bruun Wyller²  Shams Dakhil²  Stian Lydersen³  Pernille Thingstad⁴  Ingvild Saltvedt⁵  Olav Sletvold⁵  Lars Gunnar Johnsen⁶  Eva Skovlund⁷  Frede Frihagen⁸ 

[1] Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway;Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway;Institute of Clinical Medicine, University of Oslo, Oslo, Norway;Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Orthopedic Trauma Unit, Department of Orthopedic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway;Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway;

关键词: Orthogeriatric;    Hip fracture;    Activities of Daily living (ADL);   

DOI  :  10.1186/s12877-021-02152-7

来源: Springer

【 摘 要 】

BackgroundThe incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL).MethodsThis study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery.ResultsSeven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points.ConclusionsMerged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.

【 授权许可】

CC BY