Aim Post‐hip fracture knee pain (PHFKP) develops in 28–37.4% of patients with hip fracture and contributes to prolonged hospitalization. Although reduced balance and gait speed contribute to falls, the effects of PHFKP remain unclear. This study aimed to clarify whether PHFKP is a factor in balance and gait speed. Methods We retrospectively reviewed the medical records of patients after hip fracture. Development of PHFKP, basic information, and physical function were examined. Berg balance scale (BBS) and maximum walking speed (MWS) were collected at discharge. These parameters were compared with the presence or absence of PHFKP. In addition, multiple analyses were conducted with BBS and MWS as dependent variables and PHFKP as one of the independent variables. Results Of the 146 patients enrolled, 43 (29.5%) developed PHFKP, and 37.2% of patients with PHFKP showed residual symptoms at discharge. Intensity of PHFKP was mostly mild to moderate. The PHFKP group showed an extended length of stay (+13.3 days) and a tendency toward more discharges to facilities compared with the control group. Knee extension range of motion limitation, knee extensor strength, and BBS did not differ between groups, while MWS was significantly lower in the PHFKP group (0.85 ± 0.32 m/s vs. 1.07 ± 0.39 m/s). Multiple analyses showed that development of PHFKP was not associated with BBS, but was associated with decreased MWS (standardized beta = −0.202, P = 0.005). Conclusions PHFKP was identified as an independent factor in gait speed decline. PHFKP patients should be monitored for reduced gait speed during rehabilitation. Geriatr Gerontol Int 2021; 21: 830–835.
Background: Post-hip fracture knee pain (PHFKP) is an important issue that contributes to reduced gait speed and prolonged hospitalization. Femoral morphology has been reported to contribute to the development of PHFKP, but an independent association has not been confirmed and clinically applicable cutoffs for predicting the development of PHFKP remain unclear. Objective: To determine whether femoral morphology and knee extension range of motion limitation are independent factors in PHFKP and to determine cutoffs for predicting the development of PHFKP. Design: Retrospective chart review study. Setting: Convalescent inpatient rehabilitation hospital. Participants: Patients in a convalescent ward after intertrochanteric femoral fracture surgery. Main Outcome Measures: PHFKP development, radiographic femoral morphology (leg length discrepancy and neck-shaft angle), and knee extension range of motion limitation. Results: PHFKP developed in 36 (35%) of the 103 patients enrolled. The PHFKP group had a longer hospital stay (p = .029), greater weight (p = .031), greater knee extension range of motion limitation (p = .001), and more varus neck-shaft angle (p < .001) compared to the non-PHFKP group. Varus neckshaft angle (odds ratio, 0.85; 95% confidence interval [CI], 0.78-0.92; p < .001) and knee extension range of motion limitation (odds ratio, 1.18; 95% CI, 1.07-1.30; p = .001) were significant factors for PHFKP development. Neck-shaft angle discrepancy and knee extension range of motion limitation demonstrated moderate accuracy in discriminating development of PHFKP according to receiver operating characteristic analysis, with cutoffs of 9.6 and 7.5 , respectively. Areas under the receiver operating characteristic curve were 0.77 (95% CI, 0.66-0.88; p < .001) for neck-shaft angle discrepancy and 0.67 (95% CI, 0.56-0.79; p = .004) for knee extension range of motion limitation. Conclusions: Varus neck-shaft angle and knee extension range of motion limitation were identified as independent predictors of PHFKP. The cutoff for neckshaft angle may be useful for predicting PHFKP development and to define an acceptable angle of fracture reduction to prevent PHFKP.
Objectives: Stroke patients with hemiplegia can sometimes achieve independent life at home or in light care facilities after rehabilitation. This study examined the outcomes of rehabilitation in stroke patients with severe hemiplegia. Methods: This study included 50 patients with Brunnstrom recovery stage I–II hemiplegia at the start of rehabilitation for stroke. Good outcome after rehabilitation was defined as independent life with functional independence measure (FIM) score of 100 or greater. Predictors for post-rehabilitation functional recovery were statistically analyzed. Results: FIM scores of 100 or greater in 12 of 50 patients (24%) allowed independent life after stroke rehabilitation. According to univariate analysis, factors associated with a FIM score of 100 or greater and good prognosis after rehabilitation were younger age (<70 years), paralysis caused by intracerebral hematoma (ICH), no cortical lesions, short time from admission to comprehensive inpatient rehabilitation (CIR) for stroke (within 1 month), and good status at the start of early rehabilitation and CIR. Eleven of the 12 patients with good prognosis (FIM ≥100) had ICH and a basal ganglia lesion with no cortical damage. Analysis of the location of lesions suggested that many patients with basal ganglia ICH lesions and little cortical involvement have good prognoses. Conclusions: Stroke patients with severe hemiplegia showed a slightly different distribution of lesions between ICH and cerebral ischemia. Cortical involvement may be a prognostic factor for outcome after rehabilitation in stroke patients with severe hemiplegia. More aggressive rehabilitation interventions may be important for patients with severe hemiplegia, especially without cortical involvement.
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