Elli Sara, Contro Diego, Castaldi Silvana, Fornili Marco, Ardoino Ilaria, Caserta Antonello V, Panella Lorenzo
Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy,
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Patient Prefer Adherence. 2018 Sep 21;12:1889-1895. doi: 10.2147/PPA.S164380. eCollection 2018.
The aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient's health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure.
We enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient's caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient.
Analysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland-Altman plot of -2.43, 95% CI=-2.93 to -1.93, -test <0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition.
This study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered perception of such an important factor can lead to a general lack of satisfaction with the outcome achieved by the patient at the end of the rehabilitation process. We therefore believe that an adequate, effective communication between the people making up the health care team and the patient's social and family network is the foundation of the rehabilitation process. It is precisely on this foundation that the individual's care and assistance need to be assembled.
我们研究的目的是评估髋部骨折患者的照料者在急性事件发生前即刻如何看待患者的健康状况和自主性，以及这些判断是否实际上与在康复机构中照料该患者的医疗团队所预测的预后相符。
我们纳入了147名年龄≥65岁的男女患者，他们因各种类型的髋部骨折接受手术治疗后被转诊至我们中心。在康复计划开始时，要求每位患者的照料者完成布莱洛克风险评估筛查评分（BRASS）问卷。负责照料患者的医生同时填写相同的问卷。
数据分析表明，照料者倾向于给出比医生更低的分数，与布兰德 - 奥特曼图的平均差异为 -2.43，95%置信区间 = -2.93至 -1.93，P检验<0.001。此外，在评估临界临床状况患者的临床问题时出现了客观性差异。
本研究表明，照料者在急性事件发生前系统性地误判了髋部骨折患者的临床状况。对这一重要因素的认知改变可能导致对患者在康复过程结束时所取得的结果普遍不满意。因此，我们认为医疗团队成员与患者的社会和家庭网络之间进行充分、有效的沟通是康复过程的基础。正是在此基础上，需要整合个人的护理和援助。
