RESUMEN
BACKGROUND: Hip fractures are most likely to occur in older people, and after hip surgery muscle mass and the ability to perform activities of daily living often decline. In this study, we conducted inpatient rehabilitation after surgery for hip fracture and measured changes in muscle mass and physical performance. METHODS: We retrospectively analyzed patients aged 65 years or older who underwent surgery (prosthetic replacement or internal fixation) and inpatient rehabilitation for hip fracture at our hospital between August and December 2020. The training included a joint range of motion exercise, muscle-strengthening exercise, gait training, early mobilization training, and neuromuscular electrical stimulation. We measured the following factors after one and six weeks postoperatively: muscle mass, body weight, fat mass, grip strength, bilateral knee extension strength, ability to walk, and ability to perform activities of daily living. RESULTS: Seventeen patients were included. Median age was 84 years (interquartile range, 72-90). Lower limbs skeletal muscle mass increased (median 4.8 kg to 4.9 kg, p = 0.045), while upper limbs skeletal muscle mass and body weight decreased (median 1.2 kg to 1.1 kg, p = 0.0027), (median 46.8 kg to 45.5 kg, p = 0.0039), respectively. Total skeletal muscle mass and fat mass remained unchanged. Grip strength was maintained, and knee extension muscle strength on the healthy and affected sides increased (healthy side median 10.7 kgf to 13.7 kgf, p = 0.019; affected side median 5.5 kgf to 9.5 kgf, p < 0.001). All patients exhibited improved ability to perform activities of daily living; however, 52.9% of patients regained their pre-injury walking ability. CONCLUSIONS: Our rehabilitation program increased lower limb skeletal muscle mass in patients with hip fractures.
RESUMEN
BACKGROUND: Older patients are more likely to have comorbidities than younger patients, and multiple comorbidities are associated with mortality in patients with cancer. Therefore, we hypothesized that a functional comorbidity index could predict the therapeutic effects of rehabilitation. OBJECTIVES: In this study, we investigate whether the comorbidities influenced the execution and therapeutic effects of rehabilitation. METHODS: A consecutive cohort of 48 patients with gastrointestinal cancer who underwent surgery between January 1 and November 30, 2020, was analyzed. Charlson Comorbidity Index (CCI) scores were calculated based on data derived from medical records. The primary outcomes were ambulation status, duration (days) from the start of postoperative rehabilitation, and length of hospital stay. We investigated the relationship between CCI scores and primary outcomes. RESULTS: The CCI did not correlate with the duration of rehabilitation or the length of hospital stay. Subsequently, patients with functional recovery problems were evaluated, and we identified the conditions that were not included in the list using CCI scores. Most conditions are associated with surgical complications. Furthermore, using the Clavien-Dindo classification (CDC), we assessed the clinical features of the severity of complications. We found that the length of stay and the duration to start rehabilitation were significantly longer in the patients with higher severity of surgical complications (CDCâ§III) than in those with lower severity (CDCâ¦II). CONCLUSIONS: Treatment-related conditions may significantly impact the perioperative period more than the original comorbidities. In addition to original comorbidities, events related to surgical complications should be assessed to determine the therapeutic effects of rehabilitation in patients with gastrointestinal cancer.