Procena uticaja snage stiska šake kao prediktora rehabilitacionog ishoda kod pacijenata sa prelomom kuka

Abstract

Prelomi kuka su globalni problem koji često rezultuje lošim zdravstvenim ishodima i visokim troškovima zdravstvene zaštite. Predviđanje rehabilitacionih ishoda kod pacijenata nakon preloma kuka je ključno pitanje za optimizaciju rehabilitacionih protokola, definisanje optimalne raspodele resursa i organizacije nege. Cilj ovog istraživanja je bio određivanje prediktora uspešnosti oporavka starijih pacijenata nakon operativno lečenog preloma kuka. Među ispitivanim prediktorima poseban cilj je bio da se proceni povezanost snage stiska šake merene rano nakon preloma kuka i klasifikovane prema ERGSS2 kriterijumima i drugih ulaznih varijabli, kao i njena uloga u predikciji kratkoročnog i dugoročnog mortaliteta, funkcionalnog oporavka i kvaliteta života u ovoj grupi isptianika. Praćen je 191 pacijent stariji od 65 godina nakon preloma kuka, koji je operisan na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Srbije u periodu od 1.marta 2017. do 1.septembra 2018. godine. Prosečna starost ispitanika je bila 80,3±6,8 godina. Među ispitanicima 35% je imalo slabost snage stiska šake. Ovi pacijenti su bili značajno stariji, češće ženskog pola, imali su manji indeks telesne mase i bili su lošijeg zdravstvenog statusa. Pacijenti sa slabijim stiskom šake su takođe imali lošiji kognitivni status, manje vrednosti Bartelovog indeksa i lošiji kvalitet života pre preloma. Multivarijantna regresiona analiza pokazala je da je slabost snage stiska šake bila nezavisni prediktor aktivnosti dnevnog života 6 meseci nakon preloma kuka. Snaga stiska šake je takođe bila povezana sa nižim tromesečnim vrednostima aktivnosti dnevnog života, kao i tro- i šestomesečnim mortalitetom, vrednostima instrumentalizovanih aktivnosti dnevnog života, kvaliteta života, ali nije bila i njihov nezavisni prediktor. Rezultati našeg istraživanja podržavaju značaj ispitivanja snage stiska šake u akutnoj fazi u sklopu multidimenzionalne procene oporavka pacijenata sa prelomom kuka.

Hip fractures are a global concern, often resulting in poor health outcomes and high health care costs. Predicting the rehabilitation outcomes of hip fracture patients is a crucial issue to optimize rehabilitation protocols, define optimal resources allocation and care organization. This investigation aimed to determine predictors of short- and long-term recovery of elderly patients after surgically treated hip fractures. Among the predictors examined, the specific objective was to evaluate the association of handgrip strength measured early after hip fracture and classified according to the EWGSOP2 criteria and other baseline variables, as well as its role in the prediction of short- and long-term mortality, functional recovery, and quality of life. One hundred ninety-one patients older than 65 years with acute hip fractures who were surgically treated at the Clinic for Orthopedic Surgery and Traumatology, Clinical Canter of Serbia in the period 1.3.2017- 1.9.2018. were examined. The mean age of the participants was 80.3±6.8 years. Among the participants, 35% had a weakness of the hand grip strength. These patients were significantly older, more often female, had a lower body mass index, and were of worse physical health. They also had a lower cognitive level, lower Barthel index, and lower quality of life before fracture. Multivariate regression analysis revealed that hand grip weakness was an independent predictor of activites of daily living 6 months after hip fracture. Hand grip strength was also associated with lower indipendence three-month postoperatively regarding activities of daily living, as well as instrumentalized activities of daily living, quality of life, and three- and sixmonth mortality, but was not their independent predictor. The results of our study support the importance of examining hand grip strength in the acute phase as part of a multidimensional assessment of the recovery of patients with hip fractures.