Hip fracture patients' cognitive state affects family members' experiences - a diary study of the hip fracture recovery

Scand J Caring Sci; 2011; 25; 451–458
Hip fracture patients’ cognitive state affects family members’ experiences – a diary study of the hip fracture recovery Background: Many patients with hip fractures suffer from dementia disease, which has shown to affect the outcome of recovery strongly, as well as care and treatment. As most hip fracture patients are discharged home early after surgery, caregiving often falls on family members – spouses, daughters, sons, or even neighbours become informal carers. Aim: To explore how hip fracture patients’ cognitive state affect family members’ experiences during the recovery period. Methods: Eleven diaries written by family members’ of hip fracture patients were analysed by means of qualitative content analysis. Findings: The analysis generated two main categories with four categories. The first main category was; ‘Being a family member of a cognitively impaired patient’ with the categories ‘Dissatisfaction with lack of support’ and ‘Emotional distress due to the patient’s suffering’. The second main category was ‘Being a family member of a cognitively intact patient’ with the categories ‘Satisfaction with a relative’s successful recovery’ and ‘Strain due to their caring responsibilities’. Being a family member of a patient with cognitive impairment and a hip fracture meant being solely responsible for protecting the interests of the patient; in regard to care, rehabilitation and resources. The family members were also burdened with feelings of powerlessness and sadness due to the patients’ suffering. On the contrary, family members of cognitively intact hip fracture patients had positive experiences. The family members expressed pleasure from seeing their close ones make progress. However, when the healing process was delayed this led to strain on the family members. Conclusions: The findings suggest the hip fracture patient’s cognitive state is more decisive than the hip fracture itself for the family members’ experiences.     

认知康复训练治疗脑损伤后认知功能障碍的Meta分析

目的:系统评价认知康复训练治疗脑损伤后认知障碍的疗效。方法:计算机检索CNKI、VIP、CBM、万方及PubMed数据库,查找关于认知康复训练治疗脑损伤后认知障碍的临床随机对照试验。对纳入的研究逐个进行质量评价,并进一步对治疗后认知训练组和对照组的有效率、简易智力状况检查法(MMSE)、日常生活活动能力(ADL)、洛文斯顿认知功能评定测验(LOTCA)评分进行Meta分析。结果:16个研究共1281例患者符合纳入标准。结果显示,认知训练组的总有效率、MMSE、ADL及LOTCA评分均明显优于对照组(P0.05,0.01)。结论:认知康复训练治疗脑损伤后认知障碍患者可一定程度上减轻认知障碍的程度,提高患者的自我生活能力。     

Using the Omaha System to examine outpatient rehabilitation problems, interventions, and outcomes between clients with and without cognitive impairment.

A retrospective cohort design was used to examine whether the Omaha System was useful in documenting differences in outpatient rehabilitation problems, interventions, and outcomes between clients with cognitive impairment and those with intact cognition. The sample included 201 clients who had been admitted to a comprehensive outpatient rehabilitation facility. The results showed no statistically significant differences in the prevalence of main Omaha problems, interventions, and outcomes between the two groups; however, clients with cognitive impairment experienced fewer changes in knowledge and behavior associated with neuromusculoskeletal function and pain than clients with intact cognition. These findings are consistent with an earlier report published by the authors that used standard instruments and indicate that the Omaha System can be valuable for rehabilitation clinical practice and research.     

骨科康复一体化模式下髋臼骨折围手术期康复临床路径：一项前瞻性随机对照研究

目的 探讨骨科康复一体化模式下髋臼骨折围手术期康复临床路径的有效性和安全性。方法 2019年6月至2021年1月北京积水潭医院创伤骨科经急诊收治入院行手术治疗的髋臼骨折病例82例,按照随机数字表法分为对照组(n=41)和试验组(n=41)。对照组采用常规髋臼骨折治疗,试验组采用骨科康复一体化模式下的髋臼骨折围手术期康复临床路径进行治疗,共24周。比较两组不同治疗时期疼痛视觉模拟评分(VAS)、Barthel指数(BI)评分和Majeed骨盆功能评分。结果 共获得76例病例完整随访资料。两组不同时期VAS评分均无显著性差异(|Z|<1.926, P> 0.05)。试验组BI评分在出院,术后2周、6周和12周随访时均高于对照组(|Z|> 2.121, P <0.05);术前和术后24周,两组BI评分均无显著性差异(|Z|<1.862, P> 0.05)。试验组Majeed骨盆功能评分在术后2周、6周、12周和24周随访时均高于对照组(|Z|> 2.428, P <0.05)。试验组在术后6周、12周、24周Majeed骨盆功能评分为“优”的患...     

The Appearance and Disappearance of Cognitive Impairment in Elderly Patients During Treatment for Hip Fracture

We studied the natural course of cognitive state in 256 consecutive hip fracture patients who were admitted from an independent living situation. We employed a treatment programme that focused on preventing postoperative cognitive impairment. Cognitive function was assessed with the SPSMQ screening test. The incidence of postoperative cognitive impairment among those lucid on admission was 13%, which generally was reversed before discharge. Thirty-seven percent were cognitively impaired on admission; of those, 51% reached normal test scores while in hospital. Those who recovered within the first week had as good a prognosis during the first year as those who remained lucid throughout the hospital stay. Cognitive impairment was associated with an increased complication rate, e.g. a three-fold increase of early fracture displacement and a four-fold increase of wound infection. This increased risk was present even in patients with mild/moderate cognitive impairment and could not entirely be explained by age. Our results suggest that it is possible to decrease postoperative cognitive impairment by routine monitoring of cognitive status, a high level of continuity and a reorientation programme. The routine assessment of the cognitive function is recommended in geriatric patients who are admitted for surgery.     

多奈哌齐联合康复训练治疗卒中后血管性认知障碍的疗效观察

摘要 目的：观察多奈哌齐联合康复训练治疗卒中后血管性认知障碍（VCI）的疗效。 方法：筛选64例卒中后血管性认知障碍的患者随机分成药物组（32例）和对照组（32例）,其中男37例,女27例,平均年龄（64.08±9.67）岁。两组均给予康复训练,药物组在此基础上口服多奈哌齐治疗。采用简易智能精神量表（MMSE）、事件相关电位P300评定患者的认知功能,采用Barthel指数评定患者的日常生活活动（ADL)能力。 结果：治疗后,药物组MMSE总分及ADL水平明显改善（P＜0.01）,MMSE地点定向及执行功能明显改善（P＜0.01）,时间定向及记忆改善（P＜0.05）。P300潜伏期明显缩短（P＜0.01）,波幅提高（P＜0.05）;对照组MMSE评分及ADL水平改善（P＜0.05）,MMSE时间定向明显改善（P＜0.01）,地点定向及执行功能改善（P＜0.05）。P300潜伏期缩短（P＜0.05）,波幅变化不明显（P＞0.05）;两组比较,MMSE及ADL变化差异有显著性意义（P＜0.05）,MMSE子项评分差异无显著性意义（P＞0.05）。P300潜伏期变化差异有显著性意义（P＜0.05）,P300波幅变化差异有显著性意义（P＜0.01）。 结论：多奈哌齐联合康复训练较单纯康复训练,两者都能改善脑卒中患者的认知障碍及ADL能力,但前者效果更加明显。患者认知功能好转,可能更有利于运动功能的恢复。     

Discharge planning for patients receiving rehabilitation after hip fracture: A qualitative analysis of physiotherapists' perceptions

Purpose.?To explore the perceptions of clinicians about walking requirements and discharge criteria for patients being discharged home in the community from rehabilitation after hip fracture.

Methods.?Twelve experienced clinicians (all females) (mean experience in rehabilitation 13 years) were interviewed using an in-depth semi-structured format. The recorded interviews were transcribed and coded independently by two researchers. From these codes themes were developed.

Results.?For discharge planning, all clinicians considered personal/psychosocial factors such as patient goals and social support. Almost all clinicians considered that the performance factor of safe and independent ambulation was important to consider when planning the patient's discharge, but did not set specific distances or speeds. Clinicians expected that pain, a lack of confidence, and walking outdoors would affect the mobility at home but these factors were considered little in discharge planning.

Conclusions.?In planning discharge after rehabilitation for hip fracture, clinicians place more emphasis on the individual needs and goals of the patient than on specifying objective performance criteria that must be met. The expectation that lack of confidence could be a problem after returning home suggests that this factor could be considered more in discharge planning.     

52例老年髋部骨折康复效果分析

对52例老年髋部骨折患者采用手术与非手术方法治疗并进行比较,手术组患者在术后2～3d开始被动训练患肢．并逐步增加活动量及范围,术后2周开始主动伸屈活动;非手术组患者骨折初步临床愈合后开始肢体功能训练。结果：手术组康复优良率为81．6％．非手术组35．7％;手术组不良反应及并发症为47.37％．非手术组78．6％;手术组平均康复时间为4．74个月．非手术组5．8个月;提示手术组的康复效果、治疗时间、不良反应及并发症等方面均明显优于非手术组。     

Hip fracture and the influence of dementia on health outcomes and access to hospital-based rehabilitation for older individuals

Background: For older individuals who sustain a hip fracture, the presence of dementia can influence their access to hospital-based rehabilitation.

Purpose: This study compares the characteristics and health outcomes of individuals with and without dementia following a hip fracture; and access to, and outcomes following, hospital-based rehabilitation in a population-based cohort.

Method: An examination of hip fractures involving individuals aged 65 years and older with and without dementia using linked hospitalisation, rehabilitation and mortality records during 2009–2013.

Results: There were 8785 individuals with and 23 520 individuals without dementia who sustained a hip fracture. Individuals with dementia had a higher age-adjusted 30-d mortality rate compared to individuals without dementia (11.7% versus 5.7%), a lower proportion of age-adjusted 28-d re-admission (17.3% versus 24.4%) and a longer age-adjusted mean length of stay (22.2 versus 21.9 d). Compared to individuals without dementia, individuals with dementia had 4.3 times (95% CI: 3.90–4.78) lower odds of receiving hospital-based rehabilitation. However, when they did receive rehabilitation they achieved significant motor functional gain at discharge compared to admission using the Functional Independence Measure, but to a lesser extent than individuals without dementia.

Conclusion: Within a population-based cohort, older individuals with dementia can benefit from access to, and participation in, rehabilitation activities following a hip fracture. This will ensure that they have the best chance of returning to their pre-fracture physical function and mobility.

• Implications for Rehabilitation

• Older individuals with dementia can benefit from rehabilitation activities following a hip fracture.

• Early mobilisation of individuals post-hip fracture surgery, where possible, is advised.

• Further work is needed on how best to work with individuals with dementia after a hip fracture in residential aged care to maximise any potential functional gains.

     

认知康复对精神分裂症认知功能影响的研究

目的:探讨认知康复对精神分裂症认知功能的影响。方法:对象取自无锡市精神卫生中心住院精神分裂症患者100例。随机分配到个别认知康复组(个别康复)33例、集体认知康复组(集体康复)33例和单独服用抗精神病药物组(对照组)34例。认知康复的主要内容是认知重建技术和社会技能训练。每周治疗3次,每次60min,6个月为1疗程。应用韦氏成人智力量表(WAIS)和威斯康星卡片分类测验(WCST)评定治疗前后的认知功能。结果:100例患者均完成治疗,三组患者康复训练前后的WAIS、WCST均无显著差异。但康复训练后个别康复、集体康复的WAIS总分、作业增分的差值显著高于对照组(P=0.034、P=0.039),集体康复的言语分差值显著高于对照组(P=0.040)。WCST操作显示接受认知康复的患者其执行功能的改善优于对照组(P<0.05—0.01)。但个别康复和集体康复之间差异无显著性。结论:接受认知康复的精神分裂症患者在认知功能改善方面优于仅服用抗精神病药物的患者。     

Computer-based cognitive rehabilitation: the CoRe system

Purpose: This work aims at providing a tool for supporting cognitive rehabilitation. This is a wide field, that includes a variety of diseases and related clinical pictures; for this reason the need arises to have a tool available that overcomes the difficulties entailed by what currently is the most common approach, that is, the so-called pen and paper rehabilitation. Methods: We first organized a big number of stimuli in an ontology that represents concepts, attributes and a set of relationships among concepts. Stimuli may be words, sounds, 2D and 3D images. Then, we developed an engine that automatically generates exercises by exploiting that ontology. The design of exercises has been carried on in synergy with neuropsychologists and speech therapists. Solutions have been devised aimed at personalizing the exercises according to both patients’ preferences and performance. Results: Exercises addressed to rehabilitation of executive functions and aphasia-related diseases have been implemented. The system has been tested on both healthy volunteers (n?=?38) and patients (n?=?9), obtaining a favourable rating and suggestions for improvements. Conclusions: We created a tool able to automate the execution of cognitive rehabilitation tasks. We hope the variety and personalization of exercises will allow to increase compliance, particularly from elderly people, usually neither familiar with technology nor particularly willing to rely on it. The next step involves the creation of a telerehabilitation tool, to allow therapy sessions to be undergone from home, thus guaranteeing continuity of care and advantages in terms of time and costs for the patients and the National Healthcare System (NHS).

• Implications for rehabilitation

• Cognitive impairments can greatly impact an individual's existence, appreciably reducing his abilities and autonomy, as well as sensibly lowering his quality of life. Cognitive rehabilitation can be used to restore lost brain function or slow down degenerative diseases.

• Computerization of rehabilitation entails many advantages, but patients – especially elderly people – might be less prone to the use of technology and consequently reluctant towards this innovative therapeutic approach.

• Our software system, CoRe, supports a therapist during the administration of rehabilitation sessions: exercises can be generated dynamically, thus reducing repetitivity, and patients' performance trends automatically analysed to facilitate the assessment of their progress.

• Tests performed on both healthy subjects and patients provided useful information that allowed us to define an implementation strategy able to reduce patients' resistance to computerized rehabilitation as much as possible.

     

Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures

The aim of this study was to evaluate the effectiveness of a nursing and medical intervention programme for the prevention and treatment of delirium in elderly patients treated for femoral neck fractures. Forty-nine patients consecutively admitted to an orthogeriatric rehabilitation unit in a county hospital in northern Sweden were compared with historical cohorts of corresponding patients in the same and other hospitals. There was a total reorganization of nursing and medical care of patients with femoral neck fractures. The intervention programme consisted of staff education, co-operation between orthopaedic surgeons and geriatricians, individual care and planning of rehabilitation, improved ward environment, active nutrition, improved continuity of care and prevention and treatment of complications associated with delirium. The main result of the study was that the incidence of delirium was significantly lower than in all previously published studies. The incidence of other postoperative complications was also lower, and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. It can be concluded that the intervention programme reduced the incidence and duration of delirium and improved functional outcome for elderly patients treated for femoral neck fractures.     

跟骨骨折的手术与康复

目的介绍跟骨骨折的手术经验和康复要点.方法运用重建钢板、可塑形钢板、Y形钢板和T形钢板对69例77侧跟骨骨折进行治疗.骨折分型采用Sanders分型法,77侧骨折中61侧获随访,随访时间12～62个月,平均21.7个月.结果按Maryland足部评分系统评价术后功能.本组61侧骨折中,优23侧(37.7%),良35侧(53.4%),可3侧(4.9%),优良率95.1%.结论对跟骨骨折围手术期的正确处理直接影响手术疗效.     

Effect of a Video Intervention on Functional Recovery Following Hip Replacement and Hip Fracture Repair

Although much research has documented the functional outcomes in hip repair surgery, few studies have identified effective interventions to improve functional outcomes. The purpose of this study was to test the use of generic and individualized videos on patients' return to preoperative levels of independent functioning, increased physical performance, improved coping ability, and enhanced perception of ability to care for self. Two rehabilitation units in separate acute care facilities were used to recruit subjects. Data were collected on 82 participants on admission to the study, on discharge from rehabilitation, 1 week after discharge, and 3 months post discharge. The results indicate that video intervention has some benefit to persons recovering from hip repair surgery. The benefits were realized in physical performance as evidenced by a significant difference in the distance walked and time walked of participants in the treatment group.     

中老年股骨颈骨折全髋关节置换术的围术期康复指导及护理对策

目的 探讨中老年股骨颈骨折全髋关节置换术的围术期康复指导以及影响.方法 选择行髋关节患者术的中老年股骨胫骨骨折患者62例,按照随机数字表法分为观察组和对照组各31例,对照组患者采取常规护理以及肌力训练,观察组患者采取康复指导及相应护理措施,比较2组随访1年后的疗效评分以及生活质量评分.结果 对照组患者疗效评定的优良率为64.52％,观察组患者疗效评定的优良率为93.55％,采用康复指导后的观察组患者的优良率显著高于对照组(P＜0.05);生活质量评分方面,观察组患者在总生活质量以及躯体功能上显著高于对照组(P＜0.05),而在心理功能、社会经济以及家庭上2组比较差异无统计学意义(P＞0.05).结论 对中老年股骨颈骨折全髋关节置换术患者实施早期康复指导以及相应的护理措施,能够有效促进患者的康复,并提高患者的生活质量,值得临床推广使用.     

Pilon骨折的治疗与临床康复

AIM: To analyze the effect of three kinds of method on different types of Pilon fracture and advance the best treatment plan. METHODS: From March 1989 to August 2000,107 patients were regarded as having Pilon fracture by two hospitals, among which 76 cases were followed up. They were divided into three groups according to treatment method. A group included 24 cases with the treatment of manual reduction, traction of calcaneus and plaster ex-opexy. B group included 30 cases with the treatment of AO key-shaped anatomical steal plate. C group included 22 cases with the treatment of limited internal fixation combined with exopexy stand. RESULTS: After 6 months to 8 years follow-up, it was found that three kinds of treatment methods had obvious differences on the complications and effects of different types of fracture. In A group, the excellent and good rate of treatment on I type fracture was 70%, II type was 25%, Ⅲ type was 0%. In B group, the excellent and good rate of treatment on I type fracture was 7     

利培酮 奥氮平 奎硫平对康复期精神分裂症认知功能的影响

目的 探讨利培酮、奥氮平、奎硫平对康复期精神分裂症患者认知功能和社会功能的影响. 方法 将60例康复期精神分裂症患者随机分为三组,每组20例,分别口服利培酮、奥氮平、奎硫平治疗,观察12周.于治疗前及治疗12周末采用韦氏记忆量表、威斯康星卡片分类测验、连线测验、个人和社会功能量表、阳性与阴性症状量表及临床病情严重程度量表进行测评,并与60名健康体检者（对照组）进行对比分析. 结果 治疗前三组患者威斯康星卡片分类测验、连线测验及韦氏记忆量表的各项认知功能指标评分与对照组均有显著性差异（P＜0.05或0.01）;治疗后三组患者连线测验-B连线时间评分显著低于治疗前（P＜0.05或0.01）,而威斯康星卡片分类测验、连线测验-A连线时间、连线测验-A错误数、连线测验-B错误数及韦氏记忆量表记忆商评分与治疗前比较均无显著变化（P＞0.05）,且威斯康星卡片分类测验、连线测验-B错误数及韦氏记忆量表记忆商评分仍与对照组有显著性差异（P＜0.05或0.01）.治疗12周末,三组患者临床病情严重程度量表评分均较治疗前有显著下降（P＜0.05）;奎硫平组阳性与阴性症状量表总分减分值显著低于利培酮组和奥氮平组（P＜0.05）;三组不良反应均轻微. 结论 利培酮、奥氮平、奎硫平均能改善康复期精神分裂症患者的部分认知功能和社会功能,疗效相当,但短期内对执行功能及韦氏记忆量表记忆商无显著改善.     

一种新型认知障碍诊治系统用于卒中后认知障碍康复治疗的疗效观察

目的:观察认知障碍诊治系统ZM3.1对卒中后认知功能障碍患者的康复疗效。方法:入选50例脑卒中后认知功能障碍患者,采用单盲随机对照方法分为试验组和对照组,每组25例,其中试验组予以认知障碍诊治系统ZM3.1训练系统进行认知功能训练,对照组采用传统认知功能训练,均治疗4周,治疗前后采用简易智能状态量表(mini-mental state examination,MMSE)评定,比较分析治疗前后患者时间定向力、地点定向力、复述能力、计算能力、记忆能力、辨认能力、理解能力、表达能力、结构模仿能力9项认知功能亚项能力。结果:(1)试验组治疗后总评分高于治疗前,且时间定向力、地点定向力、复述能力、计算能力、记忆能力、理解能力等认知功能亚项评分高于治疗前,差异均具有显著性意义(P0.05);(2)对照组治疗后总评分高于治疗前,且时间定向力、地点定向力、记忆能力、理解能力等认知功能亚项评分高于治疗前,差异均具有显著性意义(P0.05);(3)治疗后试验组在时间定向力、计算能力等认知功能亚项的改善优于对照组(P0.05)。结论:认知障碍诊治系统ZM3.1的训练系统治疗可改善脑卒中后认知功能障碍,与传统认知康复训练相比,在时间定向力和计算能力改善方面具有一定的优势。     

出院后家庭康复指导对老年髋部骨折术后患者日常生活能力的影响

目的了解出院后家庭康复指导对老年髋部骨折术后出院患者日常生活能力的影响。方法将60例老年髋部骨折出院后的恢复期患者,按照出院先后次序分为干预组和对照组,每组各30例。干预组由社区护士在患者出院后1、3、6个月进行家访实施康复指导;对照组采用传统的家庭疗养方法。比较两组患者出院后1、3、6个月Barthel指数评分的差异。结果干预组患者出院后第1、3、6个月日常生活能力优于对照组,两组Brathel指数评分比较,均P<0.05,差异具有统计学意义。结论实施家庭康复指导可提高老年髋部骨折术后出院患者的日常生活能力,此服务模式具有可操作性和实用性,值得临床推广应用。