ABSTRACT
BACKGROUND: Proximal femur fractures are a common injury after low energy trauma in the elderly. Most rehabilitation programs are based on restoring mobility and early resumption of weight-bearing. However, therapy compliance is low in patients following lower extremity fractures. Moreover, little is known about the relevance of gait parameters and how to steer the rehabilitation after proximal femur fractures in the elderly. Therefore, the aim of this prospective, randomized controlled trial is to gain insight in gait parameters and evaluate if real-time visual biofeedback can improve therapy compliance after proximal femur fractures in the elderly. METHODS: This is a two-arm, parallel-design, prospective, randomized controlled trial. Inclusion criteria are age ≥ 60 years, a proximal femur fracture following low energy trauma, and unrestricted-weight bearing. Exclusion criteria are cognitive impairment and limited mobility before trauma. Participants are randomized into either the control group, which receives care as usual, or the intervention group, which receives real-time visual biofeedback about weight-bearing during gait in addition to care as usual. Spatiotemporal gait parameters will be measured in 94 participants per group during a 30-m walk with an ambulatory biofeedback system (SensiStep). The progress of rehabilitation will be evaluated by the primary outcome parameters maximum peak load and step duration in relation to the discharge date. Secondary outcome parameters include other spatiotemporal gait parameters in relation to discharge date. Furthermore, the gait parameters will be related to three validated clinical tests: Elderly Mobility Scale; Functional Ambulation Categories; and Visual Analogue Scale. The primary hypothesis is that participants in the intervention group will show improved and faster rehabilitation compared to the control group. DISCUSSION: The first aim of this multicenter trial is to investigate the normal gait patterns after proximal femur fractures in the elderly. The use of biofeedback systems during rehabilitation after proximal femur fractures in the elderly is promising; therefore, the second aim is to investigate the effect of real-time visual biofeedback on gait after proximal femur fractures in the elderly. This could lead to improved outcome. In addition, analysis of the population may indicate characteristics of subgroups that benefit from feedback, making a differentiated approach in rehabilitation strategy possible. TRIAL REGISTRATION: TrialRegister.nl, NTR6794 . Registered on 31 October 2017.
Subject(s)
Biofeedback, Psychology/methods , Femoral Fractures/rehabilitation , Fracture Healing , Gait , Visual Perception , Age Factors , Female , Femoral Fractures/diagnostic imaging , Femoral Fractures/physiopathology , Femoral Fractures/psychology , Humans , Male , Middle Aged , Multicenter Studies as Topic , Netherlands , Prospective Studies , Randomized Controlled Trials as Topic , Recovery of Function , Sweden , Time Factors , Treatment Outcome , Weight-BearingABSTRACT
BACKGROUND & AIMS: This study assessed the efficacy of supplemented essential amino acids on depressive symptoms, nutrition, muscle function, daily physical activity, and health-related quality of life (HRQoL) of institutionalized elderly patients. METHODS: Forty-one patients (58.5% women; mean age 79.8 yrs) with sequelae of coronary artery disease (73%), femoral fracture (34%), were randomly assigned to receive oral essential amino acids 4 gr 2 times a day for 8 weeks or isocaloric placebo. Before randomization and 8 weeks after the protocol started, the following variables were measured: depressive symptoms (Geriatric Depression Scale, GDS), nutritional panel (Mini Nutritional Assessment, MNA; serum albumin and prealbumin levels), muscle strength (Hand Grip, HG), Activity Daily Life (ADL), Quality of Life (SF-36, HRQoL) and amino acid profile. RESULTS: Compared with the placebo group, EAA patients improved nutrition (MNA score 22.6 ± 1.5 post vs 21.8 ± 1.6 pre; p < 0. 04, albumin g/dl 4.04 ± 0.35 post vs 3.88 ± 0.3 pre; p < 0.01), GDS(score 10.3 ± 1.75 post vs 13.85 ± 3.37 pre; p < 0.001), HG (Kg 19.75 ± 1.7 post vs 18.68 ± 1.36 pre; p = 0.001), ADL (p < 0.04) and both physical and mental components of SF-36 (p < 0.002). CONCLUSIONS: Oral supplementation with essential amino acids improved several determinants of quality of life in institutionalized elderly patients, including depressive symptoms, nutrition, muscle function and daily life activity.
Subject(s)
Aging/blood , Aging/psychology , Amino Acids, Essential/therapeutic use , Amino Acids/blood , Dietary Supplements , Muscle Strength , Quality of Life/psychology , Activities of Daily Living/psychology , Aged , Aged, 80 and over , Amino Acids, Essential/blood , Coronary Artery Disease/physiopathology , Coronary Artery Disease/psychology , Depression/prevention & control , Female , Femoral Fractures/physiopathology , Femoral Fractures/psychology , Homes for the Aged , Humans , Male , Malnutrition/prevention & control , Motor Activity , Nursing Homes , Nutritional Status , Psychiatric Status Rating Scales , Single-Blind MethodABSTRACT
Children in the school-aged period are those most likely to sustain a fractured femur. One method of treatment for this age group is immobilization of the fracture in 90/90 traction. Specific needs of these children are discussed, and related nursing problems are identified. The physiologic and psychosocial aspects of nursing care are also addressed. Emphasis is placed on the developmental tasks inherent in this age group. Mastery of illness and hospitalization are central issues for the school-aged child and can be facilitated through the efforts of nursing and hospital staff. A therapeutic play program is also a beneficial adjunct to treatment and nursing care.