目的:确定三种术后物理治疗活动之间的关系(术后第一次行走的时间,手术后第二天的活动,和物理治疗频率),以及髋部骨折后住院时间(LOS)和出院目的地的结果。
方法:2022年6月,在澳大利亚和新西兰髋部骨折注册急性康复Sprint审核的36家参与医院中,对437名年龄≥50岁的髋部骨折手术患者进行了队列研究。研究结果包括医院LOS和出院目的地。分别使用广义线性回归和逻辑回归,针对潜在的混杂因素进行了调整。
结果:在437例患者中,62%是女性,56%的人年龄≥85岁,23%以前住在老年护理机构,48%的人通常在步态辅助下行走,38%的人在受伤前出现认知障碍。中位急性和总LOS分别为8天(IQR5-13)和20天(IQR8-38)。最初居住在私人住宅中的患者中约有71%(n=179/251)返回家中,而29%(n=72/251)已出院到老年护理机构。与术后第1天行走的患者相比,以前的移动患者如果行走第2-3天(10.3天;95%CI3.2,17.4)或用机械升降器转移或第1天没有下床(7.6天;95%CI0.6,14.6),则总LOS较高。以前从私人住所流动的患者如果步行第2-3天,返回私人住所的几率降低(OR0.38;95%CI0.17,0.87),第4天+(OR0.38;95%CI0.15,0.96),或者他们只是坐着,与术后第1天行走的人相比,在第1天站立或踩踏(OR0.29;95%CI0.13,0.62)。在私人住宅的患者中,每天每次额外的物理治疗与-2.2(95%CI-3.3,-1.0)天的急性LOS缩短相关,返回私人住宅的对数几率增加(OR1.76;95%CI1.02,3.02)。
结论:步行较早的髋部骨折患者,术后第一天更活跃,和/或接受更多物理治疗的疗程更有可能在较短的LOS后返回家中。
OBJECTIVE: To determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture.
METHODS: A cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint
Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders.
RESULTS: Of 437 patients, 62% were female, 56% were aged ≥ 85 years, 23% were previously living in a residential aged care facility, 48% usually walked with a gait aid, and 38% were cognitively impaired prior to their injury. The median acute and total LOS were 8 (IQR 5-13) and 20 (IQR 8-38) days. Approximately 71% (n = 179/251) of patients originally living in private residence returned home and 29% (n = 72/251) were discharged to a residential aged care facility. Previously mobile patients had a higher total LOS if they walked day 2-3 (10.3 days; 95% CI 3.2, 17.4) or transferred with a mechanical lifter or did not get out of bed day 1 (7.6 days; 95% CI 0.6, 14.6) compared to those who walked day 1 postoperatively. Previously mobile patients from private residence had a reduced odds of return to private residence if they walked day 2-3 (OR 0.38; 95% CI 0.17, 0.87), day 4 + (OR 0.38; 95% CI 0.15, 0.96), or if they only sat, stood or stepped on the spot day 1 (OR 0.29; 95% CI 0.13, 0.62) when compared to those who walked day 1 postoperatively. Among patients from private residence, each additional physiotherapy session per day was associated with a -2.2 (95% CI -3.3, -1.0) day shorter acute LOS, and an increased log odds of return to private residence (OR 1.76; 95% CI 1.02, 3.02).
CONCLUSIONS: Hip fracture patients who walked earlier, were more active day 1 postoperatively, and/or received a higher number of physiotherapy sessions were more likely to return home after a shorter LOS.