A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery. An experiment in a rehabilitation unit in Northern Italy
A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery. An experiment in a rehabilitation unit in Northern Italy
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DOI：
10.1007/s00198-011-1849-x
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发表时间：
2012-08-01
影响因子：
4
通讯作者：
Trabucchi, M.
中科院分区：
文献类型：
--
作者：
Bellelli, G.;Noale, M.;Trabucchi, M.
制定了髋部骨折术后不同程度（高、中、低）患者骨折前行走能力恢复不成功风险的评分。398名心衰患者参加了这项研究。该评分显著且独立地预测出院时不能独立行走、12个月后不能独立行走和12个月后死亡。该评分可能对临床医生和卫生保健管理人员的康复计划的目标人群有用。建立一个模型，预测老年髋部骨折（HF）患者在出院时是否能恢复独立行走能力，并接受康复治疗。数据来自2001年1月至2008年6月间意大利一家康复科接受心衰手术的所有患者。对认知、临床、功能和社会参数等变量进行评估。通过对应分析确定了主要措施，并定义了可变评分。确定了三个风险等级（最小、中等和高），并使用单变量和多变量逻辑回归来评估模型的预测性和各种结果的风险等级。398例HF患者入组。选取年龄、性别、体重指数、药物服用次数、迷你精神状态检查、日常生活工具活动、骨折前Barthel指数等变量构成评分。单因素分析显示，该评分并不优于骨折前Barthel指数，但多因素分析显示，该评分是所有预后的独立预测指标，而骨折前Barthel指数仅预测出院时的预后。特别是，该评分显著预测出院时不能独立行走、12个月后不能独立行走和12个月后死亡。设计了一种方法来识别不同程度（高、中、低）的hf术后患者骨折前行走能力恢复不成功的风险。该方法可能是有用的临床医生和卫生保健管理人员的目标人群的康复计划。
A score for identifying post-hip-fracture surgery patients at various levels (high, medium, and low) of risk for unsuccessful recovery of pre-fracture walking ability was developed. Three hundred ninety-eight HF patients were enrolled in the study. The score significantly and independently predicted failure to walk independently at discharge, failure to walk independently after 12 months, and death after 12 months. The score may be useful for clinicians and healthcare administrators to target populations for rehabilitative programs.To develop a model predicting at the time that elderly hip-fracture (HF) patients undergo rehabilitation if they will have recovered walking independence at discharge.Data from all patients admitted to a Department of Rehabilitation in Italy between January 2001 and June 2008 after HF surgery were used. Variables concerning cognitive, clinical, functional, and social parameters were evaluated. Predominant measures were identified through correspondence analysis, and a variable score was defined. Three risk classes (minimum, moderate, and high) were identified and univariate and multivariate logistic regressions were used to assess the model's predictivity and risk classes for the various outcomes.Three hundred ninety-eight HF patients were enrolled. The variables selected to construct the score were age, gender, body mass index, number of drugs being taken, the Mini Mental State Examination, the Instrumental Activity of Daily Living, and the pre-fracture Barthel index. According to univariate analysis, the score was not better than the pre-fracture Barthel's index, but, according to multivariate analysis, it was an independent predictor for all the outcomes, while the pre-fracture Barthel index predicted only outcomes at discharge. In particular, the score significantly predicted failure to walk independently at discharge, failure to walk independently after 12 months, and death after 12 months.A method of identifying post-HF surgery patients at various levels (high-, medium-, and low-) of risk for unsuccessful recovery of pre-fracture walking ability has been designed. The method may be useful for clinicians and healthcare administrators to target populations for rehabilitative programs.