Department of Physical Medicine and Rehabilitation, 1259University of Michigan, Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, MI, USA.
Clin Rehabil. 2023 Jan;37(1):119-131. doi: 10.1177/02692155221123544. Epub 2022 Aug 29.
Rehabilitation may mitigate the high mortality rates and health declines post-fracture for adults with cerebral palsy, but this is understudied. The objectives were to characterize the post-fracture rehabilitation pathways and identify their association with 1-year survival among adults with cerebral palsy.
A retrospective cohort study of adults with cerebral palsy with a fragility fracture with continuous health plan enrollment ≥1-year prior to and ≥1 day after their fracture date was performed using a random 20% Medicare fee-for-service dataset. Participants were categorized as a home discharge or inpatient rehabilitation admission post-fracture. For the home discharge cohort, weekly exposure to outpatient physical/occupational therapy (PT/OT) was examined up to 6-month post-fracture. Cox regression examined the association between time-varying PT/OTuse within 6-month post-fracture and mortality from 30 days to 1-year post-fracture before and after adjusting for confounders (e.g. medical complexity).
Of 3598 adults with cerebral palsy with an incident fragility fracture, 74% were discharged home without inpatient rehabilitation; they were younger, but more medically complex compared to the 26% admitted to inpatient rehabilitation. Among the home discharge cohort (n = 2662), 43.1% initiated PT/OTwithin 6-month post-fracture, and cumulative PT/OTexposure post-fracture was associated with improved survival; for example, per 3 weeks of PT/OTexposure, the adjusted mortality rate was 40% lower (95% confidence interval (CI) = 0.41-0.89).
Most adults with cerebral palsy with a fragility fracture were discharged home rather than to inpatient rehabilitation, and only 43.1% of that group initiated outpatient PT/OTwithin 6 months post-fracture. Receiving outpatient PT/OTwas associated with improved 1-year survival.
康复治疗可能减轻脑瘫成年人骨折后的高死亡率和健康状况下降，但这方面的研究还很不足。本研究旨在描述骨折后康复途径，并确定其与脑瘫成年人 1 年生存率的关系。
采用 20%的随机 Medicare 按服务项目付费数据集，对有脆性骨折且骨折前 1 年和骨折后 1 天连续有医疗保险计划参保的脑瘫成年人进行回顾性队列研究。患者骨折后被分为出院回家或住院康复治疗。对于出院回家的患者，在骨折后 6 个月内，每周检查门诊物理治疗/职业治疗（PT/OT）的暴露情况。Cox 回归分析了骨折后 6 个月内 PT/OT 治疗的时间变化与骨折后 30 天至 1 年死亡率之间的关系，该分析在调整混杂因素（如医疗复杂性）前后分别进行。
在 3598 例有脆性骨折的脑瘫成年人中，74%出院回家，没有接受住院康复治疗；与接受住院康复治疗的 26%患者相比，这些患者年龄较小，但医疗复杂性更高。在出院回家的患者中（n=2662），43.1%在骨折后 6 个月内开始接受 PT/OT 治疗，骨折后接受的 PT/OT 治疗与生存率提高有关；例如，PT/OT 治疗每增加 3 周，调整后的死亡率降低 40%（95%置信区间（CI）为 0.41-0.89）。
大多数有脆性骨折的脑瘫成年人出院回家，而非住院康复治疗，其中只有 43.1%的患者在骨折后 6 个月内开始接受门诊 PT/OT 治疗。接受门诊 PT/OT 治疗与 1 年生存率提高有关。
