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日本京都老年髋部骨折患者术后康复实施现状:基于医疗和长期护理保险索赔数据的一项研究

Implementation status of postoperative rehabilitation for older patients with hip fracture in Kyoto City, Japan: A population-based study using medical and long-term care insurance claims data.

机构信息

Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Kyoto, Japan.

出版信息

PLoS One. 2024 Sep 12;19(9):e0307889. doi: 10.1371/journal.pone.0307889. eCollection 2024.

Abstract

Continuing rehabilitation after hip fractures is recommended to improve physical function and quality of life. However, the long-term implementation status of postoperative rehabilitation is unclear. This study aims to investigate the implementation status of postoperative rehabilitation for older patients with hip fractures and the factors associated with continuing rehabilitation. A retrospective cohort study evaluated medical and long-term care insurance claims data of patients aged 75 years or older in Kyoto City, Japan, who underwent hip fracture surgeries from April 2013 to October 2018. We used logistic regression analysis to examine factors associated with six-month rehabilitation continuation. Of the 8,108 participants, 8,037 (99%) underwent rehabilitation the first month after surgery, but only 1,755 (22%) continued for six months. The following variables were positively associated with continuing rehabilitation for six months: males (adjusted odds ratio: 1.41 [95% confidence interval: 1.23-1.62]), an intermediate frailty risk (1.50 [1.24-1.82]), high frailty risk (2.09 [1.69-2.58]) estimated using the hospital frailty risk scores, and preoperative care dependency levels: support level 1 (1.69 [1.28-2.23]), support level 2 (2.34 [1.88-2.90]), care-need level 1 (2.04 [1.68-2.49]), care-need level 2 (2.42 [2.04-2.89]), care-need level 3 (1.45 [1.19-1.76]), care-need level 4 (1.40 [1.12-1.75]), and care-need level 5 (1.31 [0.93-1.85]). In contrast, dementia was cited as a disincentive (0.53 [0.45-0.59]). Less than 30% of older patients continued rehabilitation for six months after surgery. Factors associated with continuing rehabilitation were male sex, higher frailty risk, care dependency before hip fracture surgeries, and non-dementia.

摘要

髋部骨折后持续康复治疗被推荐用于改善身体功能和生活质量。然而,术后康复的长期实施情况尚不清楚。本研究旨在调查老年髋部骨折患者术后康复的实施情况,以及与继续康复相关的因素。一项回顾性队列研究评估了 2013 年 4 月至 2018 年 10 月在日本京都市接受髋部骨折手术的年龄在 75 岁及以上的患者的医疗保险和长期护理保险索赔数据。我们使用逻辑回归分析来研究与术后 6 个月康复延续相关的因素。在 8108 名参与者中,8037 名(99%)在手术后第一个月接受了康复治疗,但只有 1755 名(22%)持续了 6 个月。与持续康复 6 个月相关的变量有:男性(调整后的优势比:1.41 [95%置信区间:1.23-1.62])、中等脆弱风险(1.50 [1.24-1.82])、高脆弱风险(2.09 [1.69-2.58]),采用医院脆弱风险评分评估)和术前护理依赖程度:支持水平 1(1.69 [1.28-2.23])、支持水平 2(2.34 [1.88-2.90])、护理需求水平 1(2.04 [1.68-2.49])、护理需求水平 2(2.42 [2.04-2.89])、护理需求水平 3(1.45 [1.19-1.76])、护理需求水平 4(1.40 [1.12-1.75])和护理需求水平 5(1.31 [0.93-1.85])。相反,痴呆症被认为是一个抑制因素(0.53 [0.45-0.59])。手术后,不到 30%的老年患者继续康复治疗 6 个月。与继续康复相关的因素包括男性、更高的脆弱风险、髋部骨折手术前的护理依赖以及非痴呆症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f79/11392384/d0ee730a406d/pone.0307889.g001.jpg

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