A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia-Subgroup analyses of a randomized controlled trial
A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia-Subgroup analyses of a randomized controlled trial
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DOI：
10.1016/j.archger.2011.08.013
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发表时间：
2012-05-01
影响因子：
4
通讯作者：
Olofsson, Birgitta
中科院分区：
文献类型：
--
作者：
Stenvall, Michael;Berggren, Monica;Olofsson, Birgitta
背景：患有认知障碍和痴呆的人在髋部骨折手术后预后较差，大约30-50%的髋部骨折患者患有痴呆。因此，目的是研究多学科术后干预方案是否可以减少痴呆患者的术后并发症并改善功能恢复。方法：采用随机对照试验，对痴呆患者进行亚组分析。瑞典于默奥大学医院股骨颈骨折64例，年龄bb0 = 70岁。干预措施包括员工教育、个性化护理计划和康复、积极预防、发现和治疗术后并发症，特别是谵妄。工作人员以小组形式进行全面的老年评估、管理和康复，包括术后4个月的随访。对照组遵循常规的术后常规。结果：干预组术后尿路感染等并发症较少，p = 0.001；营养问题，p = 0.025；术后谵妄，p = 0.002；下降，p = 0.006。在4个月时，干预组恢复了先前独立室内行走能力的比例更大，p = 0.005。12个月时，干预组恢复到骨折前日常生活活动（ADL）水平的比例较大，p = 0.027。结论：本研究表明，患有髋部骨折的痴呆患者可以从多学科的老年评估和康复中获益，不应被排除在康复计划之外。2011爱思唯尔爱尔兰有限公司版权所有。
Background: People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery, about 30-50% of all those who sustain a hip fracture have dementia. Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia. Methods: A randomized controlled trial with subgroup analyses among patients with dementia. Sixty-four patients with femoral neck fracture, aged >= 70 years at Umea University Hospital, Sweden. The intervention consisted of staff education, individualized care planning and rehabilitation, active prevention, detection and treatment of postoperative complications, especially delirium. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation, including a follow-up at 4 months postoperatively. The control group followed conventional postoperative routines. Results: There were fewer postoperative complications in the intervention group such as urinary tract infections, p = 0.001; nutritional problems, p = 0.025; postoperative delirium, p = 0.002; falls, p = 0.006. At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance, p = 0.005. At 12 months a larger proportion in the intervention group had regained the activities of daily living (ADL) performance level they had before the fracture, p = 0.027. Conclusion: This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs. (C) 2011 Elsevier Ireland Ltd. All rights reserved.