Department of Rehabilitation, Nishi-Kobe Medical Center, Kojidai, Nishiku, Kobe, Hyogo, Japan; Department of Community Health Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Sumaku, Kobe, Japan.
Department of Community Health Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Sumaku, Kobe, Japan; Department of Rehabilitation, Kobe City Medical Center West Hospital, Ichiban-Cho, Nagataku, Kobe, Japan.
Arch Phys Med Rehabil. 2019 Jan;100(1):32-38. doi: 10.1016/j.apmr.2018.06.012. Epub 2018 Jul 4.
To investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase.
Prospective cohort study.
Three acute care hospitals.
Hip fracture patients (N=200) who were consecutively admitted to 3 acute hospitals because of falling.
Not applicable.
Patients were stratified into 3 groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE<0.7), intermediate (0.7≤EI/TEE<1), and adequate (EI/TEE≥1) groups. The functional status was evaluated using the motor domain of a FIM. We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation.
The median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median EI/TEE, 0.54; interquartile range, 0.42-0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE, 0.87; interquartile range, 0.78-0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE, 1.10; interquartile range, 1.04-1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P<.01). After adjustment for potential confounders, a significant association between postoperative EI/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized β =-0.14; reference: adequate group; P=0.03; R for the entire model =0.25).
Postoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture.
研究髋部骨折患者术后自主能量摄入（EI）是否会影响急性期的功能恢复。
前瞻性队列研究。
3 家急性护理医院。
因跌倒而连续入住 3 家急性医院的髋部骨折患者（N=200）。
无。
根据测量的 EI 与估计的总能量消耗（TEE）的比值将患者分为 3 组，即不足（EI/TEE＜0.7）、中等（0.7≤EI/TEE＜1）和充足（EI/TEE≥1）组。采用 FIM 的运动域评估功能状态。我们根据运动 FIM 评分计算效率（术后运动 FIM 评分的变化/康复期的长度），以评估康复的有益效果。
中位住院时间为 24 天。不足组包括 73 例（36.5%）患者（中位 EI/TEE，0.54；四分位距，0.42-0.64）；中等组包括 92 例（46.0%）患者（中位 EI/TEE，0.87；四分位距，0.78-0.94），充足组包括 35 例（17.5%）患者（中位 EI/TEE，1.10；四分位距，1.04-1.15）。充足组的绝对功能增益（AFG）和运动 FIM 增益效率（EFG）评分均高于其他两组（P＜0.01）。在校正潜在混杂因素后，仍观察到术后 EI/TEE 组与对数 EFG 评分之间存在显著关联（不足组，标准化β=-0.14；参考：充足组；P=0.03；整个模型的 R 值=0.25）。
髋部骨折术后 EI 低于 TEE 的 70%会降低功能恢复。
