PubMed · 9451355
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
A Mercado, J Meza, L Lamerato. 1998. Geriatric functional assessment.. https://pubmed.ncbi.nlm.nih.gov/9451355/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
BACKGROUND: The management of common low back pain has two principal objectives: to relieve acute pain and to attempt prevention of transition to chronicity. Several studies have shown the ineffectiveness of prolonged periods of bed rest. OBJECTIVE: To compare 4 days of bed rest with continued normal daily activity in acute low back pain, taking into account the type of work (physical or sedentary labor). METHODS: This open, comparative multicenter study enrolled 281 ambulatory patients, ages 18 to 65 years, with low back pain (onset < 72 hours). The subjects did not have pain radiating below the buttocks and did not have work-related injuries. They were randomized into two treatment groups: one instructed to continue normal activity (insofar as the pain allowed), and the other prescribed 4 days of bed rest. After inclusion, patients were seen at three visits: on day 6 or 7, after 1 month, and after 3 months. RESULTS: On day 6 or 7, pain intensity was similar for both groups, as was the overall judgment of the treatment by patients and physicians. At 1 and 3 months, the groups again had equivalent intensity of back pain, functional disability, and vertebral stiffness. A higher proportion of patients in the bed rest group than in the normal activity group had an initial sick leave (86% vs 52%; P < 0.0001). This difference was greater for the patients whose work was sedentary. CONCLUSIONS: For patients with acute low back pain, normal activity is at least equivalent to bed rest. The findings of this study indicate that prescriptions for bed rest, and thus for sick leaves, should be limited when the physical demands of the job are similar to those for daily life activities.
PURPOSE: To describe and compare eating difficulties from admission to discharge, with regard to length of stay (LOS) and discharge to institutional care, as well as in relation to gender. METHOD: Patients, aged 65 or above, admitted for stroke rehabilitation, having at least one eating difficulty were observed (n =108) as regards to eating on admission and at discharge. Analysis followed earlier findings in which eating difficulties had been found to have three components, i.e. ingestion, deglutition and energy. RESULTS: Of the components, ingestion difficulties were the most common, followed by low energy. The most common single difficulties were low food consumption, difficulties in manipulating food on the plate and transporting it to the mouth. Ingestion difficulties especially decreased during the rehabilitation period. Women were older and ate less on admission and at discharge than men, improved less than men, and also a higher proportion had a low food intake at the time of discharge if having longer LOS and/or being discharged to institutional care. Patients with longer LOS and those discharged to institutional care had more eating difficulties on admission and were more dependent in activities of daily living (ADL) than those with shorter LOS and those who returned home. LOS was mainly explained by ingestion difficulties on admission and low age. Discharge to institutional care was explained by living alone before admission, ingestion difficulties at discharge, male gender and high age. CONCLUSIONS: Ingestion difficulties on admission indicate a longer in-hospital stay and decrease to a greater extent than other types of eating difficulties. If these difficulties persist at the time of discharge the patients are more likely to need institutional care. It is important to assess and take systematic measures for each of the three variants of eating difficulties, i.e. ingestion, deglutition, and energy, to improve eating abilities. Women in particular need attention with regard to low food intake.
BACKGROUND: Hip fractures in elderly people are associated with impaired function and ambulation and high rates of death and admission to institutions. Interventions designed to improve the outcomes of hip fracture (e.g., mobility and discharge to own home) that have incorporated interdisciplinary care have had mixed results. We compared the effectiveness of postoperative interdisciplinary care with that of usual care for elderly patients with hip fracture. METHODS: The study population consisted of 279 patients at least 70 years of age from the community and from nursing homes who underwent surgical repair of hip fracture at a university-affiliated acute care hospital. The subjects were randomly assigned to receive postoperative interdisciplinary care (n = 141) or usual care (n = 138) during their hospital stay. Interdisciplinary care included routine assessment and care by an internist-geriatrician, physiotherapist, occupational therapist, social worker and clinical nurse specialist, as well as twice-weekly interdisciplinary rounds to set goals for the patients and to monitor their progress. The primary outcome measure was the proportion of patients alive with no decline in ambulation or transfers in and out of a chair or bed and no change in place of residence at 6 months after surgery. RESULTS: At 6 months, 56 patients (39.7%) in the interdisciplinary care group and 47 (34.1%) in the usual care group were alive and had no decline from baseline in terms of ambulation, chair and bed transfers or place of residence (difference 5.6%, 95% confidence interval -5.6% to 17.0%). Multiple logistic regression analysis with adjustment for baseline factors showed no significant difference between treatment groups for the primary outcome measure at 3 months (p = 0.44) or at 6 months (p = 0.67). The initial length of stay in hospital was longer for patients receiving interdisciplinary care: 29.2 (standard deviation [SD] 22.6) v. 20.9 (SD 18.8) days (p < 0.001). However, the mean number of days spent in an institution (including hospital, inpatient rehabilitation and nursing home) over the 6-month follow-up period was similar in the 2 groups (p = 0.84). A subgroup analysis suggested a trend to benefit from interdisciplinary care in patients with mild to moderate cognitive impairment. INTERPRETATION: Postoperative inpatient interdisciplinary care did not result in significantly better 3- or 6-month outcomes in elderly patients with hip fracture.