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PubMed2005

Changes in personal control as a predictor of quality of life after pulmonary rehabilitation.

OBJECTIVE: Perceptions of mastery and self-efficacy may be related to better outcomes in pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). This study examined (1) whether patients with COPD improved during a rehabilitation programme with respect to quality of life (QoL) and perceptions of self-efficacy and mastery, and (2) whether increased perceptions of mastery and self-efficacy contributed to a higher QoL after rehabilitation. METHODS: Thirty-nine consecutive COPD patients (aged 60.5 +/- 9.0) were included from a rehabilitation centre and completed self-report questionnaires assessing symptoms, QoL, and perceptions of personal control. RESULTS: COPD patients improved during rehabilitation in overall QoL and self-efficacy, although no significant changes were found in QoL domains and mastery. Changes in self-efficacy during rehabilitation contributed to the explanation of the social and psychological functioning QoL domains. CONCLUSION: Even in seriously impaired COPD patients in advanced stages of illness, positive changes in self-efficacy and overall well-being can be established during rehabilitation. Changes in self-efficacy were related to a better QoL, suggesting the importance of personal control in the adjustment to COPD. PRACTICE IMPLICATIONS: Focussing more explicitly on the enhancement of perceptions of personal control in COPD patients may be an important aim of pulmonary rehabilitation.

Aged↗
PubMed1999

Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture?

OBJECTIVES: To determine the effect of cognitive status at admission on functional gain during rehabilitation of elderly hip-fractured patients. DESIGN: Cohort study. SETTING: A hospital geriatric rehabilitation department. PATIENTS: Two hundred twenty-four elderly patients admitted consecutively for rehabilitation after surgery for hip fracture. MEASUREMENTS: Cognitive status was assessed by the Mini-Mental State Examination and the cognitive subscale of the Functional Independence Measure (cognFIM); functional status was assessed by the motor subscale of FIM; absolute functional gain was determined by the motor FIM gain (deltamotFIM); and relative functional gain (based on the potential for improvement) by the Montebello rehabilitation factor score (MRFS). RESULTS: A significant increase in FIM scores (19.7) occurred during rehabilitation, mainly due to motor functioning (19.1). When the relative functional gain (as measured by both motor MRFS efficacy [r = .591] and efficiency [r = .376] was compared with the absolute gain (as measured by deltamotFIM [r = .304]), a stronger association between cognFIM and the relative measures was found. In addition, motor FIM efficacy and efficiency were significantly lower in the cognitively impaired patients (p<.01). A better rehabilitation outcome was seen in patients with higher admission cognitive status, adjusting for the effects of age, sex, length of stay, and type of fracture (odds ratio = 2.2, 95% confidence interval 1.5-3.7). CONCLUSIONS: Impaired cognitive status at admission lowered the rehabilitation outcome of elderly hip fracture patients. Cognitive impairment was strongly and directly associated with functional gain in these patients. Absolute motor gain appeared to be independent of cognitive status, whereas the relative motor gain depended on it. These findings support the implementation of comprehensive rehabilitation for selected cognitively impaired elderly hip fracture patients.

Activities of Daily Living↗
PubMed2006

Sexual rehabilitation of women with a spinal cord injury.

STUDY DESIGN: Literature review and a qualitative study. OBJECTIVE: This article reviews literature examining the sexual rehabilitation of women following spinal cord injury (SCI). It includes recommendations for improvements in initial clinical rehabilitation efforts and counselling services. SETTING: United Kingdom, Denmark and Sweden. METHODS: Articles concerning sexual rehabilitation following SCI from the last two decades have been reviewed and critiqued. Qualitative results from discussions with women with SCI in Denmark and Sweden are presented. RESULTS: The literature focuses on the effect of neurological change on women's ability to achieve sexual arousal and orgasm. Urinary and bowel incontinence, spasticity, vaginal lubrication and autonomic dysreflexia are the physical consequences of SCI that appear to have most impact on sexual activity. More recent studies have acknowledged that psychosocial factors such as age and partnership status may also affect the successful sexual rehabilitation. Discussions with women with SCI in Denmark and Sweden on their reactions to information and counselling offered during rehabilitation revealed an overwhelming need for the exchange of information and experience with other women with SCI, and a desire for opportunities for counselling after initial rehabilitation. CONCLUSION: Successful sexual rehabilitation of women with SCI demands a holistic approach that considers individual neurological, physical and psychosocial circumstances. Peer-counselling could make a significant contribution to the sexual rehabilitation of women with SCI.

Autonomic Nervous System Diseases↗
PubMed2002

A pilot study of pain and attitudes toward pain in a rehabilitation population.

OBJECTIVE: The purpose of this pilot study was to better understand the extent of pain and patient attitudes regarding pain in a rehabilitation hospital. DESIGN: A survey of rehabilitation inpatients focused on pain intensity and patient perceptions of the adequacy and timeliness of pain interventions. SETTING: Academic rehabilitation hospital. PATIENTS: Inpatients in specialty rehabilitation programs. RESULTS: Forty-seven percent of patients surveyed reported experiencing pain in the previous 24 hours. Seventy-four percent of those patients rated their average level of pain at 5 or higher on a 0-10 scale. Fifty-seven percent of patients with pain reported that their pain interfered with their ability to participate in rehabilitation therapies. Additional data were obtained and analyzed to identify patient attitudes toward specific pain interventions and issues. CONCLUSIONS: Pain is highly prevalent in an inpatient rehabilitation hospital setting and is of moderate to severe intensity in the majority of patients who report it. Pain is judged by about half of patients to be a significant negative factor impeding rehabilitation efforts. Despite this, most patients reported satisfaction with pain treatment. Additional study is required to determine whether improvements in pain control might improve rehabilitation efficiency and outcomes.

Journal Article↗
PubMed2001

Long-term effects of in-hospital cardiac rehabilitation on the cardiac risk profile. A case-control study in pairs of siblings with myocardial infarction.

AIMS: In the general population, measures for secondary prevention of myocardial infarction are poorly utilized. Our aim was therefore to analyse whether post-myocardial infarction in-hospital rehabilitation and education programmes improve the subsequent utilization of preventive strategies. METHODS AND RESULTS: We screened 93 500 patient charts in cardiac rehabilitation clinics to identify a myocardial infarction patient with a sibling, who likewise had a myocardial infarction prior to the age of 60 years but was discordant with respect to the participation in cardiac in-hospital rehabilitation. In 92 such sibling pairs the coronary risk profile was studied by standardized questionnaire, biochemical measurements and physical examination. At the time of the acute myocardial infarction, both groups showed an equal risk factor distribution. However, at follow-up (on average 5.5 years after myocardial infarction), rehabilitation-siblings presented with significantly lower systolic (137+/-2 vs 150+/-3 mmHg, P<0.01) and diastolic blood pressure (82+/-1 vs 89+/-1 mmHg, P<0.01). Antihypertensive drug therapy resulted more often in effective (<or=140/90 mmHg) control of blood pressure (58% vs 29%, P<0.01). Blood lipid levels and smoking prevalence tended to be lower in rehabilitation-siblings. Significantly fewer rehabilitation-siblings presented with two or more modifiable risk factors (OR 0.36 (CI 0.17-0.76); P<0.01). There was a strong tendency towards fewer recurrent cardiac events (re-myocardial infarction, coronary angioplasty, coronary artery bypass grafting) during follow-up in rehabilitation-siblings (OR 0.57 (CI 0.31-1.04); P=0.07). CONCLUSION: An in-hospital programme for cardiac rehabilitation may successfully encourage therapy to modify risk factors and thus enhance the long-term implementation of secondary prevention.

Case-Control Studies↗
PubMed1997

The effects of joint damage on muscle function, proprioception and rehabilitation.

SUMMARY. The paper summarizes a series of studies investigating reduced quadriceps femoris activation and its effect on rehabilitation of patients with traumatic and arthritic knee damage. It incorporates findings from related research fields and speculates on the physiological causes of reduced voluntary activation following joint damage and its clinical implications. Arthrogenic reduction in voluntary activation is the inability to maximally activate muscles acting across damaged joints. This phenomenon may cause muscle weakness by preventing complete activation of the muscle and if prolonged may result in muscle fibre atrophy, and may possibly impede rehabilitation. In patients with anterior cruciate ligament (ACL) deficient knees the reduction in quadriceps femoris activation was related to the amount of joint damage sustained and caused some quadriceps femoris weakness. Patients with isolated ACL ruptures had a small reduction of quadriceps femoris activation that did not impede conservative rehabilitation. However, patients with ACL ruptures and associated joint damage had a large reduction in activation and responded poorly to rehabilitation. Operative stabilization of ACL-deficient limbs may increase activation and improve efficacy of rehabilitation. Quadriceps femoris activation was also reduced in patients with mild knee osteoarthritis, who responded well to rehabilitation. Following joint damage, abnormal articular afferent information may decrease alpha-motoneurone excitability, reducing voluntary quadriceps femoris activation. If joint damage is extensive the resulting large reduction in activation may prevent the threshold for stimulation of muscle hypertrophy from being reached, which impedes rehabilitation. Abnormal articular afferent information may also decrease gamma-motoneurone excitability causing proprioceptive deficits. Rehabilitation which increases alpha-motoneurone excitability may also increase gamma-motoneurone excitability, improving proprioception. Copyright 1997 Harcourt Publishers Ltd.

Journal Article↗
PubMed1999

[Deep vein thrombosis following total arthroplasty hip replacement. Ultrasonographic screening in the rehabilitation phase].

UNLABELLED: Deep vein thrombosis requires intensive therapy--either the patients require hospitalisation or their rehabilitation scheme must be adjusted and medical treatment applied. The total number of patients with deep vein thrombosis undetected before admission to rehabilitation facilities is unknown. AIM: Study parameters: 1. The occurrence of undetected deep vein thrombosis upon admittance to a rehabilitation facility. 2. The value of sonography in diagnosing, localising and determining the extent of deep vein thrombosis and 3. the influence of prophylactic antithrombotic treatment applied in the surgical hospital, as well as during the intermittent outpatient phase before admittance to the rehabilitation centre, on the occurrence of deep vein thrombosis. METHODS: 305 patients were examined between Nov. 95 and Dec. 96. The first check was carried out on the day of admission (on the 26th postoperative day, on average). The second check was done on the day of discharge from the rehabilitation centre. RESULTS: Deep vein thrombosis was found in 30 patients (10%). In 27 cases the thrombosis was located in the thigh, in one case it was found in the contralateral leg. 18 of these patients had been discharged from the surgical hospital on the 22nd postoperative day, for an average time of 7 days of outpatient care, before being admitted to the rehabilitation centre. 11 of these patients had not received any prophylactic antithrombotic treatment. One patient developed deep vein thrombosis of the thigh during the rehabilitation phase despite of prophylactic treatment. CONCLUSION: Postoperative sonographic screening of all patients undergoing hip surgery is a useful method to detect deep vein thrombosis. Prophylactic postoperative antithrombotic treatment in the rehabilitation phase is mandatory.

Aged↗
PubMed2000

[Goal-oriented measurement of short-, medium- and long-term effects in pneumological rehabilitation].

UNLABELLED: Assessment of goal-oriented short-, mean-, and long-term effects in pneumological rehabilitation: Despite of increasing quality in rehabilitation, the amount of treatment in pneumological rehabilitation has decreased by 40% in the last few years. A typical mark of quality is determination of individual objectives to reach a goal of therapy. METHODS: In 566 patients (381 male, 185 female, mean age 47.0 year, body mass index 27.5 kg/m2) goals have been assessed by a questionnaire given at the beginning, the end, 6, and 12 months after rehabilitation. The effect size (ES) of single symptoms, defined as difference between initial and following score values, divided by their standard deviation was used as mild (ES < 0.4), mean (ES < 0.8), or strong (ES > = 0.8) effect. Only those patients were considered, who initially rated for "often" and "very often" in a single symptom. RESULTS: At the end of rehabilitation the effect size was strong in 22 of 24 symptoms, mainly nocturnal symptoms. After 12 months 9 symptoms still revealed strong, and 12 mean effect sizes. These mainly again concerned nocturnal symptoms as palpation of the heart, breathlessness, cough, sweating, and headache, but even diurnal tiredness, spontaneously falling asleep, and lack of concentration revealed ES > 0.8. Additionally in 46 patients, who were incapable for work in more than 6 weeks the year before rehabilitation, a reduction of 81 days off job was measured in the year after rehabilitation. DISCUSSION: The definition of aims of therapy is a mark of quality, and ES proves as a sensitive instrument of assessment, giving remarkable effects even one year after medical rehabilitation.

Female↗
PubMed2003

[Demands for a new, patient oriented rehabilitation].

A new orientation of rehabilitation in Germany has been initiated by the social political representatives in legislation and government, based on conceptualizations of self help movements in Europe and Germany. The goal is to form a new rehabilitation which is dedicated to participation and partnership of citizens with disability ("Nothing about us without us"). Empowerment is envisaged and resources supplied by legislation to allow to implement these new concepts (personal budget). To guarantee these new rights they have been codified in a new, 9th book of the German social code (Sozialgesetzbuch IX, SGB IX). This new perspective gives rise to major evolutionary impulses in rehabilitation, notably disabled persons' participation in self-assessment, in formulating their rehabilitation goals, determining and controlling the rehabilitation process, terminating rehabilitation (co-signing their discharge reports), as well as evaluating the outcome (quality control of rehabilitation results). They have the right to get all their medical information (right of informational independence). Seven guidelines of people with disability are formulated to support implementation of the new rehabilitation.

Persons with Disabilities↗
PubMed2006

[How relevant are the benefits for participation at working life for psychosomatic inpatient rehabilitation].

Beside the stabilization of the health status the reintegration into employment are the main ambitions of the medical rehabilitation. Thereby occupational rehabilitation plays an important role in the rehabilitation system. To recommend occupational rehabilitation physicians have to know the requirements patients have to comply with. In addition formal conditions of the medical report upon discharge have to be accomplish that benefits for participation at working life will be provided by the pension insurance. In our study the differences of the amount of recommendation for occupational rehabilitation and the appraisal of the ability to work in the medical reports upon discharge of psychosomatic and orthopaedic patients are examined. The results show that psychosomatic patients achieved significantly less recommendations for occupational rehabilitation than orthopaedic patients. At the same time more psychosomatic patients who achieved the recommendation didn't claim benefits for participation at working life. In addition orthopaedic patients get a rehabilitation approval certification more often than psychosomatic patients. At the same time it appears that maybe the recommending clinics were insecure about the connection between the occupational capacity assessment and the recommendations for benefits for participation at work life. The outcomes presume that work place problems in medical rehabilitation are not taken into consideration adequately.

Employment↗
PubMed2006

[Interventions in the rehabilitation of breast cancer patients--a critical literature review of the state of the art].

On account of the "rehabilitation sciences" research funding programme of the German federal research ministry and the statutory German Pension Insurance scheme, as well as an extensive Pension Insurance quality assurance programme, major scientific progress has been achieved in rehabilitation in terms of structures, processes and outcomes. Continuing the systematic assessment and evaluation of the increasing knowledge available, the German Pension Insurance scheme has introduced a comprehensive practice guidelines programme for the development of process guidelines in rehabilitation. In the framework of this sponsored programme and exemplary for the field of cancer rehabilitation, practice guidelines are also being developed for the rehabilitation of breast cancer patients. This article summarises the results of the first phase of this project, which had included a systematic literature analysis of the interventions in the rehabilitation of breast cancer patients, an analysis aimed at verifying whether these interventions had been evidence-based as well as at deriving specific recommendations for treatment in the framework of in-patient rehabilitation. The existing national and international guidelines for the treatment of breast cancer were analysed for this purpose, and a systematic search of the established literature databases (Medline, Psyndex, PsycINFO, CINAHL, DIMDI and EBMR) was carried out. Both ambulatory and in-patient interventions were included, whereas diagnostic, medical and nursing procedures as well as drug trials were excluded from the analysis. In all, some 200 articles have eventually been extracted for systematic analysis from a total of 480,317 articles. The articles were analysed and evaluated according to the Oxford Level of Evidence. Various interventions for breast cancer patients could be validated as treatment modules by this literature analysis, such as: relaxation techniques, physiotherapy, sport therapy, massage, lymph drainage, psycho-social counselling and therapies as well as artistic therapies. There are considerable differences among the modules with respect to their various levels of evidence. Whereas good levels of evidence could be found for relaxation techniques, sport therapy and psycho-social counselling and therapy, only a low level of evidence was found for lymph drainage and artistic therapies. In summary, it can be stated that different levels of evidence are applicable concerning the various interventions available in the rehabilitation of breast cancer patients. The next step ahead toward development of treatment guidelines will involve systematic consultations with experts in this field.

Breast Neoplasms↗
PubMedDate not supplied

[Effectiveness of rehabilitation measures from the orthopedic viewpoint].

The investigations reported here were prompted by the rapid increase in the amount of rehabilitation treatment performed in recent years and the high costs it incurs. The patients considered had all undergone orthopedic treatment. Rehabilitation treatment lasted between 4 and 6 weeks. On the basis of certain criteria (alleviation of pain, improvement of function) it was attempted to show what degree of success can be achieved with rehabilitation measures following disc operations, total hip and knee-joint replacements and degenerative changes of the spine. In view of their high cost rehabilitation measures would not be justifiable if equally satisfactory results could be achieved by less costly methods. However, a complex therapeutic program generally cannot be carried out adequately on an outpatient basis. While surveys of effectiveness conducted by numerous authors have shown that considerable savings are possible in terms of general and insurance costs (Gercke 1977), accurate indication and careful assessment of the necessity for a cure are essential. The authors' investigations in 4 rehabilitation groups revealed that in a high percentage of the patients not only subjective alleviation of pain but also genuine, measurable functional improvements were achieved. Rehabilitation is one of the most important elements of pension insurance schemes: the dictum here is that "rehabilitation has priority over pensions". Nevertheless, the low chance of success assumed by pension applicants during rehabilitation should be taken into account. These patients, who are only interested in the success of their pension applications, regard the chances of success as practically non-existent.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1999

Clinical and cost effectiveness of post-acute neurobehavioural rehabilitation.

The value of post-acute, community based social and behavioural rehabilitation for people with serious neurobehavioural disability has been the subject of a dispute for a number of years. Some authorities doubt that major changes in social adaptability and independence is possible several years post-injury. This paper attempts to assess both the clinical and cost effectiveness of such rehabilitation on a group who have suffered serious brain injury and display behaviour problems and cognitive deficits which prevent them living as independent members of the community. The discharge and follow-up data on 76 people who have received rehabilitation indicates that, with a minimum of 6 months rehabilitation, many severely damaged individuals can progress to less dependent placements in the community, and maintain higher levels of social activity (independence) with fewer hours of care support. This can amount to a per capita lifetime reduction of over 1 million pounds per annum in the cost of supporting such people in the community. Time between injury and the beginning of rehabilitation is a factor influencing outcome but longer periods of rehabilitation (beyond 12 months for the most seriously disabled) is not associated with a better outcome, measured by a reduction in care hours. The cost effectiveness of rehabilitation is greater for those who receive treatment within 2 years of injury. However, those who received rehabilitation at later stages also achieved significant social outcomes and savings on care hours.

Acute Disease↗
PubMed2000

Severe anaemia: implications for functional recovery during rehabilitation.

PURPOSE: This case report examines the hospital course and functional recovery of a geriatric patient with severe anaemia undergoing rehabilitation following total hip replacement. It serves to highlight the need for further study of the impact of anaemia on recovery in the rehabilitation setting as well as the importance of developing clinical guidelines for the appropriate medical management of anaemia in this patient population. METHODS: Single case report. RESULTS: The course of recovery during rehabilitation in a geriatric patient with severe post-operative anaemia was notably different from other geriatric patients undergoing rehabilitation following total hip replacement. The patient demonstrated a markedly reduced tolerance for therapies and prolonged length of stay, but did not experience cardiopulmonary complications during intensive rehabilitation. Her hematocrit responded nicely to treatment with human recombinant erythropoietin. Despite a prolonged recovery period, the patient ultimately progressed well and achieved a good functional outcome. CONCLUSIONS: The impact of anaemia on functional recovery in the acute inpatient rehabilitation setting as well as the theoretical risk of increased morbidity and mortality during prescribed therapeutic exercise has not been closely examined in the literature. Further study is indicated to examine the implications for anaemia on functional recovery and cardiopulmonary complications during rehabilitation. General guidelines should be developed for the management of anaemia in the rehabilitation setting.

Activities of Daily Living↗
PubMed2002

On autonomy and participation in rehabilitation.

PURPOSE: To explore the concept of autonomy as a basis for social participation, with particular reference to rehabilitation. METHOD: A study of relevant literature from the field of rehabilitation, building on theory developed in other fields (ethics, social sciences), and deriving important concepts and strategies for rehabilitation practice. RESULTS: The focus of rehabilitation for people with a chronic disabling condition is shifting from a biomedical to a client-centred perspective. Conceptions of autonomy vary among individuals and cultures, but a crucial distinction can be made between decisional autonomy (the ability to make decisions without external restraint) and executional autonomy (the ability to act as one wishes). The liberal-individualist account of autonomy over-emphasizes physical independence and does not sufficiently recognize the inter-dependency of all people, including those with disabilities. An ethic of care, complementary to the principle of respect for autonomy, should guide the development of rehabilitation strategies to enhance individual autonomy and participation in daily living. For rehabilitation, this entails an attentive attitude, maximizing opportunities for informed choices, taking full account of each person's preferences, needs and social contexts. CONCLUSIONS: Autonomy is central to client-centred rehabilitation since it is a pre-requisite for effective participation. It is suggested that autonomy, conceived as a basis for participation, is the ultimate aim of rehabilitation.

Adaptation, Psychological↗
PubMed2004

Effects of counsellor race on racial stereotypes of rehabilitation counselling clients.

PURPOSE: This study investigated perceptions of European American, African American, and Asian American rehabilitation graduate students in rehabilitation counselling by assessing their clinical impressions of African American, European American, and Asian American clients. This investigation is a continuation of several studies investigating clinical perceptions and client race. METHOD: Rehabilitation graduate students in rehabilitation counselling participating in this study were randomly assigned to one of three groups and were asked to review case materials for a client portrayed either as African American, European American, or Asian American. In pursuit of the main effect of client race, three separate MANOVA analyses were conducted: one for African American graduate students in rehabilitation counselling, one for Asian American graduate students in rehabilitation counselling, and one for European American graduate students in rehabilitation counselling. RESULTS: Contrary to previous findings from comparable research, MANOVA results did not reveal a significant main effect of bias by European American, Asian American, and African American graduate students in rehabilitation counselling against any of the three groups. CONCLUSIONS: Understanding of the conditions in which racial biases and subsequent judgmental errors are likely to occur (or not occur) should allow clinicians to recognise tendencies for their assessments to be influenced by client characteristics that elicit stereotypes and thereby to make more accurate judgements.

Adult↗
PubMed2005

Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial).

BACKGROUND: delirium is a frequent adverse consequence of hospitalisation for older patients, but there has been little research into its prevention. A recent study of Hospital in the Home (admission substitution) noted less delirium in the home-treated group. SETTING: a tertiary referral teaching hospital in Sydney, Australia. METHODS: we randomised 104 consecutive patients referred for geriatric rehabilitation to be treated in one of two ways, either in Hospital in the Home (early discharge) or in hospital, in a rehabilitation ward. We compared the occurrence of delirium measured by the confusion assessment method. Secondary outcome measures were length of stay, hospital bed days, cost of acute care and rehabilitation, functional independence measure (FIM), Mini-Mental State Examination (MMSE) and geriatric depression score (GDS) assessed on discharge and at 1- and 6-month follow-up and patient satisfaction. RESULTS: the home group had lower odds of developing delirium during rehabilitation [odds ratio (OR) = 0.17; 95% confidence interval 0.03-0.65], shorter duration of rehabilitation (15.97 versus 23.09 days; P = 0.0164) and used less hospital bed days (20.31 versus 40.09, P < or = 0.0001). The cost was lower for the acute plus rehabilitation phases (7,680 pounds versus 10,598 pounds; P = 0.0109) and the rehabilitation phase alone (2,523 pounds versus 6,100 pounds; P < or = 0.0001). There was no difference in FIM, MMSE or GDS scores. the home group was more satisfied (P = 0.0057). CONCLUSIONS: home rehabilitation for frail elderly after acute hospitalisation is a viable option for selected patients and is associated with a lower risk of delirium, greater patient satisfaction, lower cost and more efficient hospital bed use.

Aged↗
PubMed2005

Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery. METHODS: Sixty elderly patients were included in a randomized, double-blind study comparing 4 days of continuous postoperative epidural infusion of 4 ml/h bupivacaine, 0.125%, and 50 mug/ml morphine versus placebo. Both patient groups received balanced analgesia and intravenous nurse-controlled analgesia with morphine. All patients followed a well-defined multimodal rehabilitation program. Pain, ability to participate in four basic physical functions, and any factors restricting participation were assessed on the first 4 postoperative days during physiotherapy. RESULTS: Epidural analgesia provided superior dynamic analgesia during all basic physical functions, and patients were significantly less restricted by pain, which was the dominating restricting factor in the placebo group. Motor blockade was not a restricting factor during epidural analgesia. Despite improved pain relief, scores for recovery of physical independence were not different between groups. CONCLUSION: Postoperative epidural analgesia after hip fracture surgery provides superior analgesia attenuating pain as a restricting factor during rehabilitation without motor dysfunction. However, superior analgesia did not translate into enhanced rehabilitation. Future studies with multimodal rehabilitation are required to establish whether superior analgesia can be translated into enhanced rehabilitation and reduced morbidity in hip fracture patients.

Aged↗