Mortality, Independence in Living, and Re-fracture, One Year Following Hip Fracture in Canadians

Παπαϊωάννου, Αλεξάνδρα; Wiktorowicz, Mary; Adachi, Jonathan D.; Goeree, Ron; Papadimitropoulos, Emmanuel A.; Bédard, Michel; Brazil, Kevin; Parkinson, William; Weaver, Bruce

doi:10.1016/s0849-5831(16)31115-6

Cited by 48 publications

(63 citation statements)

References 35 publications

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“…This observation is consistent with the Canadian context in which postfracture rehabilitation is considered to be an extension of acute care, whereas discharge to LTC occurs when patients fail to be autonomous. (33) For LTC residents at the time of fracture, their place of residence remained largely unchanged among survivors, as reported. (33) Moreover, among non-LTC residents, our descriptive analysis of discharge destination after final hospital admission indicated that a large proportion of fracture patients received postacute care services through LTC, rehabilitation care, or were referred to their CLSC, pointing to an important role of these services in fracture care.…”

Section: Discussionmentioning

confidence: 66%

“…(33) For LTC residents at the time of fracture, their place of residence remained largely unchanged among survivors, as reported. (33) Moreover, among non-LTC residents, our descriptive analysis of discharge destination after final hospital admission indicated that a large proportion of fracture patients received postacute care services through LTC, rehabilitation care, or were referred to their CLSC, pointing to an important role of these services in fracture care. In this study, we observed that 18.2% of non-LTC patients with hip/femur fractures were transferred to LTC after hospitalization for fracture care.…”

Section: Discussionmentioning

confidence: 66%

“…(32) It was previously reported that a large proportion of patients hospitalized for fracture treatment also received inpatient postacute fracture care. (29,33) After initial admission a large proportion of the fracture cases were transferred to another hospital, suggesting that a significant proportion of postacute fracture care obtained rehabilitation and/or chronic care provided by another hospital. This observation is consistent with the Canadian context in which postfracture rehabilitation is considered to be an extension of acute care, whereas discharge to LTC occurs when patients fail to be autonomous.…”

Section: Discussionmentioning

confidence: 99%

“…However, although the burden of osteoporosis-related fractures is high in terms of excess mortality, (8,12) levels of healthcare used, (29) institutionalization, (33) and their associated costs, (15) under-recognition of osteoporosis and its consequences remains problematic (4) despite the availability of effective therapy to reduce fracture risk. Therefore, effective public health interventions need to be introduced to improve the diagnosis and treatment of osteoporosis, particularly in highrisk groups (ie, those with fragility fracture) to reduce their impact on the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

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Direct medical resource utilization associated with osteoporosis-related nonvertebral fractures in postmenopausal women

Jean¹,

Bessette²,

Belzile³

et al. 2012

Journal of Bone and Mineral Research

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The purposes of this study were to assess direct medical resource utilization related to the treatment of nonvertebral osteoporotic fractures within 1 year postfracture and to evaluate whether age impacts resource utilization. A previously-validated algorithm for physician claims databases identified 15,327 women aged 50 years or older with incident fracture at nonvertebral osteoporotic sites between January 1, 2004 and December 31, 2005. Administrative databases of the health services available to all residents in Quebec served to study fracture-related health resource utilization in the year after fracture. Data were linked by a unique personal identifier, creating a longitudinal cohort of all fracture cases for health resource utilization. The proportions of fractures treated by open reduction, closed reduction, immobilization or follow-up by an orthopedic surgeon (OS) were evaluated. The mean number of claims for consultation with an OS or other clinicians in inpatient and outpatient visits, the hospitalization rate and length of stay (LOS) were assessed. Hip/femur fractures represented the highest rate of resource utilization because the majority of them required surgery (91.1%) and hospitalization (94.5%) with a mean (median) LOS of 39.2 (31) days. However, other nonvertebral fracture types needed significant clinical care related to surgery (27.9%), follow-up consultation with an OS (77.6%), and hospitalization (27.3% of total LOS). Even pelvic fractures, which often do not require surgical treatment, commanded high resource utilization due to the high hospitalization rate (67.4%) with mean (median) LOS of 34.2 (26) days. Moreover, age was an important determinant of health resource utilization, being associated with an increased number of visits to other physicians, hospitalization, and length of hospitalization (LOS), admissions to long term care (LTC), and death. Osteoporosis-related fractures accounted for substantial healthcare resource utilization. With an aging population and increased prevalence of fractures, strategies for osteoporosis management need to be introduced to reduce the healthcare burden. ß

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Direct medical resource utilization associated with osteoporosis-related nonvertebral fractures in postmenopausal women

Jean¹,

Bessette²,

Belzile³

et al. 2012

Journal of Bone and Mineral Research

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“…1 The 1-year mortality rate after hip fracture has been reported to be 25%, and 24.3% of the survivors who were previously independent were living in institutions after the fracture. 2 Almost 50% of patients living in the community after a hip fracture required a walking aid, such as a cane (32%), walker (39.4%), or wheelchair (31.8%). 3 Patients with hip fracture have reported a fear of falling and a lower quality of life than those without hip fracture.…”

Section: Hip Fractures; Physical Therapy Techniques; Rehabilitationmentioning

confidence: 99%

Body Weight–Supported Treadmill Training for Patients With Hip Fracture: A Feasibility Study

Giangregorio

Thabane

DeBeer

et al. 2009

Archives of Physical Medicine and Rehabilitation

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Objective-To determine the feasibility of body weight-supported treadmill training (BWSTT) as a strategy for improving independent ambulation among patients who had sustained a hip fracture. Design-Nonrandomized controlled trial. Setting-Inpatient rehabilitation.Participants-Patients with a stable hip fracture and at least 50% weight-bearing. Intervention-BWSTT in lieu of standard walking exercises throughout stay in rehabilitation.Main Outcomes Measures-Feasibility outcomes included the number of patients agreeing to participate in treadmill walking, the number who returned for follow-up assessments, compliance, and the number of adverse events. Secondary outcomes included the Lower Extremity Functional Scale, the Timed Up & Go test, a 2-minute walk test, and the Falls Self-Efficacy Scale. Univariate regression was used to assess the group effect on score changes from baseline to discharge and from baseline to follow-up.Results-Among 41 potentially eligible patients, 21 (51%) agreed to participate and 14 returned for follow-up assessments. The recruitment goal of 12 patients agreeing to BWSTT was achieved; however, retention by 3-month follow-up was 67%. The average compliance was 3 sessions a week; however, several patients were below average. No adverse events of BWSTT were reported. There were no significant differences between groups with respect to secondary outcomes.Correspondence to Lora Giangregorio, PhD, Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N1H 8K4, lmgiangr@healthy.uwaterloo.ca. Clinical trial registration no.: NCT00197496.Reprints are not available from the author.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. Ambulatory capacity is a predictor of returning home after discharge after hip fracture. 6,7 Mobility may be linked to lower extremity function; power of the leg extensors in the fractured leg has been positively associated with walking speed and stair-climbing time among patients after hip fracture. 8,9 Current strategies for training independent ambulation involve muscle strengthening, weight shifting, and balance exercises, as well as walking with or without assistive aids, generally in the hallways of inpatient units. Patients with hip fracture may not be allowed to bear full body weight initially, 10 which may be difficult for rehabilitation providers to control during walking exercises. Although participation in an inpatient rehabilitation program can achieve improvements in mobility, many patients with hip fracture remain dependent in transfers and locomotion at discharge. 10,11 Further, patients with a hip fracture continue to experience functional impairment a year after the fracture. 12,13A Cochrane review highlighted the paucity of evidence for rehabilitation strategies aimed at improving mobility after hip fracture. 14 BWSTT may be a useful method for retraini...

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Use of a Case Manager to Improve Osteoporosis Treatment After Hip Fracture

Majumdar¹,

Beaupré²,

Harley³

et al. 2007

Arch Intern Med

132

168

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Background: Patients who survive hip fracture are at high risk of recurrent fractures, but rates of osteoporosis treatment 1 year after sustaining a fracture are less than 10% to 20%. We have developed an osteoporosis case manager intervention. The case manager educated patients, arranged bone mineral density tests, provided prescriptions, and communicated with primary care physicians. The intervention was compared with usual care in a randomized controlled trial. Methods:We recruited from all hospitals that participate in the Capital Health system (Alberta, Canada), including patients 50 years or older who had sustained a hip fracture and excluding those who were receiving osteoporosis treatment or who lived in a long-term care facility. Primary outcome was bisphosphonate therapy 6 months after fracture; secondary outcomes included bone mineral density testing, appropriate care (bone mineral density testing and treatment if bone mass was low), and intervention costs. Results: We screened 2219 patients and allocated 220, as follows: 110 to the intervention group and 110 to the control group. Median age was 74 years, 60% were

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Mortality, Independence in Living, and Re-fracture, One Year Following Hip Fracture in Canadians

Cited by 48 publications

References 35 publications

Direct medical resource utilization associated with osteoporosis-related nonvertebral fractures in postmenopausal women

Direct medical resource utilization associated with osteoporosis-related nonvertebral fractures in postmenopausal women

Body Weight–Supported Treadmill Training for Patients With Hip Fracture: A Feasibility Study

Use of a Case Manager to Improve Osteoporosis Treatment After Hip Fracture

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