Geriatric care improves free-living physical behaviour after hip fracture surgery .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(6):19 BMC Geriatr. 2015 Dec 4;15:160397 hip fracture patients were randomised to either comprehensive geriatric care (CGC) in a geriatric ward or orthopaedic care (OC) in an orthopaedic ward. The purpose of this trial was to compare the long-term effects on the free-living physical behaviour of hip fracture patients between the geriatric ward and the orthopaedic ward. Greater improvements in free-living physical behaviour, such as longer periods spent upright, were seen at both 4-month and 12-month follow-ups in the patients managed with comprehensive geriatric care compared to those managed with orthopaedic care.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Hip fractures are often sustained in the elderly and frail population and require extensive postoperative rehabilitation to achieve pre-fracture level functionality. Measures of free-living physical behaviour can provide information about the success of the intervention in terms of the impact on the patients’ daily life. However, the free-living physical behaviour of patients in daily life has yet to be studied, leading to the objective of this study.
Qual era a principal questão de investigação?
Are there superior long-term effects with regards to free-living physical behaviour in elderly patients with hip fractures randomised to postoperative care at either a geriatric ward or an orthopaedic ward, as assessed over a 12-month period?
- Level of physical behaviour measured by mean daily upright time significantly favoured the CGC group compared to the OC group at 4 months (Mean difference (MD) 34.6 minutes; CI 9.6 to 59.6, p=0.007) and at 12 months (MD 27.7 minutes; CI 3.5 to 51.8, p=0.025)
- Significantly higher mean duration of upright events was seen in the CGC group compared to the OC group at 4 months (MD 0.6; CI 0.1 to 1.2, p=0.019) and at 12 months (MD 0.6; CI 0.1 to 1.1, p=0.033)
- Maximum length of upright events was significantly longer in the CGC group compared to the OC group at 4 months (MD 7.2; CI 0.3 to 14.1, p=0.042) and at 12 months (MD 7.2; CI 0.5 to 13.9, p=0.046)
- Median and variation in length of upright events were not significant between the two groups at 4 or 12 months (p>0.05)
- There were no statistically significant group differences for number of upright events at either 4 or 12 months
De que é que me devo lembrar mais?
Longer time was spent upright every day in hip fracture patients given postoperative comprehensive geriatric care compared to patients who were designated to the orthopaedic ward postoperatively. Mean and maximum lengths of postoperative upright events also favoured the geriatric ward patients, however, changes in the median, variability in, and the number of upright events were non-significant between groups.
Como é que isto afectará o tratamento dos meus doentes?
Based on results of this study, comprehensive geriatric care may provide a more favourable postoperative impact for older hip fracture patients when compared to orthopaedic care. Future trials should study the impact of improved physical function with improved free-living physical behaviour to determine whether there is a correlation between the two variables.
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