International Journal of Orthopaedic and Trauma Nursing最新文献

Background

Older adults with a prior history of falls that results in hip fractures have difficulties in regaining pre-fracture functional capacity. Scientific evidence has shown benefits of the implementation of multidimensional rehabilitation programs, but this evidence is not systematized with regard to continuity of care after hospital discharge.

Objective

To identify interventions that promote safety and functional recovery of older adults with hip fractures after hospital discharge.

Method

A systematic review was carried out according to Cochrane methodology. The research strategy was predefined for the MEDLINE and CINAHL databases. The identified articles were screened according to the eligibility criteria by two independent reviewers. The articles included in the bibliographic sample were evaluated for risk of bias.

Results

Of the 10,036 articles found, 10 were included in this systematic review. The safety-promoting interventions identified were: exercise training, occupational therapy/activities of daily living training, transfer and gait training, strengthening exercises, education on assistive device use, fall prevention education, nutritional assessment, environmental modifications/adjustments at home, use of an app, medication, self-care education, and support and counseling.

Conclusions

In eight studies analyzed, exercise training emerged as the most effective intervention for promoting the safety of older adults after hip fractures on returning home. Three studies associated two or more interventions, which focused on exercise training, occupational therapy/training of activities of daily living, and conventional postoperative rehabilitation with transfer and gait training, strengthening exercises, education on assistive device use and discharge planning, aiming to achieve muscle strengthening and safe gait, associated with the performance of activities of daily living.

Introduction

Elderly persons have an increased risk for negative health-related outcomes, including higher mortality rates. A centre for geriatric traumatology was established in a German-speaking Swiss hospital to provide more specialised, person-centred care and to lower negative health outcomes. Adaptations and changes in the patient pathway were made by implementing fast-track and person-centred care to better address individual needs.

Methods

The current patient pathway was analysed by an interprofessional and interdisciplinary geriatric traumatology expert team. The practice development methodology and the Person-Centred Practice Framework (PCP-Framework) were used throughout this engagement process. In consensus within the expert team, the sample was defined as elderly persons aged 65 years or older with suspected hip joint closed fractures. The focus was on three elements of “practice environment” from the PCP-Framework. These were: (1) supportive organisational systems; (2) the physical environment; (3) appropriate skill mix.

Results

Several adaptations and changes were made addressing the three elements of “practice environment”. These were for example: (1) use of specific assessments, shared decision-making; (2) proper and effective use of aids; (3) integration of Advanced Practice Nurses. The adaptations in the patient pathway were integrated into the standard operating procedures.

Conclusions

Through active engagement with the practice development methodology and the focus on person-centredness, the process of care for elderly persons was adapted. Thus, by addressing individual needs, fast-track and person-centred care in geriatric traumatology is provided. Further research is needed to evaluate and to verify implications in clinical practice.

Background

It is essential to focus on how older adults remain active and regain control of their daily lives after hip fractures. ‘Rehabilitation of Life’ is an empowerment-orientated hip fracture intervention focused on continuous rehabilitation and care between sectors in Denmark. We aimed to understand and explore older adults' experience participating in the intervention ‘Rehabilitation of Life’ and how this relates to their sense of empowerment.

Method

Qualitative data were generated from 16 semi-structured interviews with patients experiencing a hip fracture and subsequent rehabilitation in the program “Rehabilitation of Life’ The data was analysed using Graneheim and Lundman's concept-guided qualitative content analysis method.

Results

The analysis revealed five themes that the participants emphasised as vital to their rehabilitation: getting information and care when hospitalised, early visits from healthcare professionals after returning to their homes, the social aspect of training together with others, rehabilitation provision by skilled and empathic staff, and acceptance of a new me. The five themes indicated that adults aged >65 years generally experienced rehabilitation after hip fractures as motivating and reassuring.

Conclusion

Social support and peer programs can significantly improve the rehabilitation of older adults with hip fractures. The Rehabilitation of Life intervention has shown that promoting successful rehabilitation requires patient-centred strategies that encourage collaboration between different sectors. To increase patients' empowerment and engagement in their health journey, it is important to consider changes in patients' behaviour, increase their autonomy and ensure their independence after rehabilitation.

Osteoporotic fracture as a serious complication of osteoporosis which is usually treated surgically, and its recovery is closely related to one's own behavior and lifestyle, and is a long-term, complex management process that often requires the individual to self-manage many health-related factors.

Objective

To gather and synthesize the most robust evidence regarding self-management in patients with postoperative osteoporotic fractures, in order to provide scientific, evidence-based guidance for clinical healthcare professionals to assist postoperative patients in self-management efforts, and to assist patients in optimizing their self-management practices and behavioral norms.

Methods

Based on the “6 S” pyramid model of evidence resources (System, Summaries, Synopses of synthesis, Syntheses, Synopses of studies, Studies), we searched the Up To Date, BMJ Best Practice, The Cochrane Library, Australian Joanna Briggs Institute JBI Evidence-Based Medicine Center Healthcare Database, National Institute for Health and Clinical Excellence (NICE), Guidelines International Network (GIN), National Guideline Clearinghouse (NGC) and Scottish Intercollegiate Guide lines Network (SIGN), MedPulse, Embase, PubMed, CINAHL, Web of Science, SinoMed, Chinese Medical Journal Full Text Database, CNKI, Wanfang Data Knowledge Service Platform, and VIP database, etc, The search period for clinical decision-making, systematic evaluation, clinical guidelines, evidence summaries and expert consensus on self-management of postoperative osteoporotic fracture patients, and it was from the establishment of the database to 18 February 2023. To ensure the quality of the literature, three researchers strictly screened the literature according to the literature inclusion and exclusion criteria, and two or more researchers independently evaluated the quality of the included literature, and extracted and integrated the relevant evidence.

Results

Thirteen documents were finally included, including 4 clinical practice guidelines, 5 expert consensus, 2 recommended practices, 1 systematic evaluation, and 1 clinical decision report. The research team summarized the evidence in 6 dimensions: multidisciplinary teamwork, management of daily living, management of treatment adherence, management of exercise, management of fall prevention and subsequent fracture, and management of emotions, and 33 pieces of evidence were extracted.

Conclusion

The study summarized 33 best evidence of self-management in postoperative osteoporotic fracture patients, which provides a scientific and reasonable self-management program for postoperative patients, and also provides important reference and information for clinical healthcare professionals to provide more comprehensive and scientific self-management health education to patients.

Background

The adhesive elastic tape use is indicated for controlling oedema, although currently there is not the definitive evidence regarding its effectiveness. Wrist fractures are a frequent occurrence, often leading to oedema development in patients treated with forearm casts.

This pilot study aims to investigate the effects of elastic tape in controlling hand oedema among patients with forearm casts for wrist fractures and the feasibility of a future randomized controlled trial.

Methods

The study was conducted on adult patients with unilateral conservatively treated wrist fracture. The tape was applied to the intervention group after cast application, while the control group received the standard treatment. The circumference difference between baseline and the 7-day follow-up of both the 1st finger and the remaining 4 fingers merged together was evaluated. Ethical approval for the study has been obtained.

Results

23 participants were enrolled. The intervention group showed a higher reduction in finger circumferences compared to the control group (median difference T1-T0 No tape vs Tape: 0 cm vs −0.2 cm for the 1st finger and 0.5 cm vs −0.5 cm for the remaining 4 fingers), although the changes were not statistically significant.

Conclusion

Although the number of enrolled patients was limited due to Covid-19 pandemic, the study results suggest a potential reduction in oedema after the use of adhesive elastic tape, justifying the needed of a future full-scale study. Given its low cost and ease of use, we believe that tape can be considered in clinical practice.

Trial registration

ClinicalTrials.gov Identifier: NCT04683887.

Background

There is significant interest in the use of web-based technologies for rehabilitation of patients after total knee arthroplasty (TKA). BPMpathway is a combination of a wireless BPMpro sensor and mobile app to provide a personalized post-operative support programme for TKA patients.

Objective

To investigate the impact of the BPMpathway exercise rehabilitation system on home rehabilitation for TKA patients.

Methods

This study had a quasi-experimental design and was conducted with 42 inpatients after TKA. Patients were divided into a control group (n = 21) and an intervention group (n = 21) according to sequence of hospitalization. After discharge, patients in the control group received routine follow-up outside the hospital, while the intervention group, underwent out-of-hospital transitional care utilizing the BPMpathway exercise rehabilitation system. Knee function scores (HSS), quality of life scores (SF-36), and functional exercise compliance scores were compared between the two groups at 1, 3, and 6 months after TKA.

Results

The between-group differences in knee function were statistically significant at 1, 3, and 6 months post-operation (t = 6.299, 10.021, 13.064, all P < 0.05). There were between-group significant differences observed in functional exercise compliance and quality of life at 1 and 3 months (t = 7.166, 2.435, both P < 0.05; t = 2.879, 3.117, both P < 0.05). However, there were no significant differences at 6 months in these two respects (t = 0.167, 0.901, both P > 0.05).

Conclusions

The BPMpathway exercise rehabilitation system seems to be potential effective in improving knee function, early compliance with functional exercise and quality of life in TKA patients.

Purpose

To describe orthopaedic patients' perspectives on their sleep quality and their suggestions for improvement initiatives to achieve better sleep quality during hospitalisation.

Methods

In a qualitative design, 265 (50%) of 533 patients from a questionnaire survey responded to two free-text questions. Data were analysed based on a phenomenological-hermeneutic approach inspired by Paul Ricoeur's theory of narrative and interpretation.

Results

Three themes emerged: 1) Sleeping environment and preferences tailored to the individual patient, 2) The link between orthopaedic surgery care and sleeping, and 3) Noise challenged a good night’s sleep. Good sleep was related to nurses' professional behaviour and the physical environment, such as quality beds and sleeping aids. Single and shared rooms, room lighting, and fresh air all influenced sleep quality. Unfamiliar and uncomfortable sleeping positions posed a challenge for orthopaedic patients but aids such as pillows, and duvets could provide more comfort at night. Offset circadian rhythms could affect sleep quality, as could nausea and vomiting. Pain and lack of pain relief were associated with poor sleep quality. Noise from both nurses and other patients affected sleep quality. Therefore, unnecessary care activities should be kept to a minimum, and a “night noise level” was suggested.

Conclusion

Patients' sleep disturbance following orthopaedic surgery needs to be addressed by both nurses and hospital management. Patients’ involvement is essential to create a sleep environment tailored to individual needs and to provide strategies patients use at home for addressing sleeping problems.