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Evolução funcional e fatores de prognóstico em idosos com fratura da extremidade proximal do fémur
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Abstract(s)
Introdução: Estima-se que as fraturas da extremidade proximal do fémur (FEPF) atinjam um total de 6.3 milhões de pessoas no mundo. Sabe-se que a recuperação destes utentes depende da integração das suas caraterísticas individuais e clínicas para maximizar o ganho de funcionalidade. Como preditores desta, investigações passadas sugerem o sexo, a idade, o nível cognitivo, o tempo de espera para a cirurgia e a funcionalidade prévia dos utentes. No entanto, na população portuguesa pouco se sabe em relação à evolução funcional destes utentes e quais os fatores associados à mesma.
Objetivo: Este estudo teve como objetivo avaliar a evolução funcional de utentes com FEPF numa região portuguesa, e, averiguar se existe uma associação estatisticamente significativa entre os fatores supracitados e a funcionalidade aos 3 meses após a cirurgia.
Metodologia: Foi realizado um estudo de coorte prospectivo no Hospital de Portalegre com utentes com FEPF. A funcionalidade foi avaliada através do Índice de Barthel (IB) e o nível cognitivo através da Mini Mental State Examination. Para comparar as médias de funcionalidade foi realizado o teste ANOVA de medidas repetidas e utilizado o modelo de regressão linear múltiplo para avaliar as diferentes associações.
Resultados: Noventa e seis (96) utentes completaram o estudo (86% eram do sexo feminino e 71% tinha idade superior a 80 anos). Quarenta e nove porcento (49%) recuperaram a sua funcionalidade prévia. A média da funcionalidade no IB entre a baseline e os 3 meses baixou de 85,7 (±19,8) para 57,9 (±33,8) pontos (p<0,001). Na análise multivariada do modelo de regressão linear múltipla o nível cognitivo (B= 1,86, p<0,001), o tempo de espera para a cirurgia (B= -1,76, p=0,013) e o nível funcional prévio à fratura (B= 0,35, p=0,012) demonstraram ser preditores de funcionalidade. O modelo de regressão utilizado obteve um grau de predição moderado (=54%).
Conclusão: Mais de metade dos participantes não recuperou a sua funcionalidade após a fratura. O nível cognitivo foi o fator que teve maior associação e que explicou maior percentagem da variância da funcionalidade dos participantes. Os utentes com disfunção cognitiva foram aqueles que realizaram menos fisioterapia, sendo que tal poderá ter influenciado a associação entre a funcionalidade e a disfunção cognitiva.
Introduction: It is estimated that hip fractures reach a total of 6.3 million people worldwide. It is known that recovery depends on the integration of patient´s individual and clinical characteristics to maximize the gain of functionality. Some factors that have been shown to influence the prognosis of these patients are: gender, age, cognitive level, type of fracture, waiting time until operation and previous functional level. As for the Portuguese population, knowledge is scarce regarding the functional evolution of these patients and what factors are associated with it. Aim: The purpose of this study was to evaluate the functional evolution of patients with hip fracture in a Portuguese region and to investigate whether there is a statistically significant association between the referred prognostic factors and the functionality at 3 months after surgery. Methods: A prospective cohort study was carried out at the Hospital of Portalegre with patients admitted to the emergency room due to hip fracture. Functionality was evaluated through the Barthel Index (IB) and the cognitive status through the Mini Mental State Examination. To compare the means of functionality in the different months the ANOVA test of repeated measures was performed and a multiple linear regression model was used to evaluate the different associations. Results: Of the included patients, 96 completed the 3 months of the study (86% were female and 71% were over 80 years of age). Forty-nine percent (49%) recovered their previous functionality. The mean of the Barthel Index functionality between baseline and 3 months decreased from 85,7 (± 19,8) to 57,9 (± 33,8) points (p <0,001). In the multivariate analysis of the multiple linear regression model the cognitive level (B = 1,86, p <0.001), the waiting time for cirurgy (B=-1,76, p = 0.013) and the functional level prior to fracture (B=0,35, p = 0.012) proved to be predictors of functionality. The regression model used had a moderate degree of prediction (= 54%). Conclusion: More than half of the patients did not recover their functionality after the fracture. The cognitive level was the factor that had the greatest association and explained to a greater extent the variance of the participants' functionality. The patients with cognitive dysfunction were those who performed less physiotherapy, and this may have influenced the association between functionality and cognitive dysfunction.
Introduction: It is estimated that hip fractures reach a total of 6.3 million people worldwide. It is known that recovery depends on the integration of patient´s individual and clinical characteristics to maximize the gain of functionality. Some factors that have been shown to influence the prognosis of these patients are: gender, age, cognitive level, type of fracture, waiting time until operation and previous functional level. As for the Portuguese population, knowledge is scarce regarding the functional evolution of these patients and what factors are associated with it. Aim: The purpose of this study was to evaluate the functional evolution of patients with hip fracture in a Portuguese region and to investigate whether there is a statistically significant association between the referred prognostic factors and the functionality at 3 months after surgery. Methods: A prospective cohort study was carried out at the Hospital of Portalegre with patients admitted to the emergency room due to hip fracture. Functionality was evaluated through the Barthel Index (IB) and the cognitive status through the Mini Mental State Examination. To compare the means of functionality in the different months the ANOVA test of repeated measures was performed and a multiple linear regression model was used to evaluate the different associations. Results: Of the included patients, 96 completed the 3 months of the study (86% were female and 71% were over 80 years of age). Forty-nine percent (49%) recovered their previous functionality. The mean of the Barthel Index functionality between baseline and 3 months decreased from 85,7 (± 19,8) to 57,9 (± 33,8) points (p <0,001). In the multivariate analysis of the multiple linear regression model the cognitive level (B = 1,86, p <0.001), the waiting time for cirurgy (B=-1,76, p = 0.013) and the functional level prior to fracture (B=0,35, p = 0.012) proved to be predictors of functionality. The regression model used had a moderate degree of prediction (= 54%). Conclusion: More than half of the patients did not recover their functionality after the fracture. The cognitive level was the factor that had the greatest association and explained to a greater extent the variance of the participants' functionality. The patients with cognitive dysfunction were those who performed less physiotherapy, and this may have influenced the association between functionality and cognitive dysfunction.
Description
Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em Fisioterapia em Condições Músculo-Esqueléticas
Keywords
Fratura anca Função Fatores de Prognóstico Hip Fracture Function Prognostic Factors
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde