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Factors associated with outcomes of mobility and living arrangements in a comprehensive geriatric assessment after hip fracture
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
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Balance virtual rehabilitation in the elderly: The use of the “ABAR” system M. Forcano García , S. Albiol-Perez , M.C. Aula Valero , J.A. Gil Gómez , S. Solsona Hernández , P. Manzano Hernández Hospital San José, Teruel, Spain Introduction.– The Active Balance Rehabilitation System (“ABAR”), is a new and customizable virtual tool based on the use of the Wii Balance Board for patients with balance problems. The purpose of this study was to evaluate static and dynamic balance control in elderly patients. Methods.– The study was carried out in San José Hospital (Teruel, Spain). The patients performed a total of 20 sessions, about 30 min using ABAR. We tested clinical tests in two periods of time “Initial Evaluation (IE) and Final Evaluation (FE)”: Barthel index, MMSE, Philadelphia Scale. Other clinical tests based on Static Balance: Anterior Reach Test (ART), Unipedal stance Time (UST), and Dynamic Balance: Berg Balance Scale Test (BBS), Timed “Up and Go” Test (TUG), Ten-meters Walking test (10 MWT), Tinetti test (TT) and 30-s Sit-to-Stand Test (30SST). Results.– The group was composed by 12 patients, 71% men, ranging from 75 to 86 years old, mean barthel index: 62, mean MMSE: 29, mean Philadelfia scale: 6. Diagnosis included: Parkinson disease, vestibular pathology, stroke and cervical myelopathy. ANOVA results reveal significant difference in time effect (P < 0.01) in TUG (IE 36.92 ± 16.17, FE 28.58 ± 15.38), UST (IE 1.50 ± 1.49, FE 2.42 ± 1.89), 10 MWT (IE 0.44 ± 0.19, FE 0.53 ± 0.19), BBS (IE 34.25 ± 8.88, FE 40.92 ± 6.97); and a significant difference in time effect (P < 0.05) in 30SST (IE 4.92 ± 2.87, FE 7.33 ± 3.23), TT (IE 16.58 ± 7.43, FE 20.50 ± 6.29), and ART (IE 15.40 ± 5.29, FE 17.97 ± 4.28). Conclusions.– Elderly patients can benefit from new techniques based on virtual motor rehabilitation to recover gait and balance disorders, with significant improvements in balance scales. http://dx.doi.org/10.1016/j.eurger.2013.07.356 P293
Factors associated with outcomes of mobility and living arrangements in a comprehensive geriatric assessment after hip fracture M. Nuotio a,b , T. Luukkaala a,b Geriatric Unit, Seinäjoki Central Hospital, Seinäjoki, Finland b Science Center, Pirkanmaa Hospital District, Department of Health Sciences, University of Tampere, Tampere, Finland
a
Introduction.– We examined factors associated with the outcomes of mobility and living arrangements in a comprehensive geriatric outpatient assessment after hip fracture. Methods.– An observational study on 887 hip fractures patients aged 65 years and older. In the analyses, the domains of the comprehensive geriatric assessment and a diagnosis of memory disorder at the time of the fracture were the independent and changes in mobility level and living arrangements four months postoperatively the outcome variables. Results.– Of the survivors 499 (73%) attended the assessment. Of the attendants, 19% had a prefracture diagnosis of memory disorder and 56% of those without diagnosis scored less than 24 in the MMSE. Adjusted for age, almost all the domains in the comprehensive geriatric assessment were significantly associated with both of the outcomes. In the multivariate analyses, activities of daily disability, and poor performance in the Timed Up and Go (TUG) were independently associated with changes in mobility while ASA grade 3 or more was associated with moving to a more supported living. A diagnosis of memory disorder showed a protective effect
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on both worsening of the mobility level and moving to a more supported living accommodation (OR 0.38;CI 0.20–0.69) and OR 0.43;CI 0.23–0.82, respectively). Conclusions.– Activities of daily living disability, poor performance in the TUG and comorbidity are independently associated with the outcomes of mobility and living arrangements after hip fracture. A prefracture diagnosis of memory disorder may contribute to better outcome of hip fracture patients with cognitive impairment. http://dx.doi.org/10.1016/j.eurger.2013.07.357 P294
Suitability of virtual rehabilitation for elderly: A study of a virtual rehabilitation system using the SEQ ˜ Tomás , J.A. Gil Gómez , H. Gil Gómez , M.T. Munoz J.A. Lozano Quillis , S. Albiol-Pérez , M. Forcano García Hospital San-José, Teruel, Spain Introduction.– Virtual Rehabilitation (VRh) systems are also used to treat elderly patients. It’s essential to study the suitability of these systems in areas such as usability, enjoyment, comfort, or feeling of success and control. Methods.– To carry out the suitability evaluation, we used ABAR, a VRh system, based on the Wii Balance Board, intended for balance recovery of patients with different pathologies. We choose SEQ (Suitability Evaluation Questionnaire), which includes 14 questions, 13 of them with a response graded on a 5-point Likert Scale (7–10, 12 and 13 inversed point), and a last open question. Patients completed SEQ after the first session with ABAR. Inclusion criteria were: age more than 65, balance disorders. Exclusion criteria were: dementia, severe visual deficit, severe hearing impairment, hemispatial neglect, clinical instability, unsolved acute trauma injury and birth injury. Results.– The sample consisted on 15 elderly patients, 8 men and 7 women. Two patients were illiterate, 10 patients had primary studies. The average age was 81, mean Barthel index: 72. SEQ shows very good results: patients enjoyed the system (Q1, mean 4.60), they didn’t felt confused or disoriented (Q8, mean 4,9) and patients thought that ABAR will be helpful for their rehabilitation (Q11, mean 4.20). Global score media was 54,4 (13-poor suitability to 65-excellent suitability). Cronbach’s alpha was 0,7. Conclusions.– Elderly patients enjoyed ABAR, a VRh system and they did not felt discomfort. Inclusion of VRh systems in the rehabilitation process of elderly people will improve the motivation and increase their adherence to the treatment. http://dx.doi.org/10.1016/j.eurger.2013.07.358 P295
Effectiveness of innovations in geriatric rehabilitation. The SINGER Study M.S. Holstege a,b , M.A.A. Caljouw a,b , R. van Balen a,b , J. Gussekloo a,b , W.P. Achterberg a,b a Leiden University Medical Centre, Department of Public Health and Primary Care, The Netherlands b Department of Innovation and Development, Evean, Purmerend, The Netherlands Introduction.– Geriatric rehabilitation (GR) is mainly based on a fragmented approach. In order to achieve integrated care for GR, a national program for innovation in geriatric rehabilitation was initiated in the Netherlands. The aim of this study was to assess the effectiveness of this program.
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Balance virtual rehabilitation in the elderly: The use of the “ABAR” system M. Forcano García , S. Albiol-Perez , M.C. Aula Valero , J.A. Gil Gómez , S. Solsona Hernández , P. Manzano Hernández Hospital San José, Teruel, Spain Introduction.– The Active Balance Rehabilitation System (“ABAR”), is a new and customizable virtual tool based on the use of the Wii Balance Board for patients with balance problems. The purpose of this study was to evaluate static and dynamic balance control in elderly patients. Methods.– The study was carried out in San José Hospital (Teruel, Spain). The patients performed a total of 20 sessions, about 30 min using ABAR. We tested clinical tests in two periods of time “Initial Evaluation (IE) and Final Evaluation (FE)”: Barthel index, MMSE, Philadelphia Scale. Other clinical tests based on Static Balance: Anterior Reach Test (ART), Unipedal stance Time (UST), and Dynamic Balance: Berg Balance Scale Test (BBS), Timed “Up and Go” Test (TUG), Ten-meters Walking test (10 MWT), Tinetti test (TT) and 30-s Sit-to-Stand Test (30SST). Results.– The group was composed by 12 patients, 71% men, ranging from 75 to 86 years old, mean barthel index: 62, mean MMSE: 29, mean Philadelfia scale: 6. Diagnosis included: Parkinson disease, vestibular pathology, stroke and cervical myelopathy. ANOVA results reveal significant difference in time effect (P < 0.01) in TUG (IE 36.92 ± 16.17, FE 28.58 ± 15.38), UST (IE 1.50 ± 1.49, FE 2.42 ± 1.89), 10 MWT (IE 0.44 ± 0.19, FE 0.53 ± 0.19), BBS (IE 34.25 ± 8.88, FE 40.92 ± 6.97); and a significant difference in time effect (P < 0.05) in 30SST (IE 4.92 ± 2.87, FE 7.33 ± 3.23), TT (IE 16.58 ± 7.43, FE 20.50 ± 6.29), and ART (IE 15.40 ± 5.29, FE 17.97 ± 4.28). Conclusions.– Elderly patients can benefit from new techniques based on virtual motor rehabilitation to recover gait and balance disorders, with significant improvements in balance scales. http://dx.doi.org/10.1016/j.eurger.2013.07.356 P293
Factors associated with outcomes of mobility and living arrangements in a comprehensive geriatric assessment after hip fracture M. Nuotio a,b , T. Luukkaala a,b Geriatric Unit, Seinäjoki Central Hospital, Seinäjoki, Finland b Science Center, Pirkanmaa Hospital District, Department of Health Sciences, University of Tampere, Tampere, Finland
a
Introduction.– We examined factors associated with the outcomes of mobility and living arrangements in a comprehensive geriatric outpatient assessment after hip fracture. Methods.– An observational study on 887 hip fractures patients aged 65 years and older. In the analyses, the domains of the comprehensive geriatric assessment and a diagnosis of memory disorder at the time of the fracture were the independent and changes in mobility level and living arrangements four months postoperatively the outcome variables. Results.– Of the survivors 499 (73%) attended the assessment. Of the attendants, 19% had a prefracture diagnosis of memory disorder and 56% of those without diagnosis scored less than 24 in the MMSE. Adjusted for age, almost all the domains in the comprehensive geriatric assessment were significantly associated with both of the outcomes. In the multivariate analyses, activities of daily disability, and poor performance in the Timed Up and Go (TUG) were independently associated with changes in mobility while ASA grade 3 or more was associated with moving to a more supported living. A diagnosis of memory disorder showed a protective effect
S109
on both worsening of the mobility level and moving to a more supported living accommodation (OR 0.38;CI 0.20–0.69) and OR 0.43;CI 0.23–0.82, respectively). Conclusions.– Activities of daily living disability, poor performance in the TUG and comorbidity are independently associated with the outcomes of mobility and living arrangements after hip fracture. A prefracture diagnosis of memory disorder may contribute to better outcome of hip fracture patients with cognitive impairment. http://dx.doi.org/10.1016/j.eurger.2013.07.357 P294
Suitability of virtual rehabilitation for elderly: A study of a virtual rehabilitation system using the SEQ ˜ Tomás , J.A. Gil Gómez , H. Gil Gómez , M.T. Munoz J.A. Lozano Quillis , S. Albiol-Pérez , M. Forcano García Hospital San-José, Teruel, Spain Introduction.– Virtual Rehabilitation (VRh) systems are also used to treat elderly patients. It’s essential to study the suitability of these systems in areas such as usability, enjoyment, comfort, or feeling of success and control. Methods.– To carry out the suitability evaluation, we used ABAR, a VRh system, based on the Wii Balance Board, intended for balance recovery of patients with different pathologies. We choose SEQ (Suitability Evaluation Questionnaire), which includes 14 questions, 13 of them with a response graded on a 5-point Likert Scale (7–10, 12 and 13 inversed point), and a last open question. Patients completed SEQ after the first session with ABAR. Inclusion criteria were: age more than 65, balance disorders. Exclusion criteria were: dementia, severe visual deficit, severe hearing impairment, hemispatial neglect, clinical instability, unsolved acute trauma injury and birth injury. Results.– The sample consisted on 15 elderly patients, 8 men and 7 women. Two patients were illiterate, 10 patients had primary studies. The average age was 81, mean Barthel index: 72. SEQ shows very good results: patients enjoyed the system (Q1, mean 4.60), they didn’t felt confused or disoriented (Q8, mean 4,9) and patients thought that ABAR will be helpful for their rehabilitation (Q11, mean 4.20). Global score media was 54,4 (13-poor suitability to 65-excellent suitability). Cronbach’s alpha was 0,7. Conclusions.– Elderly patients enjoyed ABAR, a VRh system and they did not felt discomfort. Inclusion of VRh systems in the rehabilitation process of elderly people will improve the motivation and increase their adherence to the treatment. http://dx.doi.org/10.1016/j.eurger.2013.07.358 P295
Effectiveness of innovations in geriatric rehabilitation. The SINGER Study M.S. Holstege a,b , M.A.A. Caljouw a,b , R. van Balen a,b , J. Gussekloo a,b , W.P. Achterberg a,b a Leiden University Medical Centre, Department of Public Health and Primary Care, The Netherlands b Department of Innovation and Development, Evean, Purmerend, The Netherlands Introduction.– Geriatric rehabilitation (GR) is mainly based on a fragmented approach. In order to achieve integrated care for GR, a national program for innovation in geriatric rehabilitation was initiated in the Netherlands. The aim of this study was to assess the effectiveness of this program.