School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Roth|McFarlane Clinical Research Laboratory, Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada.
School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Roth|McFarlane Clinical Research Laboratory, Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada; Department of Surgery, University of Western Ontario, London, Ontario, Canada.
J Hand Ther. 2018 Oct-Dec;31(4):451-464. doi: 10.1016/j.jht.2017.06.009. Epub 2017 Oct 6.
STUDY DESIGN: Descriptive/Longitudinal cohort. INTRODUCTION: Distal radius fracture (DRF) is a common fall related fragility fracture that is known to be an early and independent predictor of secondary osteoporotic (OP) fractures. Changes in falls risk status, bone status and general health has not been evaluated prospectively in a population that has sustained a DRF. PURPOSE OF THE STUDY: The purpose of our study was to describe the status of fracture-specific pain/disability, fall risk factors such as physical activity (PA) and fear of falling (FOF), bone mineral density (BMD) and general health status (HS) in people with a DRF and how these variables change over four years with respect to sex, age, incidence of secondary falls and secondary OP fractures. METHODS: Patients (n = 94) self-reported their fracture-specific pain and disability (Patient-Rated Wrist Evaluation), PA (Rapid Assessment of Physical Activity), FOF (Modified Fall Efficacy Scale), HS (12-item Short Form Health Survey) and completed dual-energy X-ray absorptiometry scan based BMD assessment (lumbar spine and total hip) at baseline (1-2 weeks post-fracture), six months and four years after DRF. Descriptive statistics and general linear models were used to describe changes in recovery patterns over four years. RESULTS: There was significant (p<0.001) improvement in fracture-specific pain/disability (60 points), FOF (1 point) and physical HS (11 points) between baseline and 4 year follow-up. There were no significant changes in PA and BMD. When stratified with respect to age, sex, presence of subsequent falls and OP fractures, there were no significant differences in fracture-specific pain/disability, PA, FOF, and BMD at baseline, six months or four years after DRF. The physical HS was significantly (p<0.05) less/poorer among those with secondary falls (lower by 2-6 points) and fractures (lower by 5-6 points) compared to those without. Similarly, mental HS was significantly (p<0.05) poorer among people with secondary falls (lower by 2-6 points) and in 50-64 year age group (lower by 3-5 points) than those without secondary falls and in 65-80 year age group, respectively. CONCLUSION: Post DRF, the majority of the improvement in fracture-specific pain/disability, FOF and HS was completed at six months and very small changes were observed between the six month and four year follow-up. LEVEL OF EVIDENCE: NA.
研究设计：描述性/纵向队列研究。
引言：桡骨远端骨折（DRF）是一种常见的与跌倒相关的脆性骨折，已知是继发性骨质疏松性（OP）骨折的早期和独立预测因子。在发生 DRF 的人群中，尚未前瞻性评估跌倒风险状况、骨骼状况和整体健康状况的变化。
研究目的：我们研究的目的是描述桡骨远端骨折患者的骨折特异性疼痛/残疾、跌倒风险因素（如身体活动（PA）和跌倒恐惧（FOF））、骨矿物质密度（BMD）和整体健康状况（HS）的状况，以及这些变量如何因性别、年龄、继发性跌倒和继发性 OP 骨折的发生率而在四年内发生变化。
方法：患者（n = 94）在基线（骨折后 1-2 周）、6 个月和 4 年后自我报告骨折特异性疼痛和残疾（患者腕部评估）、PA（快速身体活动评估）、FOF（改良跌倒效能量表）、HS（12 项简短健康调查）和基于双能 X 线吸收法的 BMD 评估（腰椎和全髋关节）。使用描述性统计和一般线性模型来描述四年内恢复模式的变化。
结果：与基线相比，4 年随访时骨折特异性疼痛/残疾（60 分）、FOF（1 分）和身体 HS（11 分）有显著（p<0.001）改善。PA 和 BMD 没有显著变化。按年龄、性别、随后跌倒和 OP 骨折分层，DRF 后基线、6 个月和 4 年时，骨折特异性疼痛/残疾、PA、FOF 和 BMD 无显著差异。与无继发性跌倒和骨折的患者相比，有继发性跌倒（低 2-6 分）和骨折（低 5-6 分）的患者身体 HS 明显（p<0.05）较差/更差。同样，精神 HS 也明显（p<0.05）较差，发生继发性跌倒的人群（低 2-6 分）和 50-64 岁年龄组（低 3-5 分）比没有继发性跌倒和 65-80 岁年龄组的人群（低 3-5 分）差。
结论：DRF 后，骨折特异性疼痛/残疾、FOF 和 HS 的大部分改善在 6 个月时完成，在 6 个月和 4 年随访之间观察到的变化很小。
证据水平：无。
Osteoporos Int. 2016-12
Arch Osteoporos. 2017-12
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