| Summary: | 博士 === 長庚大學 === 臨床醫學研究所 === 101 === Hip fracture is a leading cause of disability and death among older adults. The main objective of treatment and care is to help restore physical function. However, there is a lack of investigation on the care model and mechanism facilitating functional recovery. The purpose of this study was to investigate the effects of different interventions on the post-surgical physical fitness and physical function recovery of the elderly with hip fracture, as well as to understand mediating variables affecting functional recovery, including physical fitness, depression, and nutritional status.
This longitudinal prospective study is a single-blinded randomized controlled trial. Purposive sample including 299 elderly patients with hip fracture who met the inclusion criteria and agreed to participate were recruited from the wards of Department of Traumatology and Orthopedics in a medical center in the northern Taiwan. Participants were randomized into the control group (N=99), subacute group (N=101), and comprehensive group (N=99) using dice rolling. Subacute group received geriatric consultation, continuous rehabilitation, and discharge planning. In addition to receiving the interventions for the subacute group, the comprehensive group received nutritional assessment and consultation, depression screening and management, and home environment assessment and fall prevention. The control group received the usual care which included only in-hospital rehabilitation but not geriatric consultation, in-home rehabilitation, and environmental assessment.
This study used personal characteristics, Chinese version of the Geriatric Depression Scale, short form (GDS-s), Mini Nutritional Assessment (MNA), physical fitness assessment scale, Chinese Barthel Index, and fall record to collect the data of the participants during their hospitalization and 1, 3, 6, and 12 months after hospital discharge. This study used SPSS 15.0 for Windows and the package statistical software HLM 6.07 to analyze data.
The main findings are: (1) Trajectories of hip joint flexibility, muscle fitness, resting heart rate, nutritional status, depression status, recovery of prefracture functional status, and walking ability during the first year after the surgery reflected a time quadratic nonlinear growth curve. Resting heart rate and depression status declined with the progress of time first and then slightly improved. Hip joint flexibility, muscle fitness, nutritional status, recovery of prefracture functional status, and walking ability all improved first and then slightly declined. The recovery reached the climax at postoperative 6 to 8 months. The recovery in the first six months after the surgery was most significant, and then slightly declined. At the same time, the trajectories of fall and balance reflected the linear growth model. (2) In terms of the effect of different interventions, the interventions for the comprehensive group and those for the subacute groups were both beneficial to recovery of prefracture functional status. Hip extension angle and time of eye-closed one foot standing was significantly better in the comprehensive group than control group. There was no significant difference between the subacute group and the control group in physical fitness variables. (3) In terms of the test on the model of mediation effect, hip joint flexibility, balance, nutrition, and depression mediated the treatment effects on the postoperative recovery of functional status. The interventions for the comprehensive group can increase the probability of recovery prefracture functional status by improving the participants’ hip joint flexibility, balance, nutritional status, and reducing depressive symptoms.
The research findings provide empirical data on the change over time in the physical fitness, depression status, nutritional status, and improvement of physical functions of the elderly with hip fracture one year after the surgery, to support the fact that the postoperative recovery of physical functions is dynamic and may be affected by multiple factors. Moreover, hip joint flexibility, balance, depression status, and nutritional status are the significant mediating variables affecting the recovery of functions.
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