Unnanuntana Aasis, Kuptniratsaikul Vilai, Srinonprasert Varalak, Charatcharoenwitthaya Natthinee, Kulachote Noratep, Papinwitchakul Lak, Wattanachanya Lalita, Chotanaphuti Thanainit
Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Injury. 2023 Nov;54(11):111039. doi: 10.1016/j.injury.2023.111039. Epub 2023 Sep 14.
INTRODUCTION: Appropriate care and rehabilitation following surgery for fragility hip fractures in older adults is associated with better outcomes and a greater likelihood of achieving pre-injury functioning. Clinical guidelines specifically for the post-operative care and rehabilitation of patients with hip fractures are scarce; as such, country-specific protocols benchmarked against established guidelines are essential given the wide variation in cultures and beliefs, clinical practice and diverse healthcare systems in Asia. We aimed to provide clinically relevant recommendations for post-operative fragility hip fracture care and rehabilitation to improve patient outcomes and prevent subsequent fractures in Thailand. METHODS: A targeted literature review was conducted to identify key evidence on various elements of post-hip fracture care and rehabilitation. Further discussions at a meeting and over email correspondence led to the development of the recommendations which amalgamate available evidence with the clinical experience of the multidisciplinary expert panel. RESULTS: Our recommendations are categorized by one period domain - acute post-operative period, and five major domains during the post-operative period - rehabilitation, optimization of bone health, prevention of falls, nutritional supplementation, and prophylaxis for venous thromboembolism. A multidisciplinary approach should be central to the rehabilitation process with the involvement of orthopedists, geriatricians/internists, physiatrists, physical and occupational therapists, endocrinologists, pharmacists and nursing staff. Other key components of our recommendations which we believe contribute to better functional outcomes in older patients undergoing hip fracture surgery include comprehensive pre-operative assessments, early surgery, goal setting for recovery and rehabilitation, early mobilization, medication optimization, tailored exercise plans, adequate coverage with analgesia, assessment and appropriate management of osteoporosis with due consideration of the fracture risk, fall prevention plans, and nutritional assessment and support. Patients and their caregivers should be a part of the recovery process at every step, and they should be counseled and educated appropriately, particularly on the importance of adherence to their rehabilitation plan. CONCLUSION: We have provided guidance on the critical domains of clinical care in the post-operative setting to optimize patient outcomes and prevent fracture recurrence. Our recommendations for post-operative care and rehabilitation of older adults with hip fracture can serve as a framework for hospitals across Thailand.
引言:老年患者脆性髋部骨折手术后的适当护理和康复与更好的治疗效果以及恢复伤前功能的更大可能性相关。专门针对髋部骨折患者术后护理和康复的临床指南很少;因此,鉴于亚洲文化和信仰、临床实践以及多样化医疗保健系统的广泛差异,以既定指南为基准的特定国家方案至关重要。我们旨在为泰国脆性髋部骨折术后护理和康复提供临床相关建议,以改善患者治疗效果并预防后续骨折。 方法:进行了有针对性的文献综述,以确定髋部骨折后护理和康复各个要素的关键证据。通过会议和电子邮件通信进行的进一步讨论促成了这些建议的制定,这些建议将现有证据与多学科专家小组的临床经验相结合。 结果:我们的建议按一个时期领域——术后急性期,以及术后五个主要领域——康复、骨骼健康优化、跌倒预防、营养补充和静脉血栓栓塞预防进行分类。多学科方法应是康复过程的核心,骨科医生、老年病科医生/内科医生、物理医学与康复医生、物理治疗师和职业治疗师、内分泌学家、药剂师和护理人员都应参与其中。我们认为,我们建议的其他关键组成部分有助于接受髋部骨折手术的老年患者获得更好的功能结果,包括全面的术前评估、早期手术、恢复和康复目标设定、早期活动、药物优化、量身定制的运动计划、充分的镇痛覆盖、考虑骨折风险对骨质疏松症进行评估和适当管理、跌倒预防计划以及营养评估和支持。患者及其护理人员应在恢复过程的每一步都参与其中,并且应给予他们适当的咨询和教育,特别是关于坚持康复计划的重要性。 结论:我们为术后临床护理的关键领域提供了指导,以优化患者治疗效果并预防骨折复发。我们对老年髋部骨折患者术后护理和康复的建议可作为泰国各地医院的框架。
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