Vincent Heather K, DeJong Gerben, Mascarenas Don, Vincent Kevin R
Department of Orthopedics and Rehabilitation, University of Florida, Gainesville, Florida 32611, USA.
Am J Phys Med Rehabil. 2009 Mar;88(3):201-9. doi: 10.1097/PHM.0b013e318198b549.
To determine the effect of body mass index and hip abductor brace use on inpatient rehabilitation outcomes after total hip replacement.
This was a retrospective, comparative study of natural course of rehabilitation care in 15 inpatient rehabilitation facilities. Patients with total hip replacement (n = 1947) and inpatient rehabilitation were stratified into four body mass index groups: nonobese (body mass index <25 kg/m2), overweight (25-29.9 kg/m2), moderately obese (30-40 kg/m2), severely obese (body mass index >or=40 kg/m2), and further stratified by hip abductor brace (brace, no brace). The proportions of patients in each group who used hip abductor braces ranged from 14.5%-17.5%. The main outcomes were length of stay, functional independence measure scores, facility-related charges, and discharge destination.
Length of stay was 0.8-1.3 days longer in the body mass index <25 kg/m2 group compared with the remaining body mass index groups (P < 0.05). Average improvement in total and motor functional independence measure scores ranged 53%-58% and 74%-83% across groups (both P < 0.001). Total rehabilitation charges were highest in the <25 kg/m2 body mass index group ($15,125 vs. $13,608-14,622; P < 0.0001). Hip brace use was associated with an average of $697 excess therapy/pharmacy charges during the rehabilitation stay, but no differences in other outcomes.
Severe obesity and abductor brace use do not impair rehabilitation functional gains or discharge home, but is related with excess rehabilitation costs. Hip abduction braces do not seem necessary during rehabilitation, particularly for obese patients.
确定体重指数和使用髋关节外展支具对全髋关节置换术后住院康复结局的影响。
这是一项对15家住院康复机构康复护理自然病程的回顾性比较研究。全髋关节置换术患者（n = 1947）及住院康复患者被分为四个体重指数组：非肥胖（体重指数<25 kg/m²）、超重（25 - 29.9 kg/m²）、中度肥胖（30 - 40 kg/m²）、重度肥胖（体重指数≥40 kg/m²），并进一步按是否使用髋关节外展支具分层（使用支具、未使用支具）。每组使用髋关节外展支具的患者比例在14.5% - 17.5%之间。主要结局指标为住院时间、功能独立性测量得分、机构相关费用及出院去向。
与其他体重指数组相比，体重指数<25 kg/m²组的住院时间长0.8 - 1.3天（P < 0.05）。各组总功能独立性测量得分和运动功能独立性测量得分的平均改善幅度分别为53% - 58%和74% - 83%（均P < 0.001）。体重指数<25 kg/m²组的总康复费用最高（15,125美元，相比13,608 - 14,622美元；P < 0.0001）。使用髋关节支具与康复住院期间平均多花费697美元的治疗/药物费用相关，但在其他结局方面无差异。
重度肥胖和使用外展支具并不影响康复功能改善或出院回家，但与康复费用过高有关。在康复期间，髋关节外展支具似乎并非必要，尤其是对肥胖患者而言。
