Ariza-Vega Patrocinio, Lozano-Lozano Mario, Olmedo-Requena Rocío, Martín-Martín Lydia, Jiménez-Moleón José Juan
From the Department of Rehabilitation and Traumatology, Virgen de las Nieves University Hospital (PA-V); Departments of Physical Therapy (PA-V, ML-L, LM-M) and Preventive Medicine and Public Health (RO-R, JJJ-M), University of Granada; CIBER of Epidemiology and Public Health, CIBEResp (JJJ-M); and Institute for Biomedical Research of Granada (ibs. GRANADA), Servicio Andaluz de Salud/University of Granada (JJJ-M), Granada, Spain.
Am J Phys Med Rehabil. 2017 Feb;96(2):109-115. doi: 10.1097/PHM.0000000000000550.
The aims of this study were to study the mobility recovery in hip fracture patients and determine the influence of cognitive impairment on mobility within the first 3 months after surgery.
This prospective cohort study was carried out in an acute public hospital in southern Spain and included 275 patients, 65 years or older, with a hip fracture. Mobility and Cognitive status were measured by Tinetti Performance-Oriented Mobility Assessment and Pfeiffers' Scale (Short Portable Mental State Questionnaire), respectively. Multiple linear regression was used to examine the influence of cognitive impairment on mobility.
The median Performance-Oriented Mobility Assessment score changed from 4 (3-4) points at discharge to 17 (7-22) at 3 months. All degrees of cognitive impairment were negatively associated with gait and balance at 1 and 3 months after surgery (P < 0.01). Age, weight bearing, length of hospital stay, and postsurgical complications were also identified as independent predictors of mobility outcome at 3 months.
Cognitive impairment is a negative prognostic factor for the recovery of mobility in elderly patients with a hip fracture. New treatment strategies are needed for hip fracture patients with cognitive impairment.
本研究旨在探讨髋部骨折患者的活动能力恢复情况，并确定认知障碍对术后前3个月内活动能力的影响。
这项前瞻性队列研究在西班牙南部的一家急性公立医院开展，纳入了275例65岁及以上的髋部骨折患者。分别采用Tinetti以表现为导向的活动能力评估量表和 Pfeiffer量表（简易便携式精神状态问卷）测量活动能力和认知状态。采用多元线性回归分析认知障碍对活动能力的影响。
以表现为导向的活动能力评估量表的中位数得分从出院时的4（3 - 4）分变为3个月时的17（7 - 22）分。所有程度的认知障碍在术后1个月和3个月时均与步态和平衡呈负相关（P < 0.01）。年龄、负重情况、住院时间和术后并发症也被确定为3个月时活动能力结果的独立预测因素。
认知障碍是老年髋部骨折患者活动能力恢复的不良预后因素。需要为有认知障碍的髋部骨折患者制定新的治疗策略。
