Prognostic factors that predict functional outcome after hip fracture

描述（由申请人提供）：髋部骨折是一个重要的公共卫生问题，因为它的普遍性、经济成本和严重的医疗后果。据报道，即使手术成功，53.3%的患者仍会再次跌倒，五分之一的髋部骨折患者会在骨折后的一年内死亡。尽管急性护理管理正在得到改善，但髋部骨折的幸存者仍会经历功能丧失，这导致一系列事件，最终导致许多身体功能领域的过度残疾（比预期的年龄更大）。早期的家庭物理治疗侧重于教导患者通过改变或适应新的策略来补偿，以实现独立的功能，而不是恢复相关下肢的功能。这种不对称可能会导致力量和平衡能力的进一步下降以及未来的跌倒。目前尚不存在具有患者特异性并能准确预测谁最有可能从恢复性治疗中获益的临床指标。一种利用力平台变量来测量坐立任务中受累侧和未受累侧不对称性的新方法可能单独或与临床变量相结合，用于预测髋部骨折后的身体功能和跌倒。这将是一项前瞻性队列研究，以康复出院为起点。开始时收集的数据将包括独特的生物力学测量和适合恢复性护理的临床测量。髋部骨折后6个月，当患者的身体能力趋于稳定时，主要的结果将是自我报告的功能。这项研究将有助于确定物理治疗出院时的预后因素，并对将受益于恢复性护理计划的患者亚组进行分析。

DESCRIPTION (provided by applicant): Hip fracture is a significant public health concern because of its prevalence, financial costs, and serious medical consequences. Even after a successful surgery, 53.3% of persons are reported to fall again and one out of five people who sustain a hip fracture will die by the end of the first year following the fracture. Although improvements in acute care management are being realized, survivors of hip fracture experience loss of functional ability, which leads to a sequence of events that ends in excess disability (greater than that expected with aging) in many areas of physical function. Early home physical therapy focuses on teaching patients to compensate by altering or adapting a new strategy to achieve independent functioning, rather than restoring function of the involved lower extremity. This asymmetry may lead to further decline in strength and balance and future falls. Clinical indicators that are patient-specific and accurately predict who is most likely to benefit from restorative care do not exist. A novel approach using force platform variables to measure asymmetry between the involved and uninvolved sides during a sit to stand task may be useful alone, or when combined with clinical variables, in predicting physical function and falls following hip fracture. This will be a prospective cohort study using discharge from rehabilitation as an inception point. Data collected at inception will include unique biomechanical measures and clinical measures amenable to restorative care. Six months post hip fracture, when patients typically plateau in their physical abilities, the primary outcome will be self-report of function. This study will be useful in identifying prognostic factors at discharge from physical therapy and for profiling subgroups of patients that will benefit from a program of restorative care. PUBLIC HEALTH RELEVANCE: Hip fracture is a significant public health concern because of its prevalence, financial costs, and serious medical consequences. Following hip fracture, patients receive physical therapy interventions that teach them how to compensate by altering or adapting a new strategy to achieve independent functioning. The goal of this proposal is to identify which patients will benefit from restorative care to improve function and reduce falls risks in patients following hip fracture.