A Study of Inter-rater Reliability of Lower Limb Muscle Strength Measurements Using a Hand-held Dynamometer in Patients with Hip Fracture / 日本農村医学会雑誌

　　This study sought to identify whether the inter-rater reliability of lower limb muscle strength measurements made using a hand-held dynamometer differs for patients with hip fracture according to the severity of their cognitive impairment. Of the 144 patients with hip fracture hospitalized at our institution, we excluded 28 from this study (18 with level III, IV, or M of independence in daily living for the demented elderly, 8 with a history of central nervous system disorders, and 2 who were transferred to another department), leaving 116 patients for analysis. These 116 patients were divided into three groups according to their severity of cognitive impairment: 44 with a normal level of independence in daily living for the demented elderly, 38 with level I independence, and 34 with level II independence. We compared the intra-class correlation coefficients and the standard error of measurement between the groups. There were no significant differences in the intra-class correlation coefficients between the groups. The standard error of measurement in the group with level II independence in daily living for the demented elderly was significantly lower than that in the other two groups. These findings indicate that the inter-rater reliability of lower limb muscle strength measurements using a hand-held dynamometer in patients with hip fracture did not differ between patients with mild or moderate cognitive impairment. Furthermore, the inter-rater reliability was high.

Factor Affecting Stair-Climbing Ability of Patients With Hip Factures / 日本農村医学会雑誌

　　The purpose of this study was to identify the factors affecting the stair-climbing ability of patients with hip fractures.　　Out of a total of 75 inpatients with hip fractures, 14 disabled elderly patients, whose ability to perform independently the basic activities of daily living was assessed as rank B or C before injury, and 10 demented elderly patients, whose ability was rank II, III, IV or M, were excluded. The remaining 51 patients were selected for the present study. The subjects were divided into two groups: 19 patients who were able to ascend and descend the stairs (the riser height: 20cm) by holding the handrails and 15 patients who could not.. In another experiment, the 51 subjects were divided into two groups: 19 patients who were able to go up and down the stairs without the aid of the handrails and 32 patients could not. Age, gender, height, weight, fracture type, number of postoperative days, hip abductor strength, knee extensor strength, level of pain, leg length discrepancy, tandem stance time, and stair-climbing ability were investigated.　　First, the correlation between the parameters and stair-climbing ability was verified using a univariate analysis. Subsequently, a multiple logistic regression analysis was performed using the parameters that represent a significant correlation with the stair-climbing ability as the dependent variable.　　These analyses revealed that “non-fractured knee extensor strength” was significantly associated with the stair-climbing ability when the subjects were allowed to use the handrails, while “non-fractured knee extensor strength” and “tandem stance time” were significantly associated with the stair-climbing ability without the aid of the handrails.　　These findings suggested that the improvement of non-fractured knee extensor strength was important for the acquisition of stair-climbing ability with the aid of the handrails and the improvement of static balance as well as non-fractured knee extensor strength was important for the acquisition of stair-climbing ability without the aid of the handrails.