What is new this week for hip fractures

This is what you get when a car swerves into your bike lane.

These are abstracts, the first two I received in an email from NCBI.  The first has a contact email on the Pubmed abstract (I did not put it on here), the rest I will check to see if I can review it through APTA’s Open Door or somewhere else.

1. Do you educate your male patients about osteoporosis?

Gaines JM, Marx KA, Caudill J, Parrish S, Landsman J, Narrett M, Parrish JM. Older men’s knowledge of osteoporosis and the prevalence of risk factors. J Clin Densitom. 2010 Apr-Jun;13(2):204-9. Epub 2010 Mar 29.

It has been estimated that up to 45% of men in the United States have low bone density. Yet, only a few studies have examined men’s knowledge of bone health and disease. Men’s knowledge of sex-specific issues related to osteoporosis is especially not well understood. We surveyed 1535 community-dwelling men with a mean age of 79 yr. The assessed risk factors included a current diagnosis of low bone mass, positive history for fracture, recent level of physical activity, and current medications with the potential to affect bone health. Knowledge about male risk factors for osteoporosis was also assessed, including the effects of advancing age, frame size, fracture risk, calcium and Vitamin D supplementation, low testosterone level, and treatment for prostate cancer. Within this sample, only 11% of the men reported a current diagnosis of low bone mass, whereas 11% reported a prior hip fracture. Only 5% of the sample reported taking some type of Food and Drug Administration-approved medication for osteoporosis. In the aggregate, the participating men answered only 39% of the 6 male osteoporosis-knowledge questions correctly. It is imperative that bone health promotion campaigns that have educated many women effectively now expand their focus to advance the bone health of men also.

2. It takes patients longer to load the affected leg at least four months after fracture:

Nightingale EJ, Sturnieks D, Sherrington C, Moseley AM, Cameron ID, Lord SR. Impaired weight transfer persists at least four months after hip fracture and rehabilitation. Clin Rehabil. 2010 Jun;24(6):565-73. Epub 2010 Apr 21.

OBJECTIVE: To determine whether choice stepping reaction time performance is impaired in people after hip fracture and whether different aspects of choice stepping performance improve with rehabilitation.

DESIGN: This study includes a secondary analysis of data obtained from participants in a randomized controlled trial of exercise after hip fracture.

SETTING: Data were either collected in a hospital rehabilitation unit, research institute or participant homes.

SUBJECTS: The hip fracture group (n = 91) were recruited from three rehabilitation hospitals in metropolitan Sydney. The control group (n = 77) were healthy age-, gender- and dwelling-matched controls, participating in unrelated studies of fall risk factors.

MAIN MEASURES: Response time, movement time and total time components of the choice stepping reaction time test.

RESULTS: Improvements in choice stepping reaction time were seen in people after hip fracture, during a 16-week rehabilitation period, however performance remained impaired (1808 +/- 663 ms), compared with matched controls (1029 +/- 255 ms, P<0.001). Further, choice stepping performance was significantly slower when transferring weight onto the affected leg (1271 +/- 615 ms), compared with the unaffected leg (1119 +/- 499 ms, P<0.001).

CONCLUSIONS: Movement deficits are evident for an extended time frame following rehabilitation for hip fracture. The slower response time following the rehabilitation period highlights ongoing difficulties with weight transfer onto the affected leg.

Reading that abstract led me to the next –

3. not new (2007), but it points to the need for further research in post-hip fracture treatment:

Handoll HH, Sherrington C.Mobilisation strategies after hip fracture surgery in adults. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001704.

BACKGROUND: Hip fracture mainly occurs in older people. Mobilisation strategies such as gait retraining and exercises are used at various stages of rehabilitation after surgery.

OBJECTIVES: To evaluate the effects of different mobilisation strategies after hip fracture surgery in adults.

SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE and other databases, conference proceedings and reference lists of articles, up to January 2006.

SELECTION CRITERIA: All randomised or quasi-randomised trials comparing different mobilisation strategies after hip fracture surgery.

DATA COLLECTION AND ANALYSIS: The authors independently selected trials, assessed trial quality and extracted data. There was no data pooling.

MAIN RESULTS: Most of the 13 included trials (involving 1065 participants, generally over 65 years) were small and all had methodological limitations, including inadequate follow up. Seven trials evaluated mobilisation strategies started soon after hip fracture surgery. One historic trial found no significant differences in unfavourable outcomes for weight bearing started at two versus 12 weeks after internal fixation of a displaced intracapsular fracture. Two trials compared a more with a less intensive regimen of physiotherapy: one found no difference in recovery, the other found a higher level of drop-out in the more intensive group with no difference in length of hospital stay. One trial found short-term improvement in mobility and balance for a two-week programme of weight-bearing versus non-weight-bearing exercise. One trial found improved mobility in those given a quadriceps muscle strengthening exercise programme. One trial found no significant difference in recovery of mobility after a treadmill versus conventional gait retraining programme. One trial found a greater recovery of pre-fracture mobility after neuromuscular stimulation of the quadriceps muscle. Six trials evaluated strategies started after hospital discharge. Started soon after discharge, two trials found improved outcome after 12 weeks of intensive physical training and a home-based physical therapy programme respectively. Begun after completion of standard physical therapy, one trial found improved outcome after six months of intensive physical training whereas another trial found no significant effects of home-based resistance or aerobic training. One trial found improved outcome after home-based exercises started around 22 weeks from injury. One trial found home-based weight-bearing exercises starting at seven months produced no statistically significant differences aside for greater quadriceps strength.

AUTHORS’ CONCLUSIONS: There is insufficient evidence from randomised trials to establish the effectiveness of the various mobilisation strategies used in rehabilitation after hip fracture surgery. Further research is required to establish the possible benefits of the additional provision of interventions, including intensive supervised exercises, primarily aimed at enhancing mobility.

4. And finally, that one led me to this one, which addresses more the psychosocial aspect of patients post-hip fracture which is an interest of mine:

Crotty M, Unroe K, Cameron ID, Miller M, Ramirez G, Couzner L. Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007624.

BACKGROUND: Social and psychological factors such as fear of falling, self-efficacy and coping strategies are thought to be important in the recovery from hip fracture in older people.

OBJECTIVES: To evaluate the effects of interventions aimed at improving physical and psychosocial functioning after hip fracture.

SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE and EMBASE (to December 2008), other databases and reference lists of related articles.

SELECTION CRITERIA: Randomised and quasi-randomised trials of rehabilitation interventions applied in inpatient or ambulatory settings to improve physical or psychosocial functioning in older adults with hip fracture. Primary outcomes were physical and psychosocial function and ‘poor outcome’ (composite of mortality, failure to return to independent living and/or readmission).

DATA COLLECTION AND ANALYSIS: Two authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Disagreements were moderated by a third author.

MAIN RESULTS: Nine small heterogeneous trials (involving 1400 participants) were included. The trials had differing interventions, including ‘usual care’ comparators, providers, settings and outcome assessment. Although most trials appeared well conducted, poor reporting hindered assessment of their risk of bias.Three trials testing interventions (reorientation measures, intensive occupational therapy, cognitive behavioural therapy) delivered in inpatient settings found no significant differences in outcomes. Two trials tested specialist-nurse led care, which was predominantly post-discharge but included discharge planning in one trial: this trial found some benefits at three months but the other trial found no differences at 12 months. Coaching (educational and motivational interventions) was examined in two very different trials: one trial found no effect on function at six months; and the other showed coaching improved self-efficacy expectations at six months, although not when combined with exercise. Two trials testing interventions (home rehabilitation; group learning program) started several weeks after hip fracture found no significant differences in outcomes at 12 months.

AUTHORS’ CONCLUSIONS: Some outcomes may be amenable to psychosocial treatments; however, there is insufficient evidence to recommend practice changes. Further research on interventions described in this review is required, including attention to timing, duration, setting and administering discipline(s), as well as treatment across care settings. To facilitate future evaluations, a core outcome set, including patient-reported outcomes such as quality of life and compliance, should be established for hip fracture trials.

photo credit: This is what you get when a car swerves into your bike lane., originally uploaded by radiant.baby


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