Yoshitaka Teruhito, Shimaoka Yasunori, Yamanaka Issei, Tanida Akira, Tanimoto Junichi, Toda Naoki, Akimori Taro, Hamawaki Junichi
Department of Orthopedic Surgery, Hiroshima City Rehabilitation Hospital, Hiroshima, Japan.
Hamawaki Orthopaedic Hospital.
Prog Rehabil Med. 2022 May 18;7:20220026. doi: 10.2490/prm.20220026. eCollection 2022.
Hip fracture is a common injury occurring in elderly people and often impairs their activities of daily living (ADL). This study aimed to identify and analyze factors associated with ADL following hip fracture treatment.
A total of 371 consecutive patients with hip fractures who were surgically treated in our hospital were enrolled. Among these, 103 patients who underwent acute- to recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the functional independence measure (mFIM) score was ≥70 before the fracture were finally included in this study. Single and multiple regression analyses were performed to identify the factors correlated with ADL. The mFIM at hospital discharge was set as the outcome variable, and various clinical factors, such as fracture type, surgical technique, serum and biological data, mini-mental state examination (MMSE) score, and serial mFIM scores, were used as explanatory variables.
Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at discharge, and MMSE had the larger effect on the outcome. Receiver operating characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2-3 weeks postoperatively compared with those with an MMSE score of ≥21.
Cognitive impairment and the preinjury ADL level were correlated with short-term ADL outcomes following hip fracture. Cognitive impairment was the most important factor affecting ADL; treatment and postoperative rehabilitation should be carefully considered for cognitively disturbed patients from the acute phase after hip fracture.
髋部骨折是老年人常见的损伤，常影响其日常生活活动（ADL）。本研究旨在识别和分析髋部骨折治疗后与ADL相关的因素。
纳入我院连续手术治疗的371例髋部骨折患者。其中，103例在我院接受急性至康复期术后康复且骨折前功能独立性测量运动量表（mFIM）评分≥70的患者最终纳入本研究。进行单因素和多因素回归分析以识别与ADL相关的因素。将出院时的mFIM设定为结局变量，将骨折类型、手术技术、血清和生物学数据、简易精神状态检查表（MMSE）评分以及连续的mFIM评分等各种临床因素用作解释变量。
仅MMSE和伤前mFIM评分与出院时的mFIM显著相关，且MMSE对结局的影响更大。受试者工作特征曲线分析显示MMSE临界值为20/21。与MMSE评分≥21的患者相比，MMSE评分≤20的患者术后2 - 3周mFIM恢复相对较差。
认知障碍和伤前ADL水平与髋部骨折后的短期ADL结局相关联。认知障碍是影响ADL的最重要因素；对于髋部骨折急性期有认知障碍的患者，应从急性期开始就仔细考虑治疗和术后康复。
