Institute of Medical Sciences, University of Toronto, St. Michael's Hospital, 30 Bond Street, M5B 1W8 Toronto, ON, Canada.
Arch Orthop Trauma Surg. 2011 Dec;131(12):1687-95. doi: 10.1007/s00402-011-1354-x. Epub 2011 Aug 2.
Elderly patients are at a major risk for a first hip fracture. The decrease in bone mineral density may account for 60-85% of the variability in fracture risk. Other contributing factors for hip fractures include cognitive impairment as well as impaired mobility and visual depth perception. Dizziness and poor or fair self-perceived health care characteristics are predictive of a second hip fracture. In general, patients over the age of 65 years admitted to a geriatric rehabilitation unit after proximal hip fracture have complex multiple interacting pathologies with 78% having significant co-morbidity. Because of the added co-morbidity, we believed that the choice of outcome assessment in hip fracture studies would reflect the practical qualities of an instrument. The purpose of our study was to evaluate the practicality of functional outcome instruments found in the current literature in the elderly following postoperative hip fracture.
We coded the instruments according to the International Classification of Functioning, Disability and Health conceptual framework. 24 different instruments measuring Body Function, 13 instruments evaluating Activity and Participation and 8 composite scores were identified. Practicality was evaluated using four dimensions: respondent burden, examiner burden, score distribution and format compatibility.
All instruments evaluating Body Function were performance-based and used exclusively in rehabilitation trials. Performance-based instruments also correlated with a high score in examiner and respondent burden. Surgical trials mostly adopted the Harris hip score which was rated low in examiner and respondent burden. The SF-36 was rated with an adequate score distribution but low in format compatibility.
An instrument with low respondent burden and minimal examiner burden demonstrated better potential for being applicable in randomized trials with elderly hip fracture patients presenting with co-morbidities. In the future we believe that practical qualities should also be considered when developing or utilizing instruments.
老年患者首次髋部骨折的风险较大。骨密度的下降可能占骨折风险变化的 60-85%。髋部骨折的其他促成因素包括认知障碍以及行动不便和视觉深度知觉受损。头晕以及较差或一般的自我感知的医疗保健特征是预测第二次髋部骨折的因素。一般来说，65 岁以上因股骨近端骨折而入住老年康复病房的患者具有复杂的多种相互作用的病理，78%的患者有明显的合并症。由于合并症的增加，我们认为髋部骨折研究中选择的结果评估方法将反映仪器的实际特性。我们的研究目的是评估当前文献中老年人术后髋部骨折后功能结果评估工具的实用性。
我们根据国际功能、残疾和健康分类框架对工具进行编码。共确定了 24 种测量身体功能的工具，13 种评估活动和参与的工具，以及 8 种综合评分。实用性通过四个维度进行评估：受访者负担、检查者负担、评分分布和格式兼容性。
所有评估身体功能的工具都是基于表现的，并且仅在康复试验中使用。基于表现的工具也与检查者和受访者负担的高评分相关。手术试验主要采用 Harris 髋关节评分，该评分在检查者和受访者负担方面评分较低。SF-36 评分分布得分较高，但格式兼容性得分较低。
具有低受访者负担和最小检查者负担的仪器在有合并症的老年髋部骨折患者的随机试验中具有更好的适用性潜力。我们相信，在未来开发或使用仪器时，也应考虑实际质量。
