Una Nedeljkovic

Do depressive symptoms on hospital admission impact early functional outcome in elderly patients with hip fracture

Depression is the most common mood disorder in elderly people and one of the most prevalent comorbidities in older people with hip fracture. While several authors have confirmed that depressive symptoms assessed at a later stage after hip fracture impact functional outcome and mortality, the role of depressive symptoms identified at an earlier stage after hip fracture remains understudied. The aim of the present study was to determine if depressive symptoms assessed on hospital admission impact early functional outcome after hip fracture surgery.

Effects of anodal tDCS and occupational therapy on fine motor skill deficits in patients with chronic stroke

BACKGROUND A growing body of evidence supports the effectiveness of using transcranial direct current stimulation (tDCS) in patients with chronic hand motor impairment resulting from stroke. OBJECTIVE In this study, we investigate and compare the combined effects of anodal tDCS and occupational therapy (OT) to sham stimulation with OT (control) on fine motor skill deficits of chronic stroke patients. METHODS A total of 26 stroke patients (at ≥ 9 months) were randomly assigned to an active treatment or a control group in a double-blinded, sham-controlled, parallel design study. Each group received OT for 45 min/day (10 sessions for 2 weeks). Treatment was preceded by either 20 minutes of 2 mA anodal tDCS over ipsilesional M1 or sham tDCS. A modified Jebsen-Taylor Hand Function Test (mJTHFT) was administered as primary outcome measure, and handgrip dynamometer and upper limb Fugl-Meyer (ULFM) assessments were performed as secondary outcomes. The assessment was done at baseline (T0), after the interventions on day 1(T1), day 10 (T2) and day 40 (T3). RESULTS We observed a statistically significant effect in the tDCS group when the results were compared to the sham group. The mJTHFT times were significantly shorter immediately after treatment and at day 40. The intervention had no effect on handgrip strength or ULFM score. CONCLUSION Fine motor skill deficits in chronic stroke survivors can be improved when intensive OT is primed with anodal tDCS over the ipsilesional hemisphere.

Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: a randomized controlled trial

Introduction Periodic relapses are one of the main characteristics of multiple sclerosis (MS), from which recovery is often incomplete despite high-dose methylprednisolone (HDMP) treatment. The aim of our study was to evaluate the potential benefits of short-term HDMP combined with multidisciplinary rehabilitation (MDR) in persons with MS in relapse in order to assess whether combination of steroid therapy with MDR is more beneficial than steroid therapy alone. Material and methods This investigation was conducted as a randomized controlled trial. The MS patients were eligible if they had an established diagnosis and relapse requiring application of HDMP. Forty-nine patients were included in the study and randomized to control and treatment groups, and 37 completed the study. High-dose methylprednisolone was administered to all patients. The treatment group additionally underwent an MDR program over a 3-week period. All outcome measures were completed at baseline and 1 and 3 months later. Results The Expanded Disability Status Scale (EDSS) and Functional Independence Measure (FIM) motor scores improved statistically significantly 1 month after HDMP, in both treatment and control groups. During the study period, in the treatment group, a sustained large effect size (ES) was found for both physical and mental composite scores of Multiple Sclerosis Quality of Life-54 (MSQoL-54), while in the controls, a sustained moderate ES was demonstrated only for physical composite score. Conclusions Our findings suggest that MDR improves MS relapse outcome.

THU0378 Predictors of One-Year Mortality in Elderly Hip Fracture Patients

Background There is growing evidence that devastating consequences of hip fracture can possibly be counteracted with multidisciplinary inpatient rehabilitation3. Recognition of variables that influence mortality at an early stage is needed in order to set realistic rehabilitation goals, adequately allocate rehabilitation resources, and optimize recovery after hip fracture. The most frequently reported predictors of mortality after hip fracture are male gender, advanced age and poor general health status 4,5. However, data on potential predictive value of early functional outcome after hip fracture has not been sufficiently investigated.6 Objectives 1) to explore predictive factors of functional level at discharge 2) to assess 1-year mortality, and 3) to evaluate the impact of early functional outcome on 1-year mortality in patients operated on for hip fractures Methods A total of 228 consecutive patients (average age 77.59±7.36)with hip fracture who met the inclusion criteria were enrolled in the study. Functional level at discharge was measured with motor FIM score. Mortality rates in the study population were calculated in absolute numbers, and as the standardised mortality ratio (SMR). Multivariate regression analysis was used to explore predictive factors for motor FIM at discharge, and 1-year mortality adjusted on important baseline variables. Results Age, health status, cognitive level, pre-injury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1 year follow-up, 57 patients (25.0%; 43 women and 14 men) died. The all-cause mortality rate observed in this group was higher in all age groups, and in both genders when compared to all-cause mortality of general population (p<0.001). Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture;(HR=0.90, 95% CI=0.87-0.92; p<0.000). Conclusions Functional level at discharge is the main determinant of long-term mortality in hip fracture patients. Motor-FIM score at discharge is a reliable predictor of mortality, and can be recommended for wide clinical use. References Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55:M498-507 Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002; 359:1929-1936. Handoll HH, Cameron ID, Mak JC, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2009;CD007125. Soderqvist A, Ekstrom W, Ponzer S, Pettersson H, Cederholm T, Dalen N, Hedstrom M, Tidermark J. Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology. 2009;55:496-504. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374. Alegre-Lopez J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernandez-Melon J. Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int. 2005;16:729-736. Disclosure of Interest None Declared