Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Center for Community Liaison and Patient Consultations, Nagoya University Hospital, Nagoya, Japan.
Nagoya J Med Sci. 2023 Aug;85(3):455-464. doi: 10.18999/nagjms.85.3.455.
This study aimed to examine the effectiveness of early rehabilitation in patients with femoral neck fractures admitted to acute care settings in Japan using the data registered with the Japan Association of Rehabilitation Databases (JARD). We included data for 401 patients (out of 3088 patients) aged ≥ 65 years (85 males, 316 females) from nine hospitals who sustained a femoral neck fracture between July 2005 and September 2015. Using the number of days until surgery or the number of days until the start of rehabilitation or both as the explanatory variables, and the indoor mobility at discharge as the outcome variable, we calculated the adjusted rate ratio (ARR) and 95% confidence interval (CI) using Poisson regression analysis (age, sex, cognitive impairment, concurrent symptoms, and previous history of fracture adjusted as covariates). The ARR for independent walking at the discharge of the early-rehabilitation group (starting rehabilitation within two days after the injury) was significantly higher (ARR: 2.01, 95% CI: 1.34-3.02) than that of the non-early rehabilitation group. These results suggest that early acute-phase rehabilitation after a femoral neck fracture in older patients allows for better ambulatory ability at discharge, regardless of the time to surgery.
本研究旨在利用日本康复数据库协会（JARD）登记的数据，考察日本急性护理环境中股骨颈骨折患者早期康复的效果。我们纳入了 2005 年 7 月至 2015 年 9 月间九家医院的 401 名（3088 名患者中）≥65 岁患者（85 名男性，316 名女性）的数据。使用手术前天数或康复开始前天数或两者作为解释变量，以出院时的室内移动能力作为结局变量，我们使用泊松回归分析（将年龄、性别、认知障碍、并存症状和既往骨折史作为协变量进行调整）计算调整后的率比（ARR）和 95%置信区间（CI）。早期康复组（伤后两天内开始康复）独立行走的 ARR 明显更高（ARR：2.01，95%CI：1.34-3.02）。这些结果表明，老年股骨颈骨折患者在急性早期进行康复治疗可在出院时获得更好的步行能力，而与手术时间无关。
