Recovery from hip fracture in eight areas of function
Recovery from hip fracture in eight areas of function
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DOI：
10.1093/gerona/55.9.m498
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发表时间：
2000-09-01
影响因子：
5.1
通讯作者：
Kenzora, J
中科院分区：
文献类型：
--
作者：
Magaziner, J;Hawkes, W;Kenzora, J
背景资料。这份报告描述了髋部骨折后八个功能领域的变化，确定了每个区域达到最大恢复水平的时间点，并评估了跨多个功能领域的康复顺序。对1990-1991年间在马里兰州巴尔的摩8家医院住院的674名社区髋部骨折患者进行前瞻性随访，从住院时间算起为期2年。分别于入院后2、6、12、18、24个月采用访谈法和直接观察法对患者的8项功能(即上肢和下肢的日常生活活动能力；步态和平衡能力；社会功能、认知功能和情感功能)进行评定。描述了每个地区的恢复水平，并使用广义估计方程和纵向数据估计了达到最大恢复的时间。在骨折后的第一年，大多数功能区域的依赖性逐渐减少，每个区域的恢复程度和达到最大水平的时间各不相同。对于骨折前不需要设备或人工帮助的人，在体力和器械工作上的新依赖程度从穿裤子的20.3%到爬五级楼梯的高达89.9%不等。康复时间因功能部位不同而异，抑郁症状约4个月(3.9个月)，上肢功能约4个月(4.3个月)，认知功能约1年(4.4个月)，下肢功能约1年(11.2个月)。髋部骨折后的功能障碍是严重的，不同功能区域的恢复模式不同，功能区域达到最大水平的顺序似乎是有序的。
Background. This report describes changes in eight areas of functioning after a hip fracture, identifies the point at which maximal levels of recovery are reached in each area, and evaluates the sequence of recuperation across multiple functional domains.Methods. Community-residing hip fracture patients (n = 674) admitted to eight hospitals in Baltimore, Maryland, 1990-1991, were followed prospectively for 2 years from the time of hospitalization. Eight areas of function (i.e., upper and lower extremity physical and instrumental activities of daily living; gait and balance; social, cognitive, and affective function) were measured by personal interview and direct observation during hospitalization at 2, 6, 12, 18, and 24 months. Levels of recovery are described in each area, and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data.Results. Most areas of functioning showed progressive lessening of dependence over the first postfracture year, with different levels of recovery and time to maximum levels observed fur each area. New dependency in physical and instrumental tasks fur those not requiring equipment or human assistance prefracture ranged from as low as 20.3% for putting on pants to as high as 89.9% for climbing five stairs. Recuperation times were specific to area of function, ranging from approximately 4 months fur depressive symptoms (3.9 months), upper extremity function (4.3 months), and cognition (4.4 months) to almost a year for lower extremity function (11.2 months).Conclusions. Functional disability following hip fracture is significant, patterns of recovery differ by area of function, and there appears to be an orderly sequence by which areas of function reach their maximal levels.