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Falls, fractures and function. Focus on women with a distal forearm fracture

Nordell, Eva LU (2003)
Abstract (Swedish)
Popular Abstract in Swedish

Fall och frakturer hos äldre är ett vanligt förekommande och ökande hälsoproblem, som orsakar fysiska, sociala och psykologiska problem hos den enskilde och är kostsamt för samhället. Syftet med avhandlingen är att undersöka fallolyckor bland de patienter i åldern 65-74 år som kommit till ortopedklinikens akutmottagning, att undersöka reliabiliteten beträffande gångtest i den modifierade balansåttan (MFE), och att jämföra den med andra balanstest, att undersöka om patienter som ådragit sig en distal underarmsfraktur uppvisar riskfaktorer för nya fall och frakturer och att följa fysisk funktion och utvärdera hälsorelaterad livskvalitet hos kvinnor med en distal underarmsfraktur. Fraktur uppstod i... (More)
Popular Abstract in Swedish

Fall och frakturer hos äldre är ett vanligt förekommande och ökande hälsoproblem, som orsakar fysiska, sociala och psykologiska problem hos den enskilde och är kostsamt för samhället. Syftet med avhandlingen är att undersöka fallolyckor bland de patienter i åldern 65-74 år som kommit till ortopedklinikens akutmottagning, att undersöka reliabiliteten beträffande gångtest i den modifierade balansåttan (MFE), och att jämföra den med andra balanstest, att undersöka om patienter som ådragit sig en distal underarmsfraktur uppvisar riskfaktorer för nya fall och frakturer och att följa fysisk funktion och utvärdera hälsorelaterad livskvalitet hos kvinnor med en distal underarmsfraktur. Fraktur uppstod i 72% av fallolyckorna. Fler kvinnor än män ådrog sig frakturer och den vanligaste frakturen var en distal underarmsfraktur. En tredjedel lades in på sjukhus. Patienter som inte var helt friska fick oftare en fraktur. Information om riskfaktorer för fall och frakturer dokumenterades ofta inte i patientjournalerna. Fullständig dokumentation är en förutsättning för att kunna bedriva fall- och frakturprevention. Två personer undersökte balansförmågan hos äldre kvinnor, vid två tillfällen med en veckas mellanrum. Testen var MFE, enbensstående, tandemstående, stående på en bit skumgummi och gångtest. Interbedömarreliabiliteten var hög till mycket hög i samtliga test. MFE-tiden korrelerade signifikant med gångtesten. MFE visade hög reliabilitet och tillfredsställande samtidig validitet, och kan rekommenderas för användning av olika bedömare och över tid. Sextiosex patienter som ådragit sig en distal underarmsfraktur vid fall, undersöktes kort tid efter frakturen. Majoriteten var fysiskt aktiva. En tredjedel rapporterade tidigare fall och frakturer. Hälften av patienterna undersöktes regelbundet på grund av kroniska sjukdomstillstånd och hälften medicinerade regelbundet. Deras fysiska förmåga överensstämde med friska personers i motsvarande åldrar. Ett år efter frakturen undersöktes 43 kvinnor. Handgreppsstyrka och gånghastighet visade en signifikant minskning. De kvinnor som rapporterade sjukdomar och rapporterade låg fysisk aktivitet, hade lägre poäng i de två frågeformulären om hälsorelaterad livskvalitet som de fyllde i; EQ-5D och SF-12. Utöver frakturbehandling bör patienter som ådragit sig en distal underarmsfraktur vid fall, bli undersökta avseende fall- och frakturrisk, och få sekundärpreventiva åtgärder beträffande fall och frakturer. Behandling, utöver frakturbehandling, med inriktning mot behållen fysisk förmåga bland dessa patienter bör undersökas närmare. Låga resultat i frågeformulären om hälsorelaterad livskvalitet kan peka på underliggande sjuklighet, som inte framkommer vid test av den fysiska förmågan. Dessa patienter bör remitteras för vidare hälso- och sjukvård. Det finns ett starkt samband mellan fall och frakturer hos äldre personer. Även om de flesta fall inte resulterar i en fraktur, uppstår de allra flesta frakturerna vid ett fall hos äldre personer. Det finns ett stort behov av att öka medvetenheten bland vårdgivare beträffande fall, frakturer och funktion. Lokala handlingsplaner och riktlinjer för frakturbehandling bör innefatta prevention med fokus på fall och funktion. (Less)
Abstract
Falls and fractures in older people are a common and increasing health problem which causes physical, social and psychological problems for the individual and is costly to society. The aims of this thesis were to investigate accidental falls of patients aged 65 - 74 who attended an orthopedic emergency ward, to investigate reliability of the modified figure of eight (MFE) and compare it with other balance performance tests, to investigate whether patients with a distal forearm fracture exhibited risk factors for new falls and fractures, and to follow physical performance and evaluate health-related quality of life in women after a distal forearm fracture. In the accidental falls, 72% led to fractures. More women than men sustained... (More)
Falls and fractures in older people are a common and increasing health problem which causes physical, social and psychological problems for the individual and is costly to society. The aims of this thesis were to investigate accidental falls of patients aged 65 - 74 who attended an orthopedic emergency ward, to investigate reliability of the modified figure of eight (MFE) and compare it with other balance performance tests, to investigate whether patients with a distal forearm fracture exhibited risk factors for new falls and fractures, and to follow physical performance and evaluate health-related quality of life in women after a distal forearm fracture. In the accidental falls, 72% led to fractures. More women than men sustained fractures and the most common fracture was a distal forearm fracture. One third were admitted to hospital. Patients who were less healthy sustained fractures more often. Information regarding risk factors for falls and fractures were often not documented in the patients’ medical files. Satisfactory documentation is a prerequisite for prevention measures for further falls and fractures. Two examiners measured balance capacity in elderly women on two occasions with one week in between. The tests were MFE, one-legged stance, tandem stance, standing on foam and walking tests. There was a high to very high inter-rater reliability for all the tests. MFE-time significantly correlated to walking speed. The MFE was highly reliable, showed satisfactory concurrent validity and can be recommended for use by different examiners and over time. Sixty-six patients with a fall-related distal forearm fracture were examined shortly after the fracture. The majority of the patients were physically active. One third reported previous falls and fall-related fractures. Half of the patients were regularly examined for chronic ailments and were on regular medication. Their physical performance was comparable to a healthy population of the same age. One year after the fracture, 43 women came for a follow-up. A significant decrease in handgrip strength and walking speed was found. Women who reported comorbidity and low physical activity scored lower in the two health-related quality of life (HRQoL) questionnaires; EQ-5D and SF-12. Besides the fracture treatment, patients with a fall-related distal forearm fracture should be screened for fall and fracture risk, and be targeted for secondary preventive measures for falls and fractures. Additional treatment aimed at maintaining physical capacity should be further explored for this patient group. Low results in HRQoL questionnaires might indicate underlying comorbidity, not captured by physical performance tests alone. Those patients should be referred to continued health care. There is a strong relationship between falls and fractures in elderly persons. Although most falls do not result in a fracture, a majority of fractures in the elderly are sustained in a fall. There is a great need for increased awareness among the caregivers concerning falls, fractures and function. Local action plans and fracture treatment protocols should include preventive measures with the focus on falls and function. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Professor Svensson, Olle, Umeå Universitet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Physical medicine, elderly, falls, Distal forearm fracture, fractures, health-related quality of life, risk factors, physical performance, rehabilitation, Rehabilitering (medicinsk och social), kinesitherapy, revalidation
pages
120 pages
publisher
Department of Physical Therapy, Lund University Hospital
defense location
Universitetssjukhuset, Lund
defense date
2003-05-09 10:15
ISBN
91-628-5618-9
language
English
LU publication?
yes
id
1f044f40-1b6b-4360-8762-747bac916041 (old id 465652)
date added to LUP
2007-09-27 14:09:51
date last changed
2016-09-19 08:45:07
@misc{1f044f40-1b6b-4360-8762-747bac916041,
  abstract     = {Falls and fractures in older people are a common and increasing health problem which causes physical, social and psychological problems for the individual and is costly to society. The aims of this thesis were to investigate accidental falls of patients aged 65 - 74 who attended an orthopedic emergency ward, to investigate reliability of the modified figure of eight (MFE) and compare it with other balance performance tests, to investigate whether patients with a distal forearm fracture exhibited risk factors for new falls and fractures, and to follow physical performance and evaluate health-related quality of life in women after a distal forearm fracture. In the accidental falls, 72% led to fractures. More women than men sustained fractures and the most common fracture was a distal forearm fracture. One third were admitted to hospital. Patients who were less healthy sustained fractures more often. Information regarding risk factors for falls and fractures were often not documented in the patients’ medical files. Satisfactory documentation is a prerequisite for prevention measures for further falls and fractures. Two examiners measured balance capacity in elderly women on two occasions with one week in between. The tests were MFE, one-legged stance, tandem stance, standing on foam and walking tests. There was a high to very high inter-rater reliability for all the tests. MFE-time significantly correlated to walking speed. The MFE was highly reliable, showed satisfactory concurrent validity and can be recommended for use by different examiners and over time. Sixty-six patients with a fall-related distal forearm fracture were examined shortly after the fracture. The majority of the patients were physically active. One third reported previous falls and fall-related fractures. Half of the patients were regularly examined for chronic ailments and were on regular medication. Their physical performance was comparable to a healthy population of the same age. One year after the fracture, 43 women came for a follow-up. A significant decrease in handgrip strength and walking speed was found. Women who reported comorbidity and low physical activity scored lower in the two health-related quality of life (HRQoL) questionnaires; EQ-5D and SF-12. Besides the fracture treatment, patients with a fall-related distal forearm fracture should be screened for fall and fracture risk, and be targeted for secondary preventive measures for falls and fractures. Additional treatment aimed at maintaining physical capacity should be further explored for this patient group. Low results in HRQoL questionnaires might indicate underlying comorbidity, not captured by physical performance tests alone. Those patients should be referred to continued health care. There is a strong relationship between falls and fractures in elderly persons. Although most falls do not result in a fracture, a majority of fractures in the elderly are sustained in a fall. There is a great need for increased awareness among the caregivers concerning falls, fractures and function. Local action plans and fracture treatment protocols should include preventive measures with the focus on falls and function.},
  author       = {Nordell, Eva},
  isbn         = {91-628-5618-9},
  keyword      = {Physical medicine,elderly,falls,Distal forearm fracture,fractures,health-related quality of life,risk factors,physical performance,rehabilitation,Rehabilitering (medicinsk och social),kinesitherapy,revalidation},
  language     = {eng},
  pages        = {120},
  publisher    = {ARRAY(0x8df5870)},
  title        = {Falls, fractures and function. Focus on women with a distal forearm fracture},
  year         = {2003},
}