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Ferrara, Italy

Giusti A.,Bone Clinic | Barone A.,Bone Clinic | Razzano M.,Galliern Hospital | Pizzonia M.,Galliern Hospital | Pioli G.,Orthogeriatric Unit
European Journal of Physical and Rehabilitation Medicine | Year: 2011

Hip fracture (HF) is a common event in the geriatric population and is often associated with significant morbidity, mortality and costs for the Healthcare Systems. The growing awareness of HF consequences and the expected rise in the total number of HF worldwide have led to the development and implementation of models of care alternative to the traditional ones for the acute and post-acute management of HF older adults. These services were set to minimize in-hospital complications, streamline hospital care and provide early discharge with the main objectives of improving functional and clinical outcomes, and reducing healthcare costs associated with hip and other fractures. Basically, the main feature that distinguishes these models is the different healthcare professional that retains the responsibility of the care during the acute and postacute phases. This review has been conceived to provide a brief description of the models implemented in the last twenty years, to describe their potential benefits on short- and long-term outcomes, to define the strengths and limitations of these models and the areas of uncertain, and to make some consideration about the future. Actually, on the basis of available studies, it is not possible to define the best model of care for HF older adults. However, the more complex and sophisticated services, characterized by a multi-disciplinary approach demonstrated, in randomizedcontrolled and before-after observational studies, to produce better outcomes compared to the traditional or simplest models. Further research is warranted to confirm long-term functional and clinical benefits of these models and to evaluate their cost-effectiveness. Source

Martins M.,University of Minho | Santos C.P.,University of Minho | Page S.,CNRS Institute of Robotics and Intelligent Systems | Saint-Bauzel L.,CNRS Institute of Robotics and Intelligent Systems | And 2 more authors.
IEEE International Conference on Rehabilitation Robotics | Year: 2015

Assisted gait monitoring can benefit from the measurement of feet positions and orientations. Thus, in this paper, rollator type walkers are equipped with one active depth sensor for gait assessment. Also, a real-Time feet positions and orientations algorithm is proposed and a gait assessment method is provided for clinical evaluation purposes. Results using the proposed algorithm are compared with motion capture system, as reference data (ground truth) and tested with hospitalized elderly. The proposed gait assessment was able to extract important frail elderly gait characteristics. © 2015 IEEE. Source

Pioli G.,Geriatric Unit | Barone A.,Orthogeriatric Unit | Mussi C.,University of Modena and Reggio Emilia | Tafaro L.,University of Rome La Sapienza | And 5 more authors.
Aging Clinical and Experimental Research | Year: 2014

This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Società Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture. © 2014, Springer International Publishing Switzerland. Source

Pioli G.,Geriatric Unit | Lauretani F.,University of Parma | Pellicciotti F.,Geriatric Unit | Pignedoli P.,Orthopaedic Unit | And 12 more authors.
Osteoporosis International | Year: 2016

Summary: Modifiable and non-modifiable predictors of mobility recovery were analyzed on a sample of 774 hip fracture patients according to pre-fracture abilities. Overall predictors were mostly non-modifiable factors related to frailty of patients with the exception of 25-hydroxyvitamin D concentration which significantly affected walking recovery, especially in patients with higher pre-fracture performance. Introduction: This study aims to investigate mobility changes after hip fracture with the aim of identifying modifiable and non-modifiable predictors of mobility recovery according to different pre-fracture abilities. Methods: This is a prospective inception cohort study of consecutive older patients, admitted with a fragility hip fracture in three Hospitals of Emilia Romagna (Italy). A sample of 774 patients alive at the sixth month was divided into three groups according to pre-fracture ambulation ability (group 1: mobile outdoors; group 2: mobile indoors; and group 3: mobile with help). The relationship between baseline characteristics of patients and the odds of walking recovery was analyzed using multivariate regression analysis. Results: Mortality differed significantly among the three groups and was the highest in patients needing help to walk. Among the survivors, only 50.3 % of patients recovered walking ability. In a multivariate analysis, independent risk factors were different among the three groups. In group 1, older age, comorbidities, the use of walking devices before fracture, and low albumin level acted as negative factors while male gender, a pre-fracture high functional status, and higher 25-hydroxyvitamin D levels increased the probability of full recovery. In group 2, only pre-fracture functional status and 25-hydroxyvitamin D concentration were related to the recovery of walking ability. Pre-fracture functional status was also the only significant predictor for patients in group 3. Conclusions: Several baseline characteristics of patients are related to the likelihood of recovering walking ability after hip fracture. The 25-hydroxyvitamin D level seems to be the only relevant modifiable factor even if the effectiveness of its supplementation has yet to be demonstrated. © 2016, International Osteoporosis Foundation and National Osteoporosis Foundation. Source

Savino E.,University of Ferrara | Martini E.,S. Orsola Malpighi University Hospital | Lauretani F.,University of Parma | Pioli G.,Geriatric Unit | And 10 more authors.
American Journal of Medicine | Year: 2013

Background In older people, hip fractures often lead to disability and death. We evaluated handgrip strength, an objective measure of physical function for bedridden patients, as a predictor of walking recovery in the year after fracture surgery. Methods This multicenter prospective cohort study included 504 patients, aged 70 years or more, who were admitted to the hospital for hip fracture surgery and were formerly able to walk independently. A multidimensional geriatric evaluation that included a physical examination, Short Portable Mental Status Questionnaire, Geriatric Depression Scale, Charlson Index, Basic Activities of Daily Living, and grip strength was administered at the time of admission. Follow-ups were performed every 3 months for 1 year after surgery to assess functional status and survival. The walking recovery probability was evaluated using multivariable logistic regression models. Results The mean age of the participants was 85.3 ± 5.5 years, and 76.1% of the participants were women. The mean grip strength was greater in men (β: 6.6 ± 0.62, P <.001) and was directly related to the Short Portable Mental Status Questionnaire results (P <.001), Basic Activities of Daily Living results (P <.001), serum vitamin D levels (P =.03), and time before surgery (P <.001), whereas it was inversely related to age (P <.001), Geriatric Depression Scale score (P <.001), and Charlson Index (P <.001). After adjusting for confounders, the grip strength was directly associated with the probability of both incident and persistent walking recovery (odds ratio highest tertile vs lowest tertile, 2.84, confidence interval, 1.76-4.59 and 2.79, confidence interval, 1.35-5.79, respectively). Conclusions In older patients with hip fractures, early grip strength evaluation might provide important prognostic information regarding the patient's future functional trajectory. © 2013 Elsevier Inc. All rights reserved. Source

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