COMORBIDITY IMPACT ON SOCIAL FUNCTIONING AFTER HIP FRACTURE: THE ROLE OF REHABILITATION

ABSTRACT Objective: To analyze the impact of rehabilitation treatment on social functioning in elderly patients after hip fracture during a rehabilitation program. Methods: This study included 203 patients with hip fracture. Four groups were analyzed on rehabilitation: Group 1, at admission, Group 2, at discharge, Group 3, three months after discharge and Group 4, six months after discharge. The analyzed parameters included: musculoskeletal, neurological and cognitive impairments. Impairment severity was graded by cumulative index rating scale for geriatrics (CIRS-G). Evaluation of social functioning was completed by social functioning component (SFC) from quality of life (SF-36) questionnaire. Results: There was a significant improvement in SF-36 SFC values for observed impairments from admission to six months after discharge for each severity degree (p<0.01), except for CIRS-G severity degree 4 for cognitive impairment, where significance was p<0.05. For the group of patients with musculoskeletal impairment, there was a significant difference between the values of SF-36 SFC concerning different severity degrees of CIRS-G only at six months after discharge (p<0.05). Patients with neurological or cognitive impairments have shown significant differences between the values of SF-36 SFC in regard to severity degrees of CIRS-G in all observational groups. Conclusion: Different degrees of observed impairments influence the degree of social functioning recovery in the elderly after hip fracture. Level of Evidence II, Prognostic Studies .

Effect of short-term exercise training in patients following acute myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: Exercise-based rehabilitation is an important part of treatment patients following acute myocardial infarction (MI). However, data are scarce on the efffects of short-term exercise programs in patients with acute MI treated with primary percutaneous coronary intervention (PPCI). AIM: To evaluate the effect of short-term exercise training on cardiopulmonary exercise testing (CPET) parameters in patients suffering acute MI treated with PPCI. STUDY DESIGN: Observational longitudinal study. SETTING: Inpatient cardiac rehabilitation. POPULATION: Sixty consecutive patients with MI treated with PPCI referred for rehabilitation. METHODS: We studied 60 consecutive patients with MI treated with PPCI reffered for rehabilitation to our institution. The study population consisted of 54 men and 6 women (age 52.0±8.4 years, left ventricular ejection fraction 54.1±8.1%), who participated in a 3-week clinical cardiac rehabilitation program. The program consisted of cycling for 7 times/week, and daily walking for 45 minutes at an intensity of 70-80% of the individual maximal heart rate. All patients performed symptom-limited CPET on a bicycle ergometer with a ramp protocol of 10 w/min. The CPET was also performed after cardiac rehabilitation programs. RESULTS: After 3 weeks of exercise-based cardiac rehabilitation program improved exercise tolerance as compared to baseline (peak workload 119.28±20.45 vs. 104.35±22.01 watts, respectively, P<0.001), as well as peak respiratory exchage ratio (1.10±0.14 vs. 1.04±0.01, respectively, P<0.001). Peak heart rate at rest, peak and after 1 minute of rest were also improved. Most importantly, peak VO2 (19.27±4.16 vs. 17.27±3.34 ml/kg/min, respectively, P<0.001), peak VCO2 (1.83±0.38 vs. 1.58±0.30, respectively, P<0.001), peak ventilatory exchange (53.73±12.47 vs. 45.50±11.32 L/min, respectively, P<0.001) and peak breathing reserve (55.20±12.36 vs. 60.18±14.19%, respectively, P<0.001) were also improved. No major adverse cardiac events were noted during the rehabilitation program. CONCLUSIONS: Our data indicate that short-term exercise training in patients with acute MI treated with PPCI is safe and improves functional capacity, as well as test duration, work load and heart rate response. CLINICAL REHABILITATION IMPACT: It appears that three week cardiac rehabilitation is an effective approach to improve exercise capacity in patients with acute MI treated with PPCI.

Functional status measured by Levine questionnaire in surgically and conservatively treated patients with carpal tunnel syndrome regarding nerve conduction studies.

AIM: To evaluate and compare the functional status in surgically treated patients with Carpal tunnel syndrome (CTS) compared with those treated conservatively by Levine Questionnaire (LQ) in relation to electroneurographic findings. METHODS: The prospective study included 80 patients with diagnosed CTS. Patients were assessed clinically and electrophysiologically. The main outcome measures were sensory latency of median nerve (SL II), and terminal (distal) motor latency of median nerve (TML). For the assessment of functional status we performed Levine Questionnaire (LQ) scoring examination which was divided in two sections: symptoms severity scale (SSS) and functional status scale (FSS). Regarding treatment options patients were divided into 2 groups: group that underwent surgical procedure (Group A) and group that underwent only conservative treatment (Group B). Patients were assessed neurophysiologically twice: before treatment and 12 months after treatment. RESULTS: There is significant increase in LQ-FSS (p=0.021) and LQ-SSS (p=0.038) scores for increased TML and significant increase of LQ-SSS scores (p=0.027) for increased SL II for Group A, while in Group B, LQ-FSS (p=0.034) and LQ-SSS (p=0.018) were significantly increased in patients with increased SL II. After treatment there was significant increase in LQ-FSS (p=0.037) and LQ-SSS (p=0.041) scores for increased SL II for Group B, while in Group A after treatment, we have noticed non-significant differences both regarding TML and SL II values. CONCLUSION: We have demonstrated the benefits of surgical treatment and better functional improvement with symptoms reduction particularly in more severe cases of patients with CTS. KEY WORDS: Carpal tunnel syndrome, Conservative treatment.

COMORBIDITY IMPACT ON SOCIAL FUNCTIONING AFTER HIP FRACTURE: THE ROLE OF REHABILITATION.

OBJECTIVE: To analyze the impact of rehabilitation treatment on social functioning in elderly patients after hip fracture during a rehabilitation program. METHODS: This study included 203 patients with hip fracture. Four groups were analyzed on rehabilitation: Group 1, at admission, Group 2, at discharge, Group 3, three months after discharge and Group 4, six months after discharge. The analyzed parameters included: musculoskeletal, neurological and cognitive impairments. Impairment severity was graded by cumulative index rating scale for geriatrics (CIRS-G). Evaluation of social functioning was completed by social functioning component (SFC) from quality of life (SF-36) questionnaire. RESULTS: There was a significant improvement in SF-36 SFC values for observed impairments from admission to six months after discharge for each severity degree (p<0.01), except for CIRS-G severity degree 4 for cognitive impairment, where significance was p<0.05. For the group of patients with musculoskeletal impairment, there was a significant difference between the values of SF-36 SFC concerning different severity degrees of CIRS-G only at six months after discharge (p<0.05). Patients with neurological or cognitive impairments have shown significant differences between the values of SF-36 SFC in regard to severity degrees of CIRS-G in all observational groups. CONCLUSION: Different degrees of observed impairments influence the degree of social functioning recovery in the elderly after hip fracture.Level of Evidence II, Prognostic Studies .

Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome.

OBJECTIVE: This study investigated the short-term efficacy of low-level laser therapy (LLLT) in patients with mild to moderate carpal tunnel syndrome (CTS), lasting for <1 year. METHODS: Seventy-nine patients with CTS were included in this double-blind, placebo-controlled study, and randomly divided in two treatment groups: Experimental group (EG), active laser group (40 patients); and control group (CG), placebo (sham) laser group (39 patients). A GaAlAs diode laser [780 nm, 30 mW continuous wave (CW), 0.785 cm(2), 38.2 mW/cm(2)] was applied in contact with four points perpendicularly to the skin over the carpal tunnel area for 90 sec per point (2.7 J, 3.4 J/cm(2)/point). Both groups were treated five times per week, once a day over 2 weeks, followed by 10 treatments every other day for 3 weeks, that is, for a total of 20 treatments. Clinical assessment, including visual analogue scale (VAS) pain rating, Tinel's sign, and median nerve conduction studies (NCSs) were evaluated before, and 3 weeks after, the last LLLT treatment. RESULTS: Significant reduction in pain, reduction in the percentage of patients with a positive Tinel's sign, and shortening of sensory and motor latency time in the NCS examination was observed in the experimental LLLT group (but not in the control group). CONCLUSIONS: This study has observed and documented the statistically significant short-term effects of LLLT on CTS patients in comparison with a placebo group. The results support this conclusion, especially if the LLLT is applied in the earlier stages of CTS, and with mild to moderate cases.

Estimation of functional recovery in patients after hip fracture by Berg Balance Scale regarding the sex, age and comorbidity of participants.

AIM: To evaluate the functional status measured by Berg Balance Scale (BBS) in elderly aged more than 65 years after hip fractures, and to evaluate the influence of sex, age and comorbidity on balance function improvement. METHODS: The study included 203 patients with hip fractures. Functional status was evaluated by BBS: at admission (Group 1), at discharge (Group 2) and 3 months after discharge (Group 3). We analyzed three age groups: Group 65-74 , Group 75-84 and Group 85-up; female and male sex separately; and for severity index value (SI; total cumulative illness rating scale for geriatrics score divided by number of endorsed categories): group between 0-1.99 (SI1 ) and group ≥ 2 (SI2 ). RESULTS: BBS values significantly declined in all male groups and female Group 2 and Group 3 in SI2 (P < 0.01). Group 65-74 and Group 85-up had a significant BBS values decline in Group 2 and Group 3, whereas Group 75-84 had a significant decline in all groups in the SI2 group (P < 0.01). Females and males had a significant BBS values increase in the SI1 groups (P < 0.01), and non-significant BBS values increase between Group 2/Group 3 for SI2 . Group85-up had a significant BBS values increase in SI1 (Group 1/Group 2 and Group 1/Group 3; P < 0.01); a non-significant increase between Group 1/Group 2 and Group 1/Group 3, and a non-significant decline between Group 2/Group 3 in SI2. CONCLUSIONS: Male sex, increased comorbidity and age more than 85 years could be considered with lower functional recovery capacity potential after hip fracture, and thus should be individually assessed and continuously monitored. Functional status estimation by BBS could be taken as a sensitive predictive value for the evaluation of functional improvement in these patients.

Vitamin D and parathyroid hormone in relation to bone mineral density in postmenopausal women.

BACKGROUND/AIM: Despite vitamin D insufficiency being widely reported, in Serbia the epidemiological data lack information regarding vitamin D status in the sera of postmenopausal women. The aim of this study was to establish the prevalence of inadequate serum 25-hydroxyvitamin D [25(OH)D] concentrations in postmenopausal Serbian women with seasonal variations of 25(OH)D, in relation to parathyroid hormone (PTH) and bone mineral density (BMD). METHODS: A total of 95 postmenopausal women, mean age 65.1 +/- 9.08 years, were examined. Measurements of 25(OH)D and PTH were performed both in the winter and the summer period, using electrochemiluminiscence immunoassays. BMD (g/cm2) was measured by the dual-energy x-Ray absortimetry (DXA) method on the spine and hip areas. RESULTS: A decreased value of vitamin D (< 75 nmol/L) in 88.4% of postmenopausal women and an elevated level of PTH (> 65 pg/mL) in 25.3% of the cases were found. Elevated PTH varied individually, but was mostly increased if 25(OH)D was equal or lower than 37.6 nmol/L. 25(OH)D insufficiency was found in winter in 94.5% and in summer in 80% of the cases (p < 0.01). The mean of the PTH was higher (p < 0.05) in winter than in summer. A significant negative correlation between 25(OH)D and PTH (p < 0.001) was proved. Correlation between 25(OH)D and PTH with BMD at lumbar spine was established in the whole group, but at the femoral neck in women aged over 65 years (p < 0.05). CONCLUSION: Our results showed a high prevalence of vitamin D insufficiency (88.4%) among postmenopausal women. The levels of 25(OH)D and PTH changed significantly according to the season.

Insulin-like growth factor-I in wound healing of rat skin.

Growth factors play an important role in orchestrating and enabling the cellular responses required for successful wound healing. In the present study, rat surgical incision was used to investigate insulin-like growth factor-I (IGF-I) expression in skin cells as well as its systemic and cutaneous tissue concentrations during acute phase of wound healing. Thirty two animals were sacrificed at days 2, 3, 5 and 9 after surgery. Eight animals were used as control. Tissue expression of IGF-I in both incisional and periincisional skin areas, as well as in skin of control unwounded animals was determined by immunohistochemistry. Serum and tissue concentrations of IGF-I were measured using RIA. Immunohistochemical analysis revealed enhanced IGF-I immunostaining in the incisional area at day 2 post-wounding. Presence of IGF-I immunoreactivity in the epidermis, as well as in dermal fibroblasts and monocytes within perivascular inflammatory infiltrate suggests its local synthesis. Although serum levels of IGF-I were not altered during wound healing, their tissue contents in the incisional area were significantly increased compared with periincisional area at days 2 and 3 after injury, as well as compared with skin content of unwounded control rats in all examined time points. Obtained results support a paracrine role of IGF-I during the acute phase of wound healing by primary intention in the rat.