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Poster 94: Paper presentation
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Geriatrics Poster 94: Paper presentation. Poster 95 Bilateral Sacral Insufficienct Fractures Treated with Sacroplasties: A Case Report. Toni J. Hanson, MD (Mayo Clinic, Rochester, MN). Disclosure: T.J. Hanson, none. Setting: A comprehensive spine center in a tertiarry care outpatient setting. Patient: A 76-year-old woman with back pain. Case Description: The patient had a history of a fall (0.9 –1.2m) several weeks prior to developing acute on chronic lower back and new right leg pain. Her medical history included breast cancer, melanoma, right leg thrombophlebitis and edema, and fall(s). Magnetic resonance imaging revealed bilateral sacral insufficiency fractures with multilevel foraminal stenosis, central canal stenosis, and a large central disk at the lumbosacral level. A L5–S1 intralaminar epidural steroid injection was not helpful. She did not improve with conservative management. Narcotics resulted in constipation, gait, and cognitive issues. Her functional independence was compromised. A bone scan and computed tomography were comfirmatory, with bilateral vertical components extending from the sacral ala through S2 and a horizontal component through the central aspect of the body of S2 noted. Bilateral percutaneous sacroplasties were performed. Assessment/Results: She noted significant pain relief with the bilateral percutaneous sacroplasties. Her functional status improved accordingly, with restoration of her functional independence. Physical and occupational therapy were performed to address her gait, spine, home safety evaluation, and equipment needs. She underwent a bone clinic evaluation that was unremarkable. Conclusions: Percutaneous sacroplasties, as demonstrated in this case example, can be quite helpful in the setting of selected sacral fractures unresponsive to conservative management. Significant pain reduction and rapid recovery of function are particularly desirable, as is the pevention of secondary deconditioning and medication side effects. Key Words: Geriatrics; Rehabilitation. Poster 96 Classifying Activity Limitation and Causative Impairment for the Practice of Geriatrics Rehabilitation. Wenchun Qu, MD, PhD (University of Pennsylvania, Philadelphia, PA); Margaret G. Stineman, MD. Disclosure: W. Qu, none; M.G. Stineman, none. Objective: To create an assessment tool for outpatient clinical practices that characterizes the types of activity limitations and the ways in which the activities are limited according to the perceived causative impairment. Design: Population-based complex survey design with weights used to make accurate population prevalence estimates from the 1994 National Health Interview Survey Disability Supplement and Longitudinal Study of Aging II data, controlling for age, sex, and race. SAS procedures of Proc Surveyfreq and Proc Surveylogistic were used in the analysis. Setting: Civilian noninstitutionalized population of the United States. Participants: A nationally representative sample comprised of 2106 subjects 70 years of age or older with activities of daily living (ADLs) and/or instrumental ADLs (IADLs) limitations. Interventions: Not applicable. Main Outcome Measures: The types of activity limitations (ADLs or IADLs) and the ways in which activities were limited (needed help or needed supervision with ADLs). Results: Participants with ADLs limitations attributed to brain and behavioral impairments or multiple impairments were statistically significantly more likely to need help with ADLs (34.6% and 30.4% respectively, P⬍.001). Compared with the refer-
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ence group of cardiopulmonary and hematology impairment, after controlling for age, sex, the odds of needing help in ADLs were 3.03 times higher (95% confidence interval [CI], 1.94 – 4.71) in brain and behavioral impairments and 2.54 times higher (95% CI, 1.61– 4.01) in multiple impairments. The odds of needing supervision in ADLs were 7.12 times higher (95% CI, 3.70 –17.70) in brain and behavioral impairments and 3.77 times higher (95% CI, 1.90 –7.48) in those who perceived multiple impairments as causing their limitations. Conclusions: Understanding of the causative impairment along with the types of activity limitation and the way in which activities are limited has implications for the study of prognosis, treatment planning, and evaluation of preventative and interventional measures. Key Words: Activities of daily living; Elderly; Rehabilitation. Poster 97 Clinical Outcome of a Centenarian With a Joint Replacement: Are You Getting Too Old For This? A Case Report. Steve Yoon, MD (Rusk Institute/NYU Medical Center, New York, NY); Arthur Jimenez, MD; Kenneth Vitale. Disclosure: A. Jimenez, none; K. Vitale, none; S. Yoon, none. Setting: Urban rehabilitation unit. Patient: 102-year-old man statuspost primary total hip arthroplasty (THA). Case Description: The patient initially sustained a nondisplaced left femoral neck fracture after a fall. He underwent hip pinning (Knowles pins) and was transferred to our rehabilitation unit, improved in mobility, and was successfully discharged home. 5 months later he developed recurrence of hip pain with arthritic changes. The patient’s hardware was removed and he successfully underwent a THA and was admitted to the inpatient rehabilitation unit for a second time. He improved and was discharged home to an even higher independence level than preoperatively. Assessment/Results: A tailored rehabilitation program was created to fit his needs. He fully tolerated the rehabilitation program and progressed at a rate we would see with patients far younger. He improved beyond his level of independence prior to admission. He did not have any medical setbacks during his rehabilitation. Conclusions: To our knowledge, this is one of the oldest documented patients to undergo a THA with a successful clinical outcome. This patient strongly demonstrates the old adage, “You’re never too old.” The population aged 85 years and older increased by 38% in the 1990s, increasing the potential need for primary hip arthroplasties. Oftentimes, preconceived fears of risks and complications of both provider and patient based on age alone can interfere with the possibility for hip replacement surgery, thus denying them a better quality of life. Conclusions: Physiatrists are often consulted about the rehabilitation needs of the elderly, and many of our patients ask us if they should undergo surgical procedures to treat their osteoarthritis. We would like to reinforce the teaching that, although some patients have comorbidities that may contraindicate joint replacement, they are never “just too old” for it. Key Words: Arthroplasty; Hip; Rehabilitation. Poster 98: Paper presentation. Poster 99 Patient Characteristics and Inpatient Rehabilitation Outcomes After Hip Fractures. Laura Lee, MD (University of Virginia, Charlottesville, VA); Sarah Schmidt. Disclosure: L. Lee, none; S. Schmidt, none. Objective: According to Centers for Medicare and Medicaid Services, approximately 95% of patients with hip fractures go to an inpatient rehabilitation facility (IRF) or subacute nursing facility or both after their surgical hospitalization. In many cases, predicting the optimal setting for postacute care can be difficult. The objective of this Arch Phys Med Rehabil Vol 89, November 2008
Geriatrics Poster 94: Paper presentation. Poster 95 Bilateral Sacral Insufficienct Fractures Treated with Sacroplasties: A Case Report. Toni J. Hanson, MD (Mayo Clinic, Rochester, MN). Disclosure: T.J. Hanson, none. Setting: A comprehensive spine center in a tertiarry care outpatient setting. Patient: A 76-year-old woman with back pain. Case Description: The patient had a history of a fall (0.9 –1.2m) several weeks prior to developing acute on chronic lower back and new right leg pain. Her medical history included breast cancer, melanoma, right leg thrombophlebitis and edema, and fall(s). Magnetic resonance imaging revealed bilateral sacral insufficiency fractures with multilevel foraminal stenosis, central canal stenosis, and a large central disk at the lumbosacral level. A L5–S1 intralaminar epidural steroid injection was not helpful. She did not improve with conservative management. Narcotics resulted in constipation, gait, and cognitive issues. Her functional independence was compromised. A bone scan and computed tomography were comfirmatory, with bilateral vertical components extending from the sacral ala through S2 and a horizontal component through the central aspect of the body of S2 noted. Bilateral percutaneous sacroplasties were performed. Assessment/Results: She noted significant pain relief with the bilateral percutaneous sacroplasties. Her functional status improved accordingly, with restoration of her functional independence. Physical and occupational therapy were performed to address her gait, spine, home safety evaluation, and equipment needs. She underwent a bone clinic evaluation that was unremarkable. Conclusions: Percutaneous sacroplasties, as demonstrated in this case example, can be quite helpful in the setting of selected sacral fractures unresponsive to conservative management. Significant pain reduction and rapid recovery of function are particularly desirable, as is the pevention of secondary deconditioning and medication side effects. Key Words: Geriatrics; Rehabilitation. Poster 96 Classifying Activity Limitation and Causative Impairment for the Practice of Geriatrics Rehabilitation. Wenchun Qu, MD, PhD (University of Pennsylvania, Philadelphia, PA); Margaret G. Stineman, MD. Disclosure: W. Qu, none; M.G. Stineman, none. Objective: To create an assessment tool for outpatient clinical practices that characterizes the types of activity limitations and the ways in which the activities are limited according to the perceived causative impairment. Design: Population-based complex survey design with weights used to make accurate population prevalence estimates from the 1994 National Health Interview Survey Disability Supplement and Longitudinal Study of Aging II data, controlling for age, sex, and race. SAS procedures of Proc Surveyfreq and Proc Surveylogistic were used in the analysis. Setting: Civilian noninstitutionalized population of the United States. Participants: A nationally representative sample comprised of 2106 subjects 70 years of age or older with activities of daily living (ADLs) and/or instrumental ADLs (IADLs) limitations. Interventions: Not applicable. Main Outcome Measures: The types of activity limitations (ADLs or IADLs) and the ways in which activities were limited (needed help or needed supervision with ADLs). Results: Participants with ADLs limitations attributed to brain and behavioral impairments or multiple impairments were statistically significantly more likely to need help with ADLs (34.6% and 30.4% respectively, P⬍.001). Compared with the refer-
E51
ence group of cardiopulmonary and hematology impairment, after controlling for age, sex, the odds of needing help in ADLs were 3.03 times higher (95% confidence interval [CI], 1.94 – 4.71) in brain and behavioral impairments and 2.54 times higher (95% CI, 1.61– 4.01) in multiple impairments. The odds of needing supervision in ADLs were 7.12 times higher (95% CI, 3.70 –17.70) in brain and behavioral impairments and 3.77 times higher (95% CI, 1.90 –7.48) in those who perceived multiple impairments as causing their limitations. Conclusions: Understanding of the causative impairment along with the types of activity limitation and the way in which activities are limited has implications for the study of prognosis, treatment planning, and evaluation of preventative and interventional measures. Key Words: Activities of daily living; Elderly; Rehabilitation. Poster 97 Clinical Outcome of a Centenarian With a Joint Replacement: Are You Getting Too Old For This? A Case Report. Steve Yoon, MD (Rusk Institute/NYU Medical Center, New York, NY); Arthur Jimenez, MD; Kenneth Vitale. Disclosure: A. Jimenez, none; K. Vitale, none; S. Yoon, none. Setting: Urban rehabilitation unit. Patient: 102-year-old man statuspost primary total hip arthroplasty (THA). Case Description: The patient initially sustained a nondisplaced left femoral neck fracture after a fall. He underwent hip pinning (Knowles pins) and was transferred to our rehabilitation unit, improved in mobility, and was successfully discharged home. 5 months later he developed recurrence of hip pain with arthritic changes. The patient’s hardware was removed and he successfully underwent a THA and was admitted to the inpatient rehabilitation unit for a second time. He improved and was discharged home to an even higher independence level than preoperatively. Assessment/Results: A tailored rehabilitation program was created to fit his needs. He fully tolerated the rehabilitation program and progressed at a rate we would see with patients far younger. He improved beyond his level of independence prior to admission. He did not have any medical setbacks during his rehabilitation. Conclusions: To our knowledge, this is one of the oldest documented patients to undergo a THA with a successful clinical outcome. This patient strongly demonstrates the old adage, “You’re never too old.” The population aged 85 years and older increased by 38% in the 1990s, increasing the potential need for primary hip arthroplasties. Oftentimes, preconceived fears of risks and complications of both provider and patient based on age alone can interfere with the possibility for hip replacement surgery, thus denying them a better quality of life. Conclusions: Physiatrists are often consulted about the rehabilitation needs of the elderly, and many of our patients ask us if they should undergo surgical procedures to treat their osteoarthritis. We would like to reinforce the teaching that, although some patients have comorbidities that may contraindicate joint replacement, they are never “just too old” for it. Key Words: Arthroplasty; Hip; Rehabilitation. Poster 98: Paper presentation. Poster 99 Patient Characteristics and Inpatient Rehabilitation Outcomes After Hip Fractures. Laura Lee, MD (University of Virginia, Charlottesville, VA); Sarah Schmidt. Disclosure: L. Lee, none; S. Schmidt, none. Objective: According to Centers for Medicare and Medicaid Services, approximately 95% of patients with hip fractures go to an inpatient rehabilitation facility (IRF) or subacute nursing facility or both after their surgical hospitalization. In many cases, predicting the optimal setting for postacute care can be difficult. The objective of this Arch Phys Med Rehabil Vol 89, November 2008