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Postoperative Physical Therapy to Prevent Hospital-acquired Pneumonia in Patients Over 80 Years Undergoing Hip Fracture Surgery—A Quasi-experimental Study

机译:术后物理疗法,以防止医院收购肺炎患者80多年患者接受髋关节骨折手术 - 一种准实验研究

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Background: Hip fracture requiring surgical fixation is a common condition with high mortality and morbidity in the geriatric population. The patients are usually frail, and vulnerable to postoperative complications and delayed recovery. Few studies have investigated physical therapy methods to prevent hospital-acquired pneumonia (HAP) after hip fracture surgery. Objective: To explore whether an intensified physical therapy regimen can prevent HAP and reduce hospital length of stay in patients aged 80 and older, following hip fracture surgery. Patients and Methods: The inclusion criterion was patients aged 80 or older who had undergone hip fracture surgery at ?rebro University Hospital, Sweden during eight months in 2015– 2016 (the “physical therapy group”) (n=69). The study has a quasi-experimental design with a historical control group (n=64) who had received routine physical therapy treatment. The physical therapy group received intensified postoperative physical therapy treatment, which included daily supervised early mobilization and coached deep breathing exercises with positive expiratory pressure (PEP). The patients were instructed to take deep breaths, and then exhale through the PEP-valve in three sessions of 10 deep breaths, at least four times daily. Early mobilization to a sitting position and walking was advised as soon as possible after surgery. Results: There was a significantly lower incidence of HAP in the physical therapy group; 2/69 (3%, 95%CI: 1– 10) compared to the historical control group 13/64 (20%, 95%CI: 12– 32%) ( p =0.002). Patients in the physical therapy group had a significantly shorter length of stay than the control group (10.6± 4 vs 13.4± 9 days, p =0.022). Conclusion: Intensified physical therapy treatment after hip fracture surgery may be of benefit to reduce the incidence of HAP in patients over 80 years; however, the results need to be confirmed in randomized controlled trials.
机译:背景:需要手术固定的髋部骨折是常见的病情,病原体中具有高的死亡率和发病率。患者通常是脆弱的,并且易患术后并发症和延迟恢复。少量研究已经研究了髋关节骨折手术后预防医院肺炎(HAP)的物理治疗方法。目的:探讨髋部骨折手术后80岁及以上患者的患者,探讨是否可以防止HAP和减少医院住院时间。患者和方法:纳入标准是80岁或以上的患者在2015年的八个月内进行了髋关节骨折手术,瑞典在瑞典(“物理治疗组”)(N = 69)中进行了髋关节骨折手术该研究具有拟实验设计,具有历史对照组(N = 64),谁接受了常规物理治疗治疗。物理治疗组接受加剧术后物理治疗治疗,其中包括日常监督的早期动员,并指导深呼吸的深呼吸锻炼,具有正呼气压力(PEP)。患者被指示深呼吸,然后在10个深呼吸的三个会话中通过Pep-Vall呼气,每天至少四次。在手术后尽快推动到坐姿和行走的早期动员。结果:物理治疗组中的HAP发病率显着降低;与历史对照组13/64(20%,95%CI:12-22%)相比,2/69(3%,95%CI:1-10)(p = 0.002)。物理治疗组的患者比对照组的逗留程度明显较短(10.6±4 Vs 13.4±9天,P = 0.022)。结论:髋部骨折手术后的愈合物理治疗治疗可能有益,可以减少80岁以上患者的HAP发病率;但是,在随机对照试验中需要证实结果。

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