Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore.
BMC Musculoskelet Disord. 2023 Oct 2;24(1):778. doi: 10.1186/s12891-023-06894-w.
Proximal humeral fractures (PHFs) are 3 commonest fragility fractures and cause significant functional impairment. This paper sought to determine impact of rehabilitation compliance on the clinical outcomes for non-surgically managed PHFs, while ascertaining reasons for non-compliance which can be addressed to improve compliance.
Prospective cohort study of patients undergoing non-surgical treatment for PHFs from August 2017 to April 2020 in a tertiary trauma centre was performed. Data was collected via questionnaire: patient demographic data, PHF injury details, clinical outcome measures, therapist-reported (Sport Injury Rehabilitation Adherence Scale [SIRAS]) and patient-reported (subjective compliance, frequency of exercise) rehabilitation compliance measures. Data was analysed using multiple linear regression model to account for confounding variables.
107 participants attended physical therapy follow-up for mean 137.8 days. 6-week SIRAS strongly predicted 3-month Constant score (p = 0.023; 95%CI = 0.265,3.423), OSS (p = 0.038; 95%CI = 0.049,1.634), flexion ROM (p < 0.001; 95%CI = 2.872,8.982), extension ROM (p = 0.035; 95%CI = 0.097,2.614), abduction ROM (p = 0.002;95%CI = 1.995,8.466) and achievement of functional active ROM at 3-months (p = 0.049; 95%CI = 1.001,1.638). Pain was the top reason impairing rehabilitation compliance from therapist (43.9% at 6-weeks and 20.6% at 3-months) and patient-perspective (33.6% at 6-weeks, 24.3% at 3-months). Author-developed patient-reported compliance measures had good correlation with validated SIRAS score (subjective compliance: p < 0.001 frequency of exercise: p = 0.001).
Rehabilitation compliance predicts short-term clinical outcomes up to 3-months and potentially 1-year outcomes. Pain control should be optimised to maximise rehabilitation compliance and improve PHF outcomes. There is lack of consensus definition for rehabilitation compliance measures; patient-reported measures used have good correlation to existing validated measures and could serve as a steppingstone for further research.
II, cohort study.
肱骨近端骨折（PHF）是最常见的 3 种脆性骨折，会导致明显的功能障碍。本文旨在确定康复依从性对非手术治疗 PHF 的临床结果的影响，同时确定不依从的原因，以便提高依从性。
对 2017 年 8 月至 2020 年 4 月在一家三级创伤中心接受非手术治疗的 PHF 患者进行前瞻性队列研究。通过问卷收集数据：患者人口统计学数据、PHF 损伤细节、临床结果测量、治疗师报告（运动损伤康复依从性量表[SIRAS]）和患者报告（主观依从性、运动频率）康复依从性测量。使用多元线性回归模型分析数据，以考虑混杂变量。
107 名参与者平均接受物理治疗随访 137.8 天。6 周 SIRAS 强烈预测 3 个月时的常数评分（p=0.023；95%CI=0.265，3.423）、OSS（p=0.038；95%CI=0.049，1.634）、屈曲 ROM（p<0.001；95%CI=2.872，8.982）、伸展 ROM（p=0.035；95%CI=0.097，2.614）、外展 ROM（p=0.002；95%CI=1.995，8.466）和 3 个月时实现功能性主动 ROM（p=0.049；95%CI=1.001，1.638）。疼痛是从治疗师（6 周时 43.9%，3 个月时 20.6%）和患者角度（6 周时 33.6%，3 个月时 24.3%）角度影响康复依从性的首要原因。作者开发的患者报告依从性测量与经过验证的 SIRAS 评分具有良好的相关性（主观依从性：p<0.001 运动频率：p=0.001）。
康复依从性可预测 3 个月内甚至 1 年内的短期临床结果。应优化疼痛控制以最大限度地提高康复依从性并改善 PHF 结果。目前，康复依从性的测量缺乏共识定义；使用的患者报告测量与现有的经过验证的测量具有良好的相关性，可以作为进一步研究的基础。
II 级，队列研究。
