Prognostic factors that predict functional outcome after hip fracture

描述（由申请人提供）：髋部骨折是一个重大的公共卫生问题，因为它的患病率，财务成本和严重的医疗后果。即使手术成功，据报告，53.3%的人再次跌倒，五分之一的髋部骨折患者在骨折后第一年年底死亡。虽然在急性护理管理的改善正在实现，髋部骨折的幸存者的经验丧失的功能能力，这导致一系列的事件，结束在过度残疾（大于预期的老化），在许多领域的身体功能。早期家庭物理治疗的重点是教导患者通过改变或适应新的策略来实现独立功能，而不是恢复下肢的功能。这种不对称性可能导致力量和平衡性的进一步下降以及未来的福尔斯。临床指标，是病人的具体和准确地预测谁是最有可能受益于恢复性护理不存在。一种新的方法，使用力平台变量来测量在坐立任务期间受累和未受累侧之间的不对称性，单独或与临床变量结合时，可能有助于预测髋部骨折后的身体功能和福尔斯。这将是一项前瞻性队列研究，以康复出院为起点。在开始时收集的数据将包括独特的生物力学措施和临床措施适合恢复护理。髋部骨折后6个月，患者的体能通常处于平台期，主要结局将是功能的自我报告。这项研究将有助于确定出院时的预后因素，从物理治疗和分析亚组的患者，将受益于恢复性护理计划。 公共卫生相关性：髋部骨折是一个重大的公共卫生问题，因为它的患病率，经济成本和严重的医疗后果。髋部骨折后，患者接受物理治疗干预，教他们如何通过改变或适应新的策略来补偿，以实现独立功能。本提案的目的是确定哪些患者将受益于恢复性护理，以改善功能并降低髋部骨折患者的福尔斯风险。

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.