Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany.
Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany.
Injury. 2020 Mar;51(3):628-632. doi: 10.1016/j.injury.2020.01.041. Epub 2020 Jan 29.
An early postoperative mobilization shows beneficial effects in terms of complications and long-term mobilization scores in elderly adult fracture patients. The primary objective of this study was to evaluate the overall mobilization of orthogeriatric patients during the postoperative hospital stay based on a continuous accelerometry measurement. Secondly, the collected data was analyzed to detect fracture related differences. We hypothesized that upper extremity fractures come along with higher levels of physical activity compared to fractures of the lower extremity.
Thirty-one orthogeriatric patients with proximal femur fractures (PFF) and proximal humerus fractures (PHF) were enrolled consecutively in a maximum care hospital in a prospective study design (level of evidence 2). In the PFF study group 9 patients received hip arthroplasty and 11 patients intramedullary nailing (PFNA) and in the PHF group 10 patients received osteosynthesis of the proximal humerus. All patients worn a waist placed accelerometer during the length of hospitalization to quantify mobilization and physical activity.
The PFF group (n = 21) had a mean age of 80.86 years (SD ± 6.75), the PHF (n = 10) group had a mean age of 75.20 (SD ± 6.86). A significantly higher gait speed was observed in the PHF group of 0.52 m/s (SD ± 0.27) compared to the slower PFF group with 0.29 (SD ± 0.45); p = 0.0403. Quantitative mobility was measured by using the average number of daily steps. This showed a significantly lower number of steps in the PFF group (102.7; SD ± 188.1) compared to the PHF group (413.5; SD ± 287.7; p = 0.0002).
Our data demonstrates that it is feasible and accepted by the patient to continuously measure the mobility including gait speed and characteristics of orthogeriatric patients using waist worn accelerometry based wearables. Postoperative mobility and gait speed was generally low in both groups. Actions to improve postoperative mobility of orthogeriatric patients are urgently needed. Level Of Evidence Prospective cohort study, Level of Evidence 2.
在老年骨折患者中，早期术后活动可降低并发症发生率并提高长期活动评分。本研究的主要目的是通过连续加速度计测量来评估术后住院期间骨科老年患者的整体活动情况。其次，对收集的数据进行分析以检测与骨折相关的差异。我们假设上肢骨折比下肢骨折具有更高的身体活动水平。
连续纳入一家最大护理医院的 31 例股骨近端骨折（PFF）和肱骨近端骨折（PHF）的骨科老年患者进行前瞻性研究（证据水平 2）。在 PFF 研究组中，9 例患者接受髋关节置换术，11 例患者接受髓内钉固定术（PFNA），PHF 组中 10 例患者接受肱骨近端骨折内固定术。所有患者在住院期间均佩戴腰部放置的加速度计来量化活动和身体活动。
PFF 组（n=21）的平均年龄为 80.86 岁（SD±6.75），PHF 组（n=10）的平均年龄为 75.20 岁（SD±6.86）。PHF 组的步行速度明显较快，为 0.52m/s（SD±0.27），而 PFF 组的步行速度较慢，为 0.29m/s（SD±0.45）；p=0.0403。通过平均每日步数来衡量活动量，结果显示 PFF 组的步数明显少于 PHF 组，分别为 102.7（SD±188.1）和 413.5（SD±287.7）；p=0.0002。
我们的数据表明，使用腰部佩戴的基于加速度计的可穿戴设备连续测量骨科老年患者的活动，包括步速和步态特征，是可行的，且能被患者接受。两组患者术后活动和步行速度普遍较低。迫切需要采取措施来提高骨科老年患者的术后活动能力。证据水平为前瞻性队列研究，证据水平 2。
