Early ambulation after hip fracture - Effects on function and mortality
Early ambulation after hip fracture - Effects on function and mortality
复制标题
DOI：
10.1001/archinte.166.7.766
复制
发表时间：
2006-04-10
影响因子：
--
通讯作者：
Morrison, RS
中科院分区：
文献类型：
--
作者：
Siu, AL;Penrod, JD;Morrison, RS
背景：很少有研究探讨住院患者卧床休息与功能结果之间的关系。我们研究了髋部骨折患者的不动与功能和死亡率之间的关系。方法：我们对 532 名 50 岁及以上的患者进行了一项前瞻性队列研究，这些患者在纽约 4 家医院接受了髋部骨折后的手术治疗。我们从医院就诊、医疗记录和访谈中收集信息。 “不动的天数”定义为患者从床上移到椅子旁边的天数。对第 2 个月和第 6 个月的功能（使用功能独立性测量）以及第 6 个月的生存进行随访。结果：髋部骨折患者平均需要 5.2 天的不活动天数。在调整分析中，与不动时间较长（即处于第 90 个百分位）的患者相比，处于不动状态第 10 个百分位的患者 6 个月死亡率较低（-5.4%；95% 置信区间 [CI]，-10.9% 至 -1.0%），且运动功能独立测量评分较好（0.99 分；95% CI，0.3 至 1.7 分，值越高表示越好 功能），但 6 个月时运动没有显着差异（0.58 分；95% CI，-0.3 至 1.4 分）。在基线时使用个人协助或监督进行运动的患者中，不动的不利关联最强（该组中第 90 个百分位和第 10 个百分位数之间的 6 个月死亡率差异为 -17.1% [P = .004]，对于基线时独立运动的患者仅为 1.2% [P = .38]）。结论：在髋部骨折患者中，延迟让患者下床与功能不良相关 2 个月时，6 个月生存率恶化。
Background: Few studies have examined the relationship between inpatient bed rest and functional outcomes. We examined how immobility is associated with function and mortality in patients with hip fracture.Methods: We conducted a prospective cohort study of 532 patients 50 years and older, who were treated with surgery after hip fracture in 4 hospitals in New York. We collected information from hospital visits, medical records, and interviews. "Days of immobility" was defined as days until the patient moved out of bed beyond a chair. Follow-up was obtained on function (using the Functional Independence Measure) at 2 and 6 months and on survival at 6 months.Results: Patients with hip fracture experienced an average of 5.2 days of immobility. Compared with patients with a longer duration of immobility (ie, at the 90th percentile) in adjusted analyses, patients at the 10th percentile of immobility had lower 6-month mortality (-5.4%; 95% confidence interval [CI], -10.9% to -1.0%) and better Functional Independence Measure score for locomotion (0.99 points; 95% CI, 0.3 to 1.7 points, with higher values indicating better function), but there was no significant difference in locomotion by 6 months (0.58 points; 95% CI, -0.3 to 1.4 points). The adverse association of immobility was strongest in patients using personal assistance or supervision with locomotion at baseline (difference in 6-month mortality between the 90th and 10th percentile of immobility was -17.1% [P = .004] for this group and only 1.2% [P = .38] for patients independent in locomotion at baseline).Conclusion: In patients with hip fracture, delay in getting the patient out of bed is associated with poor function at 2 months and worsened 6-month survival.