Hoang-Kim Amy, Busse Jason W, Groll D, Karanicolas P J, Schemitsch E
Institute of Medical Sciences, St. Michael's Hospital, University of Toronto, 30 Bond Street (193-6T Yonge Street), Toronto, ON, M5B 1W8, Canada,
Arch Orthop Trauma Surg. 2014 Feb;134(2):189-95. doi: 10.1007/s00402-013-1756-z. Epub 2013 Apr 25.
Hip fractures are the second leading cause of hospitalization in the aged and by 2041, epidemiologists forecast an increase in economic cost to $2.4 billion. The hip patient population often presents with comorbidities causing these patients to receive less aggressive medical treatment and have a low quality of life. We believe that physical function is a patient-important outcome for many medical and surgical interventions. The functional co-morbidity index (FCI), unlike prior co-morbidity indices, was developed with physical function as an outcome instead of being designed for administrative purposes or to predict mortality. Our objective was to evaluate the perceptions of practitioners in hip fracture care about the impact of comorbidities on physical function as primary outcome.
We piloted and then distributed a self-administered survey to members of the International Society for Fracture Repair hip fracture outcomes working group. For each of the 18 diagnoses included in the FCI index, we asked in our survey whether the presence of the co-morbidity and whether the severity of the co-morbidity was perceived to impact physical function in patients following a hip fracture.
Seventeen out of 20 respondents completed the questionnaire. The presence and severity of arthritis was 'strongly' believed to predict physical function in those with hip fracture (69 and 85.7 %, respectively). Respondents 'agreed' (range 53-73 %) that 10/18 diagnoses would predict changes in physical function following hip fracture treatment. Whereas, 63 % of the practitioners'strongly disagreed' that diabetes types I and II would change physical function scores. Furthermore, dementia was listed as an additional diagnosis that would affect physical function.
The FCI may provide a useful instrument to predict functional outcome after hip fracture; however, the index may need to be modified for this specific population.
髋部骨折是老年人住院治疗的第二大主要原因，到2041年，流行病学家预测经济成本将增至24亿美元。髋部骨折患者群体常伴有多种合并症，这导致这些患者接受的积极治疗较少，生活质量较低。我们认为，身体功能是许多医疗和外科干预措施中对患者很重要的一项结果。功能合并症指数（FCI）与先前的合并症指数不同，它是以身体功能作为一项结果来制定的，而非为行政目的或预测死亡率而设计。我们的目的是评估髋部骨折护理领域从业者对于合并症对作为主要结果的身体功能的影响的看法。
我们先进行了试点，然后向国际骨折修复协会髋部骨折结果工作组的成员发放了一份自填式调查问卷。对于FCI指数中包含的18种诊断中的每一种，我们在调查中询问该合并症的存在与否以及其严重程度是否被认为会影响髋部骨折患者的身体功能。
20名受访者中有17人完成了问卷。关节炎的存在和严重程度被“强烈”认为可预测髋部骨折患者的身体功能（分别为69%和85.7%）。受访者“同意”（比例在53%至73%之间）18种诊断中的10种可预测髋部骨折治疗后身体功能的变化。然而，63%的从业者“强烈不同意”I型和II型糖尿病会改变身体功能评分。此外，痴呆症被列为另一种会影响身体功能的诊断。
FCI可能是预测髋部骨折后功能结果的一种有用工具；然而，该指数可能需要针对这一特定人群进行修改。
