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BMC Geriatrics
Published in: BMC Geriatrics 1/2021

Open Access 01-12-2021 | Care | Research article

Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials

Authors: Shams Dakhil, Pernille Thingstad, Frede Frihagen, Lars Gunnar Johnsen, Stian Lydersen, Eva Skovlund, Torgeir Bruun Wyller, Olav Sletvold, Ingvild Saltvedt, Leiv Otto Watne

Published in: BMC Geriatrics | Issue 1/2021

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Abstract

Background

The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL).

Methods

This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery.

Results

Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points.

Conclusions

Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.
Literature
1.
Watne LO, Torbergsen AC, Conroy S, Engedal K, Frihagen F, Hjorthaug GA, et al. The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Med. 2014;12:63.CrossRef
2.
Kristensen MT. Factors affecting functional prognosis of patients with hip fracture. Eur J Phys Rehabil Med. 2011;47(2):257–64.PubMed
3.
Kammerlander C, Doshi HK, Bocker W, Gosch M. Fragility Fracture Care and Orthogeriatric Comanagement. BioMed research international. 2016;2016:2056376.CrossRef
4.
Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49(8):1458–60.CrossRef
5.
Cheng SY, Levy AR, Lefaivre KA, Guy P, Kuramoto L, Sobolev B. Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporosis Int. 2011;22(10):2575–86.
6.
Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteo. 2013;8:136.CrossRef
7.
Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, et al. Ortho-geriatric service–a literature review comparing different models. Osteo Int. 2010;21(Suppl 4):S637-46.
8.
Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28(3):e49–55.CrossRef
9.
Lin SN, Su SF, Yeh WT. Meta-analysis: Effectiveness of Comprehensive Geriatric Care for Elderly Following Hip Fracture Surgery. West J Nurs Res. 2020;42(4):293–305.CrossRef
10.
Stenqvist C, Madsen CM, Riis T, Jorgensen HL, Duus BR, Lauritzen JB, et al. Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture. Geriatric orthopaedic surgery rehabilitation. 2016;7(2):67–73.CrossRef
11.
Barone A, Giusti A, Pizzonia M, Razzano M, Palummeri E, Pioli G. A comprehensive geriatric intervention reduces short- and long-term mortality in older people with hip fracture. J Am Geriatr Soc. 2006;54(7):1145–7.CrossRef
12.
Folbert EC, Hegeman JH, Vermeer M, Regtuijt EM, van der Velde D, Ten Duis HJ, et al. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment. Osteo Int. 2017;28(1):269–77.
13.
Henderson CY, Shanahan E, Butler A, Lenehan B, O’Connor M, Lyons D, et al. Dedicated orthogeriatric service reduces hip fracture mortality. Ir J Med Sci. 2017;186(1):179–84.CrossRef
14.
Suarez S, Pesantez RF, Diaz ME, Sanchez D, Tristancho LJ, Vanegas MV, et al. Impact on Hip Fracture Mortality After the Establishment of an Orthogeriatric Care Program in a Colombian Hospital. J Aging Health. 2017;29(3):474–88.CrossRef
15.
Zeltzer J, Mitchell RJ, Toson B, Harris IA, Ahmad L, Close J. Orthogeriatric services associated with lower 30-day mortality for older patients who undergo surgery for hip fracture. The Medical journal of Australia. 2014;201(7):409–11.CrossRef
16.
Moyet J, Deschasse G, Marquant B, Mertl P, Bloch F. Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice. Int Orthop. 2019;43:1449–54.
17.
Sabharwal S, Wilson H. Orthogeriatrics in the management of frail older patients with a fragility fracture. Osteo Int. 2015;26(10):2387–99.
18.
Shields L, Henderson V, Caslake R. Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials. J Am Geriatr Soc. 2017;65(7):1559–65.CrossRef
19.
Mukherjee K, Brooks SE, Barraco RD, Como JJ, Hwang F, Robinson BRH, et al. Elderly adults with isolated hip fractures- orthogeriatric care versus standard care: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Traum Acute Care Surg. 2020;88(2):266–78.CrossRef
20.
Boyd RV, Hawthorne J, Wallace WA, Worlock PH, Compton EH. The Nottingham orthogeriatric unit after 1000 admissions. Injury. 1983;15(3):193–6.CrossRef
21.
Miura LN, DiPiero AR, Homer LD. Effects of a geriatrician-led hip fracture program: improvements in clinical and economic outcomes. J Am Geriatr Soc. 2009;57(1):159–67.CrossRef
22.
Adunsky A, Lerner-Geva L, Blumstein T, Boyko V, Mizrahi E, Arad M. Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment. J Am Med Dir Assoc. 2011;12(6):439–44.CrossRef
23.
Adunsky A, Lusky A, Arad M, Heruti RJ. A comparative study of rehabilitation outcomes of elderly hip fracture patients: the advantage of a comprehensive orthogeriatric approach. J Gerontol Series A Biol Sci Med Sci. 2003;58(6):542–7.
24.
Stenvall M, Olofsson B, Nyberg L, Lundstrom M, Gustafson Y. Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. J Rehabil Med. 2007;39(3):232–8.CrossRef
25.
Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, et al. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet. 2015;385(9978):1623–33.CrossRef
26.
Wyller TB, Watne LO, Torbergsen A, Engedal K, Frihagen F, Juliebo V, et al. The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatr. 2012;12:36.CrossRef
27.
Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556–61.CrossRef
28.
Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Prestmo A, Lamb SE, et al. Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture. The protocol of the Trondheim Hip Fracture trial. BMC Geriatr. 2011;11:18.CrossRef
29.
Saltvedt I, Prestmo A, Einarsen E, Johnsen LG, Helbostad JL, Sletvold O. Development and delivery of patient treatment in the Trondheim Hip Fracture Trial. A new geriatric in-hospital pathway for elderly patients with hip fracture. BMC Res Notes. 2012;5:355.CrossRef
30.
Gladman JR, Lincoln NB, Adams SA. Use of the extended ADL scale with stroke patients. Age Ageing. 1993;22(6):419–24.CrossRef
31.
Wade DT. Measurement in neurological rehabilitation. Curr Opin Neurol Neurosurg. 1992;5(5):682–6.PubMed
32.
33.
Wu CY, Chuang LL, Lin KC, Lee SD, Hong WH. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation. Arch Phys Med Rehabil. 2011;92(8):1281–7.CrossRef
34.
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, et al. Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol Series A Biol Sci Med Sci. 2008;63(1):92–7.
35.
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, et al. Two-year effects of interdisciplinary intervention for hip fracture in older Taiwanese. J Am Geriatr Soc. 2010;58(6):1081–9.CrossRef
36.
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, et al. A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc. 2005;53(5):811–8.CrossRef
37.
Doshi HK, Ramason R, Azellarasi J, Naidu G, Chan WL. Orthogeriatric model for hip fracture patients in Singapore: our early experience and initial outcomes. Arch Orthop Trauma Surg. 2014;134(3):351–7.CrossRef
38.
Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc. 2005;53(9):1476–82.CrossRef
39.
Deschodt M, Braes T, Broos P, Sermon A, Boonen S, Flamaing J, et al. Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. J Am Geriatr Soc. 2011;59(7):1299–308.CrossRef
40.
Swanson CE, Day GA, Yelland CE, Broome JR, Massey L, Richardson HR, et al. The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care. The Medical journal of Australia. 1998;169(10):515–8.CrossRef
41.
Elliot JR, Wilkinson TJ, Hanger HC, Gilchrist NL, Sainsbury R, Shamy S, et al. The added effectiveness of early geriatrician involvement on acute orthopaedic wards to orthogeriatric rehabilitation. N Z Med J. 1996;109(1017):72–3.PubMed
42.
Leung FK, Lau TW, Yuen GW, Chan EM, Chan P, Lam RY. Effectiveness of a multidisciplinary approach to geriatric hip fractures in improving clinical outcomes and cost of care. Hong Kong Med J. 2018;24Suppl 2(1):45–7.
43.
Patel JN, Klein DS, Sreekumar S, Liporace FA, Yoon RS. Outcomes in Multidisciplinary Team-based Approach in Geriatric Hip Fracture Care: A Systematic Review. J Am Acad Orthop Surg. 2020;28(3):128–33.CrossRef
44.
Sayeed Z, Anoushiravani A, El-Othmani M, Barinaga G, Sayeed Y, Cagle P Jr, et al. Implementation of a Hip Fracture Care Pathway Using Lean Six Sigma Methodology in a Level I Trauma Center. J Am Acad Orthop Surg. 2018;26(24):881–93.CrossRef
45.
Ranhoff AH, Holvik K, Martinsen MI, Domaas K, Solheim LF. Older hip fracture patients: three groups with different needs. BMC Geriatr. 2010;10:65.CrossRef
Metadata
Title
Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials
Authors
Shams Dakhil
Pernille Thingstad
Frede Frihagen
Lars Gunnar Johnsen
Stian Lydersen
Eva Skovlund
Torgeir Bruun Wyller
Olav Sletvold
Ingvild Saltvedt
Leiv Otto Watne
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-021-02152-7

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