Lydia Martín-Martín

Predictors of Long-Term Mortality in Older People With Hip Fracture

OBJECTIVES To determine 1-year mortality and predisposing factors in older people who had surgery after a hip fracture. DESIGN Prospective cohort study. SETTING Public acute hospital, trauma service. PARTICIPANTS Patients (N=281) aged ≥65 years who were admitted to the hospital with a hip fracture from January 2009 to January 2010, and followed up for 1 year thereafter. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Cumulative survival probability up to 1 year from surgery was calculated by means of Kaplan-Meier charts, and Cox regression models were performed to analyze the factors associated with mortality. Data were collected from medical charts and by interviews. Health status was evaluated using the American Society of Anesthesiologists rating, prefracture functional level with the FIM, and cognitive status with the Pfeiffer score. RESULTS The 1-year mortality for the 281 patients who were followed up was 21% (95% confidence interval [CI], 16.1%-25.9%). A non-weight-bearing status was associated with increased mortality in unadjusted analyses (hazard ratio [HR]=1.99; 95% CI, 1.16-3.43), but 5 other factors were identified when entered into the multiple Cox regression model: age (HR=1.05; 95% CI, 1-1.09), male sex (HR=2.92; 95% CI, 1.58-5.39), low health status (HR=2.8; 95% CI, 1.29-6.09), low prefracture function (HR=.98; 95% CI, .97-.99), and change of residence (HR=3.21; 95% CI, 1.43-7.17). CONCLUSIONS The overall 1-year mortality rate was 21%. Change of residence is the only potentially modifiable risk factor, independent of the following other traditional risk factors that were found: age, sex, health status, and prefracture functional level. Furthermore, 2 to 4 weeks of non-weight-bearing status, which is considered modifiable, is also associated with increased mortality rates in unadjusted analyses.

Effect of occupational therapy on functional and emotional outcomes after hip fracture treatment: a randomized controlled trial:

Objective: To explore whether an occupational therapy intervention combined with physiotherapy rehabilitation improved hip fracture patient outcomes regarding emotional distress, fatigue, independence and function. Design: Randomized controlled trial. Setting: Inpatient trauma ward in a rehabilitation and trauma hospital. Participants: One hundred and twenty-two patients admitted into hospital for hip fracture. Intervention: Patients were randomly assigned to a standard care group (SC, n = 61) or a combined treatment group (CT, n = 61). The SC group received conventional hospital care for hip fracture patients and the CT group underwent occupational therapy as well. Main measures: Patients’ emotional distress (GHQ-28), perceived fatigue (the first item of the BASDAI using a 0–100 visual analogue scale scale), level of independence (Modified Barthel Index) and function (Harris Hip Score) were measured at baseline and one, three and six months after the intervention. Results: Patients in the CT group experienced a considerable decrease of emotional distress at three and six months (p = 0.005 and p < 0.001, respectively). A between-group analysis showed significant differences in emotional distress at one, three and six months (p < 0.001). Although fatigue levels decreased in the SC group, the most significant decline was reported by the CT group at six months (p < 0.001, mean difference = 14 points). Regarding independence level, significant differences were found within groups at each stage, but also between groups at one month in favor of the CT group. Function improved in both groups compared with baseline (p < 0.001), but no significant differences were found in functionality between groups. Conclusion: Although both groups reported significant improvements, patients in the CT group had better scores in emotional distress and dependence throughout follow-up and better scores in all measures at six months.

Analysis of Pressure Pain Hypersensitivity, Ultrasound Image, and Quality of Life in Patients with Chronic Plantar Pain: A Preliminary Study.

OBJECTIVES To evaluate widespread pressure pain in patients with chronic plantar heel pain compared with that in healthy controls and to investigate the differences in ultrasound imaging and quality of life between these two groups. METHODS A total of 22 patients (11 female) with chronic plantar heel pain and the same number of healthy patients, matched according to age and gender, were included in this pilot study. Pressure pain thresholds (PPTs) were bilaterally assessed over the calcaneus bone, the plantar fascia, the first and fifth metatarsals, the soleus muscle, the second metacarpal, and the zygapophyseal joint of C5-C6. Plantar fascia thickness was measured via ultrasound imaging. In addition, quality of life and physical function were assessed using the Short-Form 36 (SF-36) questionnaire and the Foot and Ankle Ability Measure (FAAM) questionnaire, respectively. RESULTS Analysis of covariance (ANCOVA) results showed significant differences in the PPTs at all points between the groups (P < 0.001), but not between sides. The PPTs were significantly lower in the patients than in the controls at all sites (P < 0.05). The results showed significant increases in fascia thickness at the calcaneus insertion (group: F = 74.172, P ≤ 0.001; side: F = 8.920, P ≤ 0.001) and the middle fascia point (group: F = 133.685, P = <0.001; side: F = 11.414, P = <0.001) on ultrasound in the patient group compared with the matched control group. The analysis also revealed that the patient group had a significantly lower score on every subscale of the SF-36 and FAAM questionnaires (all P < 0.001), except for the mental component, compared with the matched control group. DISCUSSION Patients suffering from chronic plantar heel pain showed widespread and bilateral hypersensitivity, increased thickness of the plantar fascia in the affected foot, and deterioration in quality of life and physical functioning compared with matched controls.

Effectiveness of Lumbopelvic Exercise in Colon Cancer Survivors: A Randomized Controlled Clinical Trial.

INTRODUCTION This study evaluated the effectiveness of lumbopelvic exercise in improving health-related fitness, anthropometric measurements, and body composition in colon cancer survivors (CCS). METHODS Forty-six CCS (35% female, n = 14) were assigned to two groups for this randomized controlled clinical trial: a trunk muscle stabilization exercise program group (CO-CUIDATE) and a usual-care group. The CO-CUIDATE program was conducted for 8 wk (three times per week). The primary end point was isometric abdominal strength measured using the trunk curl test. The secondary end points used were isometric back strength, functional capacity, lower-body flexibility, weight, and anthropometric measurements evaluated at baseline, after the physical exercise program and after 6 months of follow-up. A trained member of the research group with 5 yr of experience working with cancer patients and who was blinded to the patient group assessed the variables. All physical tests were conducted with multiple observations. RESULTS The adherence to intervention was 88.36%, and two dropouts (10.5%) were recorded. Minor side effects, including discomfort with the exercises in the first sessions, were reported by the participants. ANOVA demonstrated significant differences in group-time interactions for isometric abdominal strength (F = 7.7; P = 0.001), functional capacity (F = 4.6; P = 0.015), lower-body flexibility (right, F = 4.3, P = 0.021 and left, F = 3.6, P = 0.034), and waist circumference (F = 5.7; P = 0.07), which were the best values for the CO-CUIDATE group. No significant changes in isometric back strength, weight, hip circumference or body composition were observed. CONCLUSION An 8-wk program based on stabilization exercises is a promising strategy to increase health-related fitness and to reduce waist circumference in CCS. An exercise program based on lumbopelvic exercise is a feasible intervention to improve the control of deep abdominal muscles and health-related fitness.

Factors Influencing Performance-Oriented Mobility After Hip Fracture

Objective: To identify the patient- and fracture-related determinants that influence performance-oriented mobility in hip fracture patients as measured by the Performance-Oriented Mobility Assessment (POMA) score. Method: A prospective study was conducted. Patients aged 65 or older (n = 186) were prospectively recruited. Patients were assessed for mobility (Tinetti POMA), level of independence (Modified Barthel Index), emotional distress (Goldberg General Health Questionnaire), comorbidities (Charlson Comorbidity Index), and Perceived Health (categorical scale). Results: The study revealed that patient age, type of fracture, length of hospital stay, level of emotional distress, and level of independence were significant predictors of performance-oriented mobility. When combined, these factors explained 44.3% of the variance in performance-oriented mobility (r2 = .443; r2 adjusted = .414; F = 15.46; p < .001). Discussion: Patients who are older, spend more days in hospital, have worse pre-fracture independence level or higher emotional distress levels at discharge, and sustain subtrochanteric or intertrochanteric fractures seem to have poorer performance-oriented mobility after hip fracture.

Effectiveness of an occupational therapy intervention in reducing emotional distress in informal caregivers of hip fracture patients: a randomized controlled trial

Objective: To examine the effectiveness of an occupational therapy intervention program in reducing emotional distress in informal caregivers of hip fracture patients. Design: Single-blind randomized controlled trial. Setting: A public Trauma and Rehabilitation Hospital in Granada, Spain. Participants: A total of 186 caregivers and their care recipients with hip fracture (93 in each group) were allocated to an intervention group or a control group using a block system. Intervention: An occupational therapy intervention during patient hospitalization focused on patient handling by caregivers and ergonomic treatment for both. Main measures: The Goldberg General Health Questionnaire was used to measure emotional distress and psychological well-being. The Goldberg Anxiety and Depression Scale was used to measure caregiver affective illness. Results: Among informal caregivers, emotional distress decreased to a greater extent in the intervention group than in the control group from the first assessment to the six-month follow-up (intervention group: 4.16 (SD 4.57) to 2.81 (SD 2.93); control group: 4.61 (SD 4.57) to 4.24 (SD 4.30)), showing significant differences at the first, third and sixth month. As regards anxiety levels, significant differences were only found at the third month (1.54 (SD 2.09) vs. 2.35 (SD 2.53) in the intervention and control groups, respectively (p < 0.05)), although the intervention group always showed lower levels from the first month. Although depression levels decreased in both groups, the decrease was also greater in the intervention group. Conclusion: Occupational therapy training for caregivers of hip fracture patients helps to significantly reduce emotional distress, anxiety and depression in caregivers.

Designing BENECA m-Health APP, A Mobile Health Application to Monitor Diet and Physical Activity in Cancer Survivors

This is the abstract of a proposed mobile health application for assessing and monitoring healthy lifestyles (in terms of diet and physical activity levels) in cancer survivors, to be fully exposed at the IWANN 2017. The main goal of this mobile health application is to help cancer patients with energy imbalance, which can increase the risk of recurrence and other associated problems, such as metabolic syndrome and even death, to adhere to the international healthy recommendations in terms of diet and physical activity. The system, called BENECA m-Health app, is still in development, and will be a reliable instrument to assess physical activity and diet in cancer survivors, offering them a real-time energy balance feedback and attempting to overcome specific identified barriers to facilitate the inclusion of exercise and healthy diet into supportive care programs for cancer survivors. This mobile application has been designed to address the new needs for support of breast cancer survivors, reflecting the emerging need to merge new, low cost treatment options. This m-Health System could be a promising approach for dietary and physical assessment, as well as for intervention programs, which can be used whenever and wherever patients want.

Influence of Cognitive Impairment on Mobility Recovery of Patients With Hip Fracture.

Objective The aims of this study were to study the mobility recovery in hip fracture patients and determine the influence of cognitive impairment on mobility within the first 3 months after surgery. Design This prospective cohort study was carried out in an acute public hospital in southern Spain and included 275 patients, 65 years or older, with a hip fracture. Mobility and Cognitive status were measured by Tinetti Performance-Oriented Mobility Assessment and Pfeiffers’ Scale (Short Portable Mental State Questionnaire), respectively. Multiple linear regression was used to examine the influence of cognitive impairment on mobility. Results The median Performance-Oriented Mobility Assessment score changed from 4 (3–4) points at discharge to 17 (7–22) at 3 months. All degrees of cognitive impairment were negatively associated with gait and balance at 1 and 3 months after surgery (P < 0.01). Age, weight bearing, length of hospital stay, and postsurgical complications were also identified as independent predictors of mobility outcome at 3 months. Conclusions Cognitive impairment is a negative prognostic factor for the recovery of mobility in elderly patients with a hip fracture. New treatment strategies are needed for hip fracture patients with cognitive impairment.

Do Patient Profiles Influence the Effects of Massage? A Controlled Clinical Trial.

Considerable scientific evidence has been published on the effectiveness of massage in different conditions, but it remains unclear whether this effectiveness is modulated by the profile of patients. The aim of this study was to compare the effects of a 21-min myofascial therapy protocol on stress responders and nonresponders stressed in the laboratory with a cold pressor test. Dependent variables included heart rate variability (HRV), blood pressure, and salivary markers such as flow rate, cortisol, immunoglobulin A (IgA), and α-amylase activity. A controlled, repeated measures, single-blind trial was conducted in 30 Caucasian students with a mean (SD) age of 20.70 (4.50) years. We found no significant between-group differences in descriptive characteristics or in any preintervention outcome measure. Analysis of covariance revealed significant increases in HRV index (F = 0.18, p = .01), salivary flow rate (F = 0.16, p = .02), and salivary IgA concentration (F = 4.36, p = .04) and significant decreases in the low-frequency domain (F = 0.18, p = .04) and LF–high-frequency ratio (F = 0.18, p = .01) in the stress responder group in comparison to the nonresponder group. In conclusion, a better response to massage was observed in stress responders than in nonresponders across various HRV parameters and salivary measures.

OP0200-HPR How many subjective measurement tools are needed in knee osteoarthritis assessment?

Background Osteoarthritis (OA) is the most common arthritis worldwide. OA ischaracterized by erosion and loss of articular cartilage accompanied by hypertrophic changes in neighboring bone that result in pain, stiffness, and gradual deterioration of mobility1. Nowadays is the most common cause of physical disability among older patients. Therefore, different instruments have been developed to evaluate the impact of OA on functioning and quality of life of patients, among them EQ-5D and WOMAC2 Objectives To determine the association and correlation among common subjective measuring toolsfor knee osteoarthritis: EQ, WOMAC and VAS Methods 120 patients with radiologically confirmed knee osteoarthritis were evaluated with Visual Analogue Scale (VAS) for pain, Western Ontario and McMaster Osteoarthritis Index (WOMAC) for functional status, and EQ-5D for Health related quality of life. That measures werecompared and the concordance (Kappa Index) among the three guides calculated Results An 80% of the sample were women, mean (SD) age 64,11 (10,361) and BMI 31,40 kg/m2 (5,3). Radiographic severity mean (SD) was 2, 63 (0,685) and 75% had more affected joints besides knee. Mean (SD) standardized tools scores were: EVA 6,46 (2,3 SD); EQ-5D 0,58 (0,23); EQ-5D VAS 56,6 (16,9); WOMAC pain 8,97 (3,7); WOMAC stiffness 3 (2); WOMAC function 29,5 (12,8) and WOMAC global 41,5 (16,86). People who reported higher scores on EVA, did the same in pain, function and global areas of WOMAC and had worse scores in quality of life instrument (EQ-5D) likewise. EQ-5D and WOMAC had also a significant association VAS EQ-5D EQ-5D VAS WOMAC WOMAC WOMAC WOMAC pain stiffness function global VAS 1 -0,408** NS 0,346** NS 0,362** 0,366** EQ-5D -0,408** 1 0,199* -0,481** -0,454** -0,703** -0,696** EQ-5D VAS NS 0,199* 1 -0,351** -0,221* -0,332** -0,359** WOMAC pain 0,346** -0,481** -0,351** 1 0,471** 0,665** 0,783** WOMAC stiffness NS -0,454** -0,221* 0,471** 1 0,599** 0,681** WOMAC function 0,362** -0,703** -0,332** 0,665** 0,599** 1 0,979** WOMAC global 0,366** -0,696** -0,359** 0,783** 0,681** 979** 1 *p<0.05; **p<0,001; NS: non-significant (p>0,05). Conclusions The high degree of association between WOMAC and EQ suggests that only one of them would be enough to get general health status data. EVA was mismatched respect to the others instruments nevertheless, so it could be useful variable to add information. We would need inquireif the different point in time which every tool takes in account to collect patient information influences these results References Sevick MA, Miller GD, Loeser RF, Williamson JD, Messier SP Xie F, Pullenayegum EM, Li SC, Hopkins R, Thumboo J, Lo NNValue Health Disclosure of Interest None Declared