Publication: Factores que influyen en la evolución y el pronóstico funcional de pacientes con fractura de cadera en la unidad de recuperación funcional de un hospital de media estancia
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2017-09-13
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Universidad Complutense de Madrid
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1. Motivos y Justificación La fractura de cadera es una de las patologías más frecuentes en la población anciana y es previsible que su incidencia siga aumentando, dado el envejecimiento poblacional. Además, conlleva un riesgo aumentado de incapacidad funcional, institucionalización y mortalidad a medio plazo. Por estos motivos deben intensificarse los esfuerzos en reducir la incidencia de secuelas a través de programas de Rehabilitación. Es esencial estudiar los mecanismos que condicionan o no la recuperación funcional tras una fractura de cadera para poder actuar sobre los mismos, determinando el tipo de tratamiento y el ámbito de aplicación más adecuado para cada paciente. 2. Introducción La incidencia de fractura de cadera en España ha aumentado en los últimos años. Actualmente se diagnostican 720 casos anuales por cada 100.000 mayores de 60 años. La incidencia aumenta con la edad y es tres veces más frecuente en mujeres. La mortalidad hospitalaria por fractura de cadera es del 5%, siendo al año del 15-30%. El 50% de los pacientes afectados por fractura de cadera no recuperará la capacidad funcional previa. Las consecuencias de la fractura de cadera, desde el punto de vista económico, son muy cuantiosas. Los elevados costes nos obligan a priorizar no sólo las medidas preventivas sino también las alternativas de rehabilitación más eficientes. Los principales factores de riesgo de las fracturas de cadera son la osteoporosis, la edad avanzada y el sexo femenino, siendo el factor desencadenante generalmente una caída casual.El diagnóstico de la fractura de cadera se realiza mediante la anamnesis (antecedente de caída), exploración física (miembro inferior acortado y en rotación externa generalmente), precisándose confirmación radiológica, para determinar el tipo de fractura. Las fracturas de cadera se clasifican en intracapsulares y extracapsulares. Esta clasificación conlleva diferencias terapéuticas. El tratamiento es quirúrgico, salvo en casos excepcionales. Para las fracturas intracapsulares en pacientes ancianos el tratamiento de elección es la prótesis parcial. En fracturas extracapsulares se realiza reducción y estabilización quirúrgicas. El tratamiento rehabilitador ha de iniciarse de forma precoz, planteando objetivos realistas e individualizados para cada paciente. Es necesario tener en cuenta factores mentales, clínicos, sociales y funcionales al determinar el nivel asistencial óptimo para cada individuo. Las Unidades de Recuperación Funcional (URF) se reservan para pacientes con deterioro funcional importante, acompañado de mayor comorbilidad y fragilidad social. 3. Hipótesis y Objetivos Hipótesis: El tratamiento de Rehabilitación Interdisciplinar Protocolizado permite mejorar el deterioro funcional de pacientes intervenidos por una fractura de cadera. Existen factores clínicos, funcionales, sociales y mentales que pueden predecir la evolución funcional de estos pacientes, el tiempo de estancia y la eficiencia del tratamiento rehabilitador. Objetivos: Describir las características de los pacientes con fractura de cadera ingresados en una URF de un hospital de media estancia. Determinar la respuesta de estos pacientes a un programa de Rehabilitación intrahospitalaria, así como los factores clínicos, funcionales, mentales y sociales asociados a la recuperación de la marcha y las actividades básicas de la vida diaria (ABVD) tras el mismo. Identificar características asociadas a la eficiencia del tratamiento y a la estancia media...
1. Reasons and Justification Hip fracture is one of most prevalent diseases over the elderly and it is expected to continue increasing, given the aging population trend. In addition hip fracture confers an increased risk of functional impairment, institutionalization and mortality in the medium term. For these reasons, efforts to reduce the incidence of sequelae through rehabilitation programmes must be intensified. It is essential to study the mechanisms that determine functional recovery after a hip fracture, to be able to act on them, determining the type of treatment and the most appropriate performance for each patient. 2. Introduction The incidence of hip fracture in Spain has increased in the last years. Nowadays, 720 cases for every 100.000 older than 60 are diagnosed each year. The incidence increases with age being three times more frequent in women. The percentage of hip fracture in-hospital mortality is around 5%, ranging from 15% to 30% annually. The 50% of hip fracture patients will not recover their previous functional capacity. From the economic perspective, hip fracture’s consequences are very substantial. Hence, implementation of preventive measures and more efficient rehabilitation alternatives are needed. The main risk factors of hip fracture development are osteoporosis, the elderly and the female sex. In this context, hip fracture is triggered after a casual fall in most cases. The hip fractures diagnosis is performed through the anamnesis (a precedent fall), physical examination (a lower limb shortened and usually in external rotation) being required radiological confirmation to determine the type of fracture. Hip fractures are classified as intracapsular and extracapsular. This classification involves different therapeutic approaches.Surgery is the main treatment. For intracapsular fractures in eldery patients, the treatment of choice is the arthroplasty. Surgical reduction and stabilization are performed in extracapsular ones. Rehabilitation treatment should begin at early stages of the disease, proposing realistic and individual objectives for each patient. It is necessary to take into account mental, clinical, social and functional factors in determining the optimum level of care for each individual. The Units of Functional Recovery (UFR) are reserved for patients with major functional impairment, along with greater comorbidity and social fragility. 3. Hypothesis and Objectives Hypothesis: The Protocolized Interdisciplinary Rehabilitation treatment improves functional deterioration of patients who underwent surgery for a hip fracture. There are clinical, functional, social and mental factors, which can predict the functional evolution of these patients, the length of the in-hospital stay and the efficiency of rehabilitation treatment. Objectives: To describe the characteristics of patients with hip fracture admitted to an UFR of a middle-stay hospital. To determine the response of these patients to a hospital rehabilitation program, and to identify clinical, functional, mental and social factors associated to the recovery of the march and the basic activities of daily living (BADL) after it. To identify characteristics associated with the efficiency of the treatment and the average stay...
1. Reasons and Justification Hip fracture is one of most prevalent diseases over the elderly and it is expected to continue increasing, given the aging population trend. In addition hip fracture confers an increased risk of functional impairment, institutionalization and mortality in the medium term. For these reasons, efforts to reduce the incidence of sequelae through rehabilitation programmes must be intensified. It is essential to study the mechanisms that determine functional recovery after a hip fracture, to be able to act on them, determining the type of treatment and the most appropriate performance for each patient. 2. Introduction The incidence of hip fracture in Spain has increased in the last years. Nowadays, 720 cases for every 100.000 older than 60 are diagnosed each year. The incidence increases with age being three times more frequent in women. The percentage of hip fracture in-hospital mortality is around 5%, ranging from 15% to 30% annually. The 50% of hip fracture patients will not recover their previous functional capacity. From the economic perspective, hip fracture’s consequences are very substantial. Hence, implementation of preventive measures and more efficient rehabilitation alternatives are needed. The main risk factors of hip fracture development are osteoporosis, the elderly and the female sex. In this context, hip fracture is triggered after a casual fall in most cases. The hip fractures diagnosis is performed through the anamnesis (a precedent fall), physical examination (a lower limb shortened and usually in external rotation) being required radiological confirmation to determine the type of fracture. Hip fractures are classified as intracapsular and extracapsular. This classification involves different therapeutic approaches.Surgery is the main treatment. For intracapsular fractures in eldery patients, the treatment of choice is the arthroplasty. Surgical reduction and stabilization are performed in extracapsular ones. Rehabilitation treatment should begin at early stages of the disease, proposing realistic and individual objectives for each patient. It is necessary to take into account mental, clinical, social and functional factors in determining the optimum level of care for each individual. The Units of Functional Recovery (UFR) are reserved for patients with major functional impairment, along with greater comorbidity and social fragility. 3. Hypothesis and Objectives Hypothesis: The Protocolized Interdisciplinary Rehabilitation treatment improves functional deterioration of patients who underwent surgery for a hip fracture. There are clinical, functional, social and mental factors, which can predict the functional evolution of these patients, the length of the in-hospital stay and the efficiency of rehabilitation treatment. Objectives: To describe the characteristics of patients with hip fracture admitted to an UFR of a middle-stay hospital. To determine the response of these patients to a hospital rehabilitation program, and to identify clinical, functional, mental and social factors associated to the recovery of the march and the basic activities of daily living (BADL) after it. To identify characteristics associated with the efficiency of the treatment and the average stay...
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Física y de Rehabilitación. Hidrología Médica, leída el 20/01/2016