...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Clinical Orthopaedics and Related Research >Can an Integrative Care Approach Improve Physical Function Trajectories after Orthopaedic Trauma? A Randomized Controlled Trial
【24h】

Can an Integrative Care Approach Improve Physical Function Trajectories after Orthopaedic Trauma? A Randomized Controlled Trial

机译：综合护理方法可以改善矫形外伤后的物理功能轨迹吗？ 随机对照试验

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Background Orthopaedic trauma patients frequently experience mobility impairment, fear-related issues, self-care difficulties, and work-related disability [12, 13]. Recovery from trauma-related injuries is dependent upon injury severity as well as psychosocial factors [2, 5]. However, traditional treatments do not integrate psychosocial and early mobilization to promote improved function, and they fail to provide a satisfying patient experience. Questions/purposes We sought to determine (1) whether an early psychosocial intervention (integrative care with movement) among patients with orthopaedic trauma improved objective physical function outcomes during recovery compared with usual care, and (2) whether an integrative care approach with orthopaedic trauma patients improved patient-reported physical function outcomes during recovery compared with usual care. Methods Between November 2015 and February 2017, 1133 patients were admitted to one hospital as orthopaedic trauma alerts to the care of the three orthopaedic trauma surgeons involved in the study. Patients with severe or multiple orthopaedic trauma requiring one or more surgical procedures were identified by our orthopaedic trauma surgeons and approached by study staff for enrollment in the study. Patients were between 18 years and 85 years of age. We excluded individuals outside of the age range; those with diagnosis of a traumatic brain injury [28]; those who were unable to communicate effectively (for example, at a level where self-report measures could not be answered completely); patients currently using psychotropic medications; or those who had psychotic, suicidal, or homicidal ideations at time of study enrollment. A total of 112 orthopaedic trauma patients were randomized to treatment groups (integrative and usual care), with 13 withdrawn (n = 99; 58% men; mean age 44 years +/- 17 years). Data was collected at the following time points: baseline (acute hospitalization), 6 weeks, 3 months, 6 months, and at 1 year. By 1-year follow-up, we had a 75% loss to follow-up. Because our data showed no difference in the trajectories of these outcomes during the first few months of recovery, it is highly unlikely that any differences would appear months after 6 months. Therefore, analyses are presented for the 6-month follow-up time window. Integrative care consisted of usual trauma care plus additional resources, connections to services, as well as psychosocial and movement strategies to help patients recover. Physical function was measured objectively (handgrip strength, active joint ROM, and Lower Extremity Gain Scale) and subjectively (Patient-Reported Outcomes Measurement Information System-Physical Function [PROMIS (R)-PF] and Tampa Scale of Kinesiophobia). Higher values for hand grip, Lower Extremity Gain Scale (score range 0-27), and PROMIS (R)-PF (population norm = 50) are indicative of higher functional ability. Lower Tampa Scale of Kinesiophobia (score range 11-44) scores indicate less fear of movement. Trajectories of these measures were determined across time points. Results We found no differences at 6 months follow-up between usual care and integrative care in terms of handgrip strength (right handgrip strength beta = -0.0792 [95% confidence interval -0.292 to 0.133]; p = 0.46; left handgrip strength beta = -0.133 [95% CI -0.384 to 0.119]; p = 0.30), or Lower Extremity Gain Scale score (beta = -0.0303 [95% CI -0.191 to 0.131]; p = 0.71).
机译：背景矫形外科患者经常经历流动性障碍，恐惧相关的问题，自我保健困难和与工作有关的残疾[12,13]。从创伤相关的伤害中恢复依赖于伤害严重程度以及心理社会因素[2,5]。然而，传统治疗不整合心理社会和早期动员，以促进改进的功能，并且他们未能提供令人满意的患者体验。问题/目的我们试图确定（1）骨科创伤患者的早期心理社会干预（综合护理）在恢复过程中改善了恢复期间的客观物理功能结果，以及（2）是否是骨科创伤的综合护理方法与通常的护理相比，患者在恢复期间改善了患者报告的物理功能结果。方法2015年11月和2017年2月，1133名患者被占整形外科创伤的一家医院，以便在研究中的三个骨科外科医生护理。我们的矫形创伤外科医生鉴定了需要一种或多种外科手术的严重或多个外胚性创伤的患者，并通过研究人员参加该研究的入学。患者在18岁之间和85岁之间。我们被排除在年龄范围之外的个人;诊断创伤性脑损伤的人[28];无法有效沟通的人（例如，在自我报告措施无法完全回答的水平）;目前使用精神药物的患者;或者在学习注册时具有精神病，自杀或凶杀案观念的人。共有112名骨科的创伤患者被随机分配给治疗组（一体化和常规护理），13次撤出（n = 99; 58％;平均44岁+/- 17岁）。在以下时间点收集数据：基线（急性住院），6周，3个月，6个月和1年。经过1年的随访，我们对随访有75％的损失。由于我们的数据在恢复的前几个月内显示了这些结果的轨迹没有差异，因此在6个月后几个月就会出现任何差异。因此，在6个月后续时间窗口中介绍了分析。综合护理包括通常的创伤护理和额外的资源，与服务的联系，以及帮助患者恢复的心理社会和运动策略。物理功能客观地（手柄强度，有源关节ROM和下肢增益标度）和主观（患者报告的结果测量信息系统 - 物理功能[PROMIS（R）-PF]和Kinesiophobia的坦帕规模）。手柄较高的值，下肢增益比例（得分范围0-27），以及PROMIS（R）-PF（人口规范= 50）表示功能较高。降低坦帕哥哥主义的坦帕尺度（得分范围11-44）分数表示对运动的恐惧较小。这些措施的轨迹在时间点确定。结果我们发现在手柄强度方面的常规护理和综合护理之间的6个月内发现了6个月的差异（右侧手柄强度β= -0.0792 [95％置信区间-0.292至0.133]; p = 0.46;左手柄强度β= -0.133 [95％CI-0.384至0.119]; p = 0.30），或下肢增益比分（β= -0.0303 [95％CI-0.191至0.131]; p = 0.71）。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号