Role of frailty in functional recovery after hip fracture, the variable impact in restoring autonomy

Background: In an old or very older adult, frailty is a common geriatric syndrome resulting from aging-associated decline including loss of autonomy related to multiple pathologies. Aim: The study aims to evaluate the frailty affects on functional and rehabilitative recovery of the elderly patient. Design: This is a retrospective study of subjects over 65 years old who underwent hip surgery following a traumatic femoral fracture. Setting: Patients admitted to intensive rehabilitation department after hip fracture event. Population: The sudy include records of 350 patients over-65-year-old with hip fracture treated in hospital with surgery. Methods: Patients enrolled were classified into three groups: youngest-old, ages 65 to 74 years; middle-old, 75 to 84 years; and oldest-old, 6585 years. Each patient underwent a multidimensional evaluation capable of identifying the deficient domains, defining the presence of frailty, and the different degrees of severity. All patients underwent a project and rehabilitation program according to the literature protocol. Results: The average age of the enrolled patients was 73.2 \ub1 5.6, 38.6% were over 75 years of age, mostly females (58.9%). The prevalence of frailty increased with age, and cognitive functions were associated with both the frailty measured with the Rockwood and Lacks scales. The recovery of Barthel and Tinetti scores correlates to the level of fragility. Conclusion: The approach based on the diagnosis and treatment of the individual disease should be radically changed to a culture and an assessment capacity of elderly persons that take into account the indicators which characterize it as comorbidity, psychological, cultural factors, and environmental health status. Frailty is the sum of these conditions, and it is the most impacting variable in the recovery of autonomy. Clinical rehabilitation impact: The approach based on the diagnosis and treatment of the individual disease should include comorbidity, psychological condition, cultural factors, and environmental health status

SPINE20 A global advocacy group promoting evidence-based spine care of value

PURPOSE: The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. METHODS: The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. RESULTS: The areas of immediate concern were "Aging spine," "Future of spine care," "Spinal cord injuries," "Children and adolescent spine," "Spine-related disability," "Spine Educational Standards," "Patient safety," and "Burden on economy." Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10-11, 2020 held from the G20 platform. CONCLUSIONS: This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence

Maximizing rehabilitation outcomes in geriatric hip fracture patients: the impact of surgical variables

Background and aim: Hip fracture is a major traumatic event with high mortality and disability rate. Its management in the acute setting and in the rehabilitation process is highly debated. This study evaluates the possible determinants of hip fracture rehabilitation outcome, among which surgical intervention type, weight-bearing status and hospitalization length Methods: The data of 738 hip fracture patients, who completed rehabilitation process in our centre, were collected and patients' functional abilities at the time of admission and discharge were analysed. Results: It has been observed that functional recovery depends on several factors: the type of surgery, the post-operative course and related complications, the hospitalisation time, the surgeon's techniques and expertise and the Orthopaedics centre where the operation is performed. Conclusions: In conclusion, data integration in perspective of an individualised rehabilitation program appears crucial for the functional recovery of the hip fracture patient

La narrazione nell'anziano ospedalizzato: un percorso di auto-narrazione durante il processo di riabilitazione

La frattura di femore \ue8 una delle patologie che maggiormente colpiscono l\u2019anziano, con conseguenze non trascurabili in termini di disabilit\ue0, istituzionalizzazione e, non di rado, mortalit\ue0. La letteratura evidenzia uno stretto legame tra alcuni fattori di ordine psicologico, quali depressione e percezione di autoefficacia, e il recupero della funzionalit\ue0 motoria in fase di riabilitazione. L\u2019obiettivo del presente studio \ue8 verificare se un intervento focalizzato su un percorso di auto-narrazione abbia un impatto significativo sul livello di autoefficacia percepita e sulla riduzione dei sintomi depressivi nell\u2019anziano ospedalizzato durante la riabilitazione. Nello specifico, \ue8 stata verificata l\u2019influenza del percorso narrativo nell\u2019aumentare la percezione di autoefficacia e diminuire il livello di depressione (Studio 1); in seguito, \ue8 stato indagato l\u2019effetto del training, dei livelli di autoefficacia e di depressione sul recupero funzionale degli anziani (Studio 2). I risultati indicano che il percorso narrativo induce un aumento dell\u2019autoefficacia e una diminuzione dei sintomi depressivi. Inoltre, tali fattori psicologici risultano essere buoni predittori dell\u2019esito del processo di riabilitazion

Pharmacogenetic testing in acute and chronic pain: A preliminary study

Background and Objectives: Pain is one of the most common symptoms that weighs on life\u2019s quality and health expenditure. In a reality where increasingly personalized therapies are needed, the early use of genetic tests that highlights the individual response to analgesic drugs could be a valuable help in clinical practice. The aim of this preliminary study is to observe if the therapy set to 5 patients suffering of chronic or acute pain is concordant to the Pharmacogenetic test (PGT) results. Materials and Methods: This preliminary study compares the genetic results of pharmacological effectiveness and tolerability analyzed by the genetic test Neurofarmagen Analgesia\uae, with the results obtained in clinical practice of 5 patients suffering from acute and chronic pain. Results: Regarding the genetic results of the 5 samples analyzed, 2 reports were found to be completely comparable with the evidences of the clinical practice, while in 3 reports the profile of tolerability and effectiveness were partially discordant. Conclusion: In light of the data not completely overlapping with results observed in clinical practice, further studies would be appropriate in order to acquire more information on the use of Neurofarmagen in routine clinical settings

Frailty and resilience in an older population. The role of resilience during rehabilitation after orthopedic surgery in geriatric patients with multiple comorbidities

Hip fracture is common in the elderly and it is usually associated with comorbidities and physiological changes which may have an impact on functioning and quality of life. The concept of resilience may explain why this impact varies among patients. The aim of this open, prospective cohort study was to explore the relationships between resilience, frailty and quality of life in orthopedic rehabilitation patients, and also to assess whether these factors might affect rehabilitation outcome. Eighty-one patients, older than 60 years, underwent a multidisciplinary assessment at the beginning and at the end of the rehabilitation period following orthopedic surgery to the lower limb. The assessments were performed using the Resilience Scale, the Multidimensional Prognostic Index (as a measure of frailty), the WHO Quality of Life-BRIEF, the Geriatric Depression Scale, and the Functional Independence Measure (as a measure of the rehabilitation outcome). A negative correlation between disability and resilience emerged and this association interacted with frailty level. We also found that resilience and quality of life are positive predictors of functional status at discharge

The role of autobiographical story-telling during rehabilitation among hip-fracture geriatric patients

Hip fracture is one of the most common health care problems among elderly people. Literature shows that high self-efficacy expectations and positive affect are some of the key issues in functional recovery after hip fracture. The present investigation tested whether selfnarration of such life-breaking event influences self-efficacy and depression during the process of rehabilitation. We designed a Self- Narration Journey (SNJ) to be administered during the in-hospital rehabilitation. In Study 1, we investigated the influence of SNJ on depression and perceived self-efficacy. Study 2 aimed to explore the effect of SNJ, depression, and self-efficacy on functional recovery of independence to perform daily activities during the rehabilitation process. The data showed that the Self-Narration Journey proved effective in increasing the perceived self-efficacy and in lowering the level of depression. The present work highlights a significant effect of the SNJ on the functional recovery process

Rehabilitation After Urgent or Elective Orthopedic Surgery: The Role of Resilience in Elderly Patients

Purpose The aim of this investigation was to assess resilience within an elderly population during postacute rehabilitation for orthopedic surgery and to identify the role of resilience on rehabilitation outcomes by comparing hip fracture and elective patients (total knee and hip arthroplasty). Design We conducted a prospective study in an orthopedic rehabilitation department. Methods On admission and on discharge, 80 patients aged over 60 years underwent a multidimensional evaluation with the Resilience Scale, the Functional Independence Measure (FIM), the Multidimensional Prognostic Index, and the World Health Organization Quality of Life-BREF. Findings Hip-fractured patients had a lower level of resilience. High-resilient fracture patients achieved higher FIM scores. For elective patients, no differences on FIM score occurred for different resilience levels. Conclusions and Clinical Relevance Resilience plays a significant role in reaching optimal functional recovery in hip-fractured elderly people. Results suggest the introduction of early routine assessment of resilience in future outcome studies in rehabilitation