Heinonen Maarit, Karppi Pertti, Huusko Tiina, Kautiainen Hannu, Sulkava Raimo
Department of Physiotherapy, Jyväskylä Central Hospital, Kinkomaa, Finland.
Aging Clin Exp Res. 2004 Dec;16(6):476-80. doi: 10.1007/BF03327405.
Although several investigations have tested physical activity a few months or one year after hip fracture, only a few have assessed physical activity shortly after hip fracture. The aim of this study was to evaluate how physical function two weeks after hip fracture operation predicts 12-month mortality. This was a prospective study of hip fracture patients with one-year follow-up, carried out in Jyväskylä Central Hospital in Finland.
In this study, there were 243 consecutive community-dwelling patients aged 65 or older, who were able to walk before hip fracture. Two weeks after operation, information was gathered on pre-fracture activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Patients' ability to stand up, sit down and walk was assessed. The follow-up lasted 12 months.
The best predictor for mortality after one year was inability to stand up, hazard ratio (HR) 4.64 (95% CI 2.11-10.18, p < 0.001). The corresponding HRs concerning inability to sit down were 4.52 (95% CI 2.10-9.72, p < 0.001), inability to walk 2.39 (95% CI 1.20-4.78, p = 0.013), ADL score 1.43 (95% CI 1.16-1.76, p = 0.001) and IADL score 1.19 (95% CI 1.03-1.38, p = 0.017). These variables were age- and sex-adjusted. According to the multiple proportional hazard model there was only one variable with statistical significance, i.e., the pre-fracture ADL-score (p = 0.025).
Inability to stand up, sit down or walk two weeks after operation were the strongest predictors for mortality among operated hip fracture patients. We suggest that focus should be directed to verify if better survival might be achieved by more intensive rehabilitation immediately after the operation. The pre-fracture ADL-score appeared to be the only variable reaching statistical significance in the multiple proportional hazard model. This fact may reflect frailty and affect decisions concerning the rehabilitation program.
尽管多项研究在髋部骨折数月或一年后对身体活动情况进行了测试，但只有少数研究评估了髋部骨折后不久的身体活动情况。本研究的目的是评估髋部骨折手术后两周的身体功能如何预测12个月的死亡率。这是一项在芬兰于韦斯屈莱中心医院进行的对髋部骨折患者进行为期一年随访的前瞻性研究。
本研究纳入了243例年龄在65岁及以上、髋部骨折前能够行走的社区居住患者。术后两周，收集了骨折前日常生活活动（ADL）和工具性日常生活活动（IADL）的信息。评估了患者站立、坐下和行走的能力。随访持续12个月。
一年后死亡率的最佳预测因素是无法站立，风险比（HR）为4.64（95%置信区间2.11 - 10.18，p < 0.001）。关于无法坐下的相应HR为4.52（95%置信区间2.10 - 9.72，p < 0.001），无法行走为2.39（95%置信区间1.20 - 4.78，p = 0.013），ADL评分1.43（95%置信区间1.16 - 1.76，p = 0.001），IADL评分1.19（95%置信区间1.03 - 1.38，p = 0.017）。这些变量进行了年龄和性别调整。根据多比例风险模型，只有一个变量具有统计学意义，即骨折前ADL评分（p = 0.025）。
术后两周无法站立、坐下或行走是髋部骨折手术患者死亡率的最强预测因素。我们建议应着重核实术后立即进行更强化的康复是否能提高生存率。骨折前ADL评分似乎是多比例风险模型中唯一具有统计学意义的变量。这一事实可能反映了虚弱状况，并影响康复计划的决策。
