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BACKGROUND AND PURPOSE: The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate- or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery. SUBJECTS: Thirty-three elderly people (24 women, 9 men; mean = 78.6 years of age, SD = 6.8, range = 64-89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group. METHODS: Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental status, and physical function were measured. Each exercise session was supervised by a physical therapist, and subjects received 20 visits over 12 weeks. The control group received biweekly mailings. The resistance training group performed 3 sets of 8 repetitions at the 8-repetition maximum intensity using a portable progressive resistance exercise machine. The aerobic training group performed activities that increased heart rate 65% to 75% of their age-predicted maximum for 20 continuous minutes. RESULTS: Resistance and aerobic training were performed without apparent adverse effects, and adherence was 98%. All groups improved in distance walked, force produced, gait speed, and physical function. Isometric force improved to a greater extent in the intervention groups than in the control group. Depressive symptoms interacted with treatment group in explaining the outcomes of 6-minute-walk distance and gait speed. DISCUSSION AND CONCLUSION: High-intensity exercise performed in the home is feasible for people with hip fracture. Larger sample sizes may be necessary to determine whether the exercise regimen is effective in reducing impairments and improving function. Depression may play a role in the level of improvement attained. 相似文献
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Stephen E. Wright Rajiv Lochan Karen Imrie Catherine Baker Ian D. Nesbitt Andrew J. Kilner Richard M. Charnley 《Intensive care medicine》2009,35(11):1974-1978
Purpose
To prospectively determine the quality of life and functional outcome at 3, 6 and 12 months following acute necrotising pancreatitis. 相似文献4.
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Background: There are an increasing number of people undergoing hip and knee joint replacement each year; approximately 68,000 hip and 76,000 knee replacements, respectively, are performed in England and Wales. Joint replacements serve to reduce pain and improve function.Objectives: The purpose of this qualitative literature review is to gain an in depth understanding into participants’ postoperative experiences following hip and knee replacement in order to establish if participants can be better supported post joint replacement and whether preoperative education can be enhanced.Methods: Searches were carried out in 13 online scientific databases (January 1995 to October 2016) to identify relevant studies. The quality of studies was assessed, data were extracted and analysed using thematic synthesis.Results: A total of 197 studies were identified and screened against the inclusion/exclusion criteria. Seven studies met the inclusion criteria. Three broad themes were identified; coping with pain, recovering function and the challenges of discharge. In general, pain was poorly understood and difficulties arose with the appropriate management postoperatively. The recovery process took commitment and required individuals to have realistic expectations. Participants also felt the need for individualised care as they approached discharge.Conclusions: Overall qualitative evidence surrounding postoperative views of participants is limited. It appears current preoperative education does not fulfil the majority of participants’ needs. Utilising the views of participants may help to tailor preoperative education or provide alternative support postoperatively. Future research should focus on clarifying the effect of a well-constructed and well-delivered preoperative education sessions. 相似文献
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Clare L. Miles Tamar Pincus Dawn Carnes Kate E. Homer Stephanie J.C. Taylor Stephen A. Bremner Anisur Rahman Martin Underwood 《European Journal of Pain》2011,15(8):775
Background
There are now several systematic reviews of RCTs testing self-management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self-management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub-groups of patients SM is optimally effective.Aims
To systematically review randomized controlled trials of self-management for chronic musculoskeletal pain that reported predictors, i.e., ‘baseline factors that predict outcome independent of any treatment effect’; moderators, i.e., ‘baseline factors which predict benefit from a particular treatment’; or mediators i.e., ‘factors measured during treatment that impact on outcome’ of outcome.Method
We searched relevant electronic databases. We assessed the evidence according to the methodological strengths of the studies. We did meta-regression analyses for age and gender, as potential moderators.Results
Although the methodological quality of primary trials was good, there were few relevant studies; most were compromised by lack of power for moderator and mediator analyses. We found strong evidence that self-efficacy and depression at baseline predict outcome and strong evidence that pain catastrophizing and physical activity can mediate outcome from self-management. There was insufficient data on moderators of treatment.Conclusions
The current evidence suggests four factors that relate to outcome as predictors/mediators, but there is no evidence for effect moderators. Future studies of mediation and moderation should be designed with ‘a priori’ hypotheses and adequate statistical power. 相似文献8.
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Goals of the work In order to strengthen cancer patients autonomy and to improve quality of palliative care, it is necessary to know what are the patients preferences for treatment at the end of life, whether they accept the idea of advance directives, and who should initiate the process of fulfilling such a document.Patients and methods We compared cancer patients preferences with respect to particular treatment options at the end of life, acceptance of the idea of advance directives, and preferences for whom should initiate writing such a document with that of healthy controls, nursing staff, and physicians (n=100 each group) using a structured questionnaire.Results Cancer patients wanted treatment with antibiotics and infringing treatments such as chemotherapy and dialysis significantly more often than healthy controls, nursing staff, and physicians (p<0.01 and p<0.001, respectively). Determinants associated with the wish to opt for these treatments were reduced health condition and older age. The groups did not differ with respect to their acceptance of advance directives; 58–75% of all those surveyed wanted their physicians to initiate a discussion about writing such a document if they thought it appropriate.Conclusions Cancer patients preferences for treatment at the end of life significantly differ compared to other groups. Oncologists should initiate a discussion about an advance directive when/if the course of the illness seems to make this appropriate, which corresponds to the wish of the majority of cancer patients, healthy controls, and medical staff.Parts of this work were presented during the 26th German Cancer Conference, Berlin, Germany, 27 February–1 March 2004.This paper contains work of the doctoral thesis of one of the authors (WR) submitted to the faculty of medicine at the Johannes-Gutenberg-University, Mainz, Germany.Competing interest statement: The authors declare no competing interests.Ethics approval: The study was approved by the ethics committee of the Medical Council of the State of Hesse, Frankfurt, Germany. 相似文献
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Can trained volunteers make a difference at mealtimes for older people in hospital? A qualitative study of the views and experience of nurses,patients, relatives and volunteers in the Southampton Mealtime Assistance Study
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Judy Robison BSc Anna L. Pilgrim MSc Gemma Rood RGN Norma Diaper MSc RGN Marinos Elia PhD FRCP Alan A. Jackson PhD FRCP Cyrus Cooper FMedSci DM FRCP Avan Aihie Sayer MSc PhD FRCP Sian Robinson BSc PhD Helen C. Roberts BSc PhD FRCP 《International journal of older people nursing》2015,10(2):136-145