Löfgren Susanne, Hedström Margareta, Ekström Wilhelmina, Lindberg Lene, Flodin Lena, Ryd Leif
Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Scand J Caring Sci. 2015 Sep;29(3):462-9. doi: 10.1111/scs.12157. Epub 2014 Jun 21.
BACKGROUND/AIM: New surgical procedures, early operation and medical optimisation in patients with hip fracture have shown positive results on length of hospital stay. Our aims were to investigate whether patient empowerment along with an individually designed, postoperative rehabilitation programme could reduce length of hospital stay and whether the patients would have better chances to return to their previous living.
DESIGN/METHOD: Patients were recruited during a 12-month period 2009-2010, with an intervention group treated with an individually designed, postoperative rehabilitation programme and a control group treated in a traditional way according to the hospitals routines. Final assessment was performed 4 month after surgery. The postoperative programme for the intervention group consisted of four standardised care tracks adapted individually for the patients. Assessments of Activity of Daily Living, American Society of Anesthesiologists classification of medical disease status and Short Portable Mental Status Questionnaire and living conditions were used to determine which care track was most appropriate. The patients were cared for with focus of empowerment in their rehabilitation.
The study involved 503 hip fracture patients, 285 patients in the intervention group and 218 patients in the control group. The mean length of stay was 4 days shorter in the intervention group than in the control group (p = 0.04). Varied only to a small extent between the age groups in the intervention group and was greater between the age groups in the control. Patients in the intervention group returned to their previous living in 90% compared with 80% in the control group (p < 0.05). There were no significant differences between the age groups.
Patient empowerment administrated by specially trained nursing staff and with specialised, tailor-made rehabilitation programme may be of benefit in helping patients to a shorter hospital stay and to return to their previous living.
背景/目的：髋部骨折患者采用新的手术方法、早期手术及医疗优化措施已显示出对缩短住院时间有积极效果。我们的目的是研究患者赋权以及个性化设计的术后康复计划是否能缩短住院时间，以及患者是否有更好的机会恢复到之前的生活状态。
设计/方法：在2009年至2010年的12个月期间招募患者，干预组采用个性化设计的术后康复计划进行治疗，对照组按照医院常规以传统方式治疗。术后4个月进行最终评估。干预组的术后计划包括根据患者个体情况调整的四个标准化护理路径。通过对日常生活活动能力评估、美国麻醉医师协会医疗疾病状态分类、简易便携式精神状态问卷及生活条件的评估来确定最适合的护理路径。在康复过程中，以患者赋权为重点对患者进行护理。
该研究纳入了503例髋部骨折患者，干预组285例，对照组218例。干预组的平均住院时间比对照组短4天（p = 0.04）。干预组各年龄组之间差异仅在小范围内，而对照组各年龄组之间差异更大。干预组90%的患者恢复到之前的生活状态，而对照组为80%（p < 0.05）。各年龄组之间无显著差异。
由经过专门培训的护理人员实施患者赋权，并采用专门定制的康复计划，可能有助于患者缩短住院时间并恢复到之前的生活状态。
