Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BMC Geriatr. 2021 Mar 25;21(1):208. doi: 10.1186/s12877-021-02152-7.
The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL).
This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery.
Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points.
Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.
预计未来几年髋部骨折的发病率将会增加。髋部骨折患者除骨折外，通常还存在复杂的医疗问题，这给社会和医疗保健系统带来了巨大负担。因此，优化这些患者的治疗以降低不良后果非常重要。本研究旨在评估综合骨科老年病学护理（CGC）对基本和工具性日常生活活动（B-ADL 和 I-ADL）的影响。
本研究基于两项随机对照试验；奥斯陆骨科试验和特隆赫姆髋部骨折试验。这两项研究是协同进行的，数据通过线性混合模型进行汇总和分析。术后 4 个月和 12 个月时，通过诺丁汉扩展 ADL 量表（NEADL）评估 I-ADL 功能，通过巴氏 ADL（BADL）评估 B-ADL。
共有 726 名患者纳入联合数据库，其中 365 名患者接受 OC，361 名患者接受 CGC。对于主要终点，CGC 组在术后 4 个月时 I-ADL 更好，组间差异为 3.56 分（95%CI 0.93 至 6.20，p=0.008）。12 个月时的组间差异为 4.28 分（95%CI 1.57 至 7.00，p=0.002）。对于 B-ADL，仅在 12 个月时组间差异有统计学意义。当排除入院时住在养老院的患者后，CGC 组在所有时间点的 I-ADL 和 B-ADL 功能均显著优于 OC 组。
两项随机对照试验的合并数据显示，直接将髋部骨折患者从急诊科收入骨科老年病学护理单元对术后 12 个月内的 ADL 有积极影响。
