Analysis of risk factors affecting mortality in elderly patients operated on for hip fractures: A retrospective comparative study.

OBJECTIVE: The aims of this study were (1) to investigate the effects of different demographic and perioperative modalities on mortality rates and (2) to compare mortality rates between different implants in elderly patients operated on for hip fractures. METHODS: In this retrospective study, a total of 314 patients who were operated on for hip fractures were included study. Patients were then divided into four groups based in their implant types: long-stem cementless bipolar hemiarthroplasty (n = 124; 102 female, 22 male; mean age = 84.2 ± 6.4 years), standard-stem cementless bipolar hemiarthroplasty (n = 74; 48 female, 26 male; mean age = 83.5 ± 6.9 years), antegrade intertrochanteric nail (n = 61; 35 female, 26 male; mean age = 78.5 ± 6.8 years), and total hip arthroplasty (n = 55; 34 female, 21 male; mean age = 72.5 ± 4.3 years). Data including gender, age, duration from injury to surgery, American Society of Anesthesiologists (ASA) score, comorbidities, use of antiplatelet agents, Barthel Index of Activities of Daily Living, type of anesthesia, operation time, preoperative hemoglobin values, blood transfusions given, duration of hospital stay, complications, and type of fracture were recorded. RESULTS: Overall, the mean follow-up was 36.5 (range = 0 - 107) months. The overall mortality rate was 53.2%. The median survival duration was 44.2 ± 5 months (range = 34.3 - 54). Survival rates were found significantly different among the groups (P = 0.001). In the first three years postoperatively, the mortality rate was higher in the standard-stem bipolar hemiarthroplasty group, but in the long-term follow-up, the long-stem bipolar hemiarthroplasty group exhibited the higher mortality rates. It was observed that some parameters had statistically significant effects on the mortality rates. Male gender, higher age, lower hemoglobin values, increased number of blood transfusions, ASA scores ≥3, the existence of ≥ 3 comorbidities were found as main predictors of increased mortality rates. CONCLUSION: The results of this study have shown that age, gender, preoperative hemoglobin levels, ASA scores, and comorbidities are significant factors affecting mortality in elderly patients operated on for hip fractures. Long-stem cementless bipolar hemiarthroplasty appears to show similar rates of mortality with standard-stem cementless bipolar hemiarthroplasty. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Timed Up and Go Test With a Cognitive Task: Correlations With Neuropsychological Measures in People With Parkinson's Disease.

Background The Timed Up and Go (TUG) test is a simple and widely used clinical test for the assessment of lower extremity function, balance, mobility, and fall risk in various populations. The TUG has been found as a valid and reliable measure in people with Parkinson's disease (PD). Besides, the addition of a cognitive task to the TUG (TUG-cognitive) enhances predictive validity related to fall risk in people with PD. However, further investigation is needed about the correlations of the TUG-cognitive test with neuropsychological measures in people with PD. Methods Thirty-three people with PD [modified Hoehn and Yahr scale, median (min-max)=2.5 (1.0-3.0)] participated in this cross-sectional study. The TUG was administered in the traditional way and with a cognitive task (counting backward by three from any number between 20 and 100). Neuropsychological measures included the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), and the Simple Reaction Time (SRT) test for stepping. The self-reported number of falls in the last six months was also recorded. Results The TUG-cognitive [13.1 (SD=8.5) seconds] was significantly longer than the TUG-traditional [12.2 (SD=8.1) seconds] (p<0.01). The TUG-cognitive significantly correlated with the MoCA [(rho=-0.712), TMT part A (TMT-A; rho=0.722), TMT part B (TMT-B; rho=0.694), SRT (rho=0.794), and number of falls (rho=0.960)] (p<0.01). The TUG-traditional also significantly correlated with the MoCA (rho=-0.682), TMT-A (rho=0.684), TMT-B (rho=0.746), SRT (rho=0.755), and number of falls (rho=0.702) (p<0.01). Conclusion Both the TUG-cognitive and TUG-traditional strongly correlated with neuropsychological measures; while the correlations were slightly stronger for the TUG-cognitive, the difference was not significant. The TUG-cognitive can be used in the clinical practice as a simple and more informative alternative to the TUG-traditional in people with PD.

The effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study.

OBJECTIVE: The aim of this study was to investigate the effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke. METHODS: 42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 ± 22.02 days (∼8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45-60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions. RESULTS: There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05). CONCLUSION: These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.