Muir Susan W, Yohannes Abebaw M
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
J Geriatr Phys Ther. 2009;32(1):24-32. doi: 10.1519/00139143-200932010-00006.
To evaluate the evidence of rehabilitation outcomes after the surgical repair of a hip fracture in older people with cognitive impairment.
Systematic review.
Searches were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials Register), ProQuest Dissertations, and Theses Database and bibliographies of extracted publications in the English language between 1990 and June 2007. Search terms included: dementia/Alzheimer disease/cognitive impairment, hip fracture, rehabilitation, outcome assessment/treatment outcome. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale, of the extracted articles. Only studies evaluating rehabilitation outcomes with data analysis specific for cognitive status were evaluated. Sackett's levels of evidence were used to summarize the main findings.
Eleven studies met the inclusion criteria. Methodological quality of the studies ranged from fair to poor. The generalizability of study findings was limited by multiple rehabilitation settings in the acute and subacute phase postsurgery, multiple methods with varying thresholds for determining cognitive impairment and multiple functional outcome scales.
There is some evidence that older adults with cognitive impairment who receive intensive inpatient rehabilitation after surgical repair of a hip fracture may be able to gain comparable benefit in physical function as cognitively intact patients. There is not enough information to guide recommendations of specific physical therapy interventions to optimize outcomes in this patient population. Further work is needed.
评估认知障碍老年人髋部骨折手术修复后的康复效果证据。
系统评价。
检索MEDLINE、EMBASE、CINAHL、PsycINFO、Cochrane图书馆（Cochrane系统评价数据库、疗效评价文摘数据库和Cochrane对照试验注册库）、ProQuest学位论文和博硕士论文数据库以及1990年至2007年6月期间英文提取出版物的参考文献。检索词包括：痴呆/阿尔茨海默病/认知障碍、髋部骨折、康复、结局评估/治疗结果。两名独立 reviewers 使用唐斯和布莱克评分量表对提取的文章进行筛选和方法学质量评估。仅评估采用针对认知状态的数据分析来评价康复效果的研究。采用萨克特证据等级来总结主要研究结果。
11项研究符合纳入标准。研究的方法学质量从中等到差不等。研究结果的可推广性受到术后急性和亚急性期多种康复环境、多种确定认知障碍阈值的方法以及多种功能结局量表的限制。
有证据表明，认知障碍的老年人在髋部骨折手术修复后接受强化住院康复治疗，在身体功能方面可能获得与认知健全患者相当的益处。没有足够的信息来指导针对该患者群体优化结局的具体物理治疗干预建议。需要进一步开展工作。
