Author/Editor		Kos, Nataša; Burger, Helena; Vidmar, Gaj
Title		Association of cognitive status with mobility and functioning after femoral neck fracture surgery in elderly patients
Translated title		Povezanost kognitivnega stanja z gibljivostjo in funkcijskim stanjem po operacijskem zdravljenju zloma vratu stegnenice pri starejših poškodovancih
Type		članek
Vol. and No.		Letnik 82, št. 3
Publication year		2013
Volume		str. 150-157
ISSN		1581-0224 - Zdravniški vestnik
Language		eng
Abstract		Izhodišče: Primerjava izida med dvema načinoma operacijskega zdravljenja zloma vratu stegnenice cementno delno endoprotezo (CDE) in notranjo fiksacijo (NF) ostaja odprto vprašanje. Opravili smo nove analize podatkov iz že objavljene študije, da bi preverili vpliv kognitivnih motenj na gibljivost in funkcijsko stanje po tovrstni operaciji ter ga primerjali med skupinama, zdravljenima s CDE in NF. Metode: V nerandomizirano prospektivno študijo je bilo vključenih 66 starejših poškodovancev. Skupini (CDE in NF, v vsaki je bilo 33 poškodovancev) sta bili uravnoteženi glede starosti, spola in dejavnosti pred poškodbo. Zbrali smo ocene sposobnosti hoje (opisne, s prehojeno razdaljo in z indeksom sposobnosti za hojo WAI), kognitivnega stanja (s kratkim preizkusom spoznavnih sposobnosti KPSS) in samostojnosti pri opravljanju dnevnih dejavnosti (opisne in z lestvico funkcijske neodvisnosti FIM). Rezultati: Povezanost z dosežkom na KPSS ob odpustu je bila v skupini, zdravljeni z NF, višja kot v skupini, zdravljeni s CDE, za vsa obravnavana merila izida: prehojeno razdaljo ob odpustu, zmožnost samostojne hoje (s pripomočki) ob odpustu, zmožnost hoje zunaj tri mesece po odpustu, stopnjo samostojnosti pri dnevnih dejavnostih tri mesece po odpustu, izboljšanje na motorični podlestvici FIM tri mesece po odpustu in oceno z WAI ob odpustu. Zaključki: Prisotnost kognitivnih motenj negativno vpliva na zmožnost hoje in funkcijsko stanje predvsem pri poškodovancih po zlomu vratu stegnenice, operacijsko zdravljenih z NF, pri poškodovancih, zdravljenih s CDE, pa ne oziroma znatno manj. To je smiselno upoštevati pri odločanju o vrsti kirurškega posega.Background: Comparison of outcomes between two different operative treatments of femoral neck fracture hemiarthroplasty (HA) and internal fixation (IF) remains an open issue. We performed new analyses of data from a previously published study with the aim of investigating the influence of cognitive problems on mobility and functioning after such surgery and comparing it between groups treated with HA and IF. Methods: Sixty-six elderly patients were consecutively enrolled in a prospective non-randomised study. The two groups (HA and IF, each comprising 33 patients) were balanced regarding age, gender and activity before injury. Data were gathered on their walking ability (categorised, measured via walking distance, and assessed using Walking Ability Index WAI), cognitive status (assessed using Mini Mental State Examination MMSE) and independence in activities of daily living (categorised, and assessed using Functional Independence Measure FIM). Results: The association with MMSE score on admission was higher in the IF group than in the HA group for all the analysed outcome measures, i.e., walking distance at discharge, ability to walk unassisted (with walking aids) at discharge, ability to walk outdoors after three months, independence in activities of daily living after three months, improvement in motor FIM subscore after three months and WAI score at discharge. Conclusions: Presence of cognitive problems adversely affects walking ability and functioning mainly in patients operatively treated with IF after femoral neck fracture, and not (or to a much lesser extent) in patients treated with HA. It is recommended to take this into account during surgical decision-making.
Descriptors		Hip fractures Surgical procedures, operative Walking Activities of Daily Living
Keywords		zlomi kolka operativni kirurški postopki hoja dnevne aktivnosti spoznavni procesi