Morri Mattia, Forni Cristiana, Guberti Monica, Chiari Paolo, Pecorari Alessia, Orlandi Antonella Magli, Gazineo Domenica, Bozzo Maria, Ambrosi Elisa
Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia.
Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Disabil Rehabil. 2022 Aug;44(16):4241-4248. doi: 10.1080/09638288.2021.1897692. Epub 2021 Mar 16.
Health systems are using ever-increasing resources on treating hip fractures. Optimal post-hospital care needs to be defined to design an effective care pathway. The aim of the present study was to describe the post-hospital care pathway of individuals with hip fracture and to assess its association with the degree of recovery of independence achieved four months after surgery.
A prognostic multicentric cohort study was conducted. All patients aged 65 years and over who were admitted with a diagnosis of fragility hip fracture were enrolled. After the hospital discharge, the patients were followed either at an inpatient rehabilitation facility with an intensive or extensive regimen, a nursing home, a long-term care facility or at home. Among the various care pathways, the intensity of rehabilitation differed according to its duration, frequency of sessions, and activities proposed. Primary outcome was the patient's degree of independence achieved four months after surgery, as measured with Activities of Daily Living scale. Several covariates were collected to test the correlation between the different post-hospital care pathways and the recovery of independence.
A total of 923 patients completed the follow-up. A post- hospital rehabilitation pathway was indicated for 88.2% of the patients. The extensive rehabilitation pathway, indicated for 36.7% of the patients, was the most common. The intensive rehabilitation pathway gave better results in terms of independence at four-month follow up, leading to a median ADL score of 1.4 (95% CI 1.0-2.0). The other care pathways did not show significant difference between each other.
High-intensity rehabilitation was associated to better results in terms of recovering of Activities of Daily Living.IMPLICATIONS FOR REHABILITATIONPost-hospital care pathways that include an intensive rehabilitation treatment should be improved/supported to make them available to a larger number of hip fracture patients.Patient selection criteria for post-hospital rehabilitation pathways should be standardized to optimize available healthcare resources.A cost-effectiveness analysis should be performed to analyze the economic sustainability of each post-hospital care pathway.
卫生系统在治疗髋部骨折方面投入的资源日益增加。需要确定最佳的出院后护理方案，以设计出有效的护理路径。本研究的目的是描述髋部骨折患者的出院后护理路径，并评估其与术后四个月实现的独立恢复程度之间的关联。
进行了一项多中心预后队列研究。纳入所有年龄在65岁及以上、因脆性髋部骨折入院诊断的患者。出院后，患者在住院康复机构接受强化或广泛康复方案治疗、在疗养院、长期护理机构或家中接受随访。在各种护理路径中，康复强度根据其持续时间、疗程频率和所提议的活动而有所不同。主要结局是术后四个月患者的独立程度，采用日常生活活动量表进行测量。收集了几个协变量，以测试不同出院后护理路径与独立恢复之间的相关性。
共有923名患者完成了随访。88.2%的患者需要出院后康复路径。36.7%的患者采用的广泛康复路径是最常见的。强化康复路径在四个月随访时的独立性方面取得了更好的结果，导致日常生活活动量表中位数得分为1.4（95%置信区间1.0 - 2.0）。其他护理路径之间没有显著差异。
高强度康复在日常生活活动恢复方面与更好的结果相关。
对康复的启示
应改进/支持包括强化康复治疗的出院后护理路径，以使更多髋部骨折患者能够获得。
应标准化出院后康复路径的患者选择标准，以优化可用的医疗资源。
应进行成本效益分析，以分析每种出院后护理路径的经济可持续性。
