Associations of hypothetical early intensive in-hospital rehabilitation with activities of daily living after hip fracture surgery in patients with and without dementia: emulating a randomized controlled trial using medical claims data

IF 7.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Clinical Epidemiology Pub Date : 2024-10-05 DOI:10.1016/j.jclinepi.2024.111550

Takaaki Ikeda , Upul Cooray , Ryutaro Matsugaki , Yuta Suzuki , Michiaki Takagi , Keiji Muramatsu , Kiyohide Fushimi , Masayasu Murakami , Ken Osaka , Shinya Matsuda

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引用次数: 0

Abstract

Objectives

To investigate the impact of early intensive in-hospital rehabilitation, initiated within 2 days of surgery and lasting up to 7 days, on the recovery of activities of daily living in patients with and without dementia.

Study Design and Setting

Medical claims data from 925 hospitals in Japan were analyzed. We enrolled patients aged ≥50 years who underwent hip fracture surgery within 2 days of admission between April 1, 2018, and December 31, 2019. Low- (20 minutes per day starting on day 2), highest- (60 minutes per day starting on day 1), and gradually increasing (20 minutes on day 1, 40 minutes on days 2–4, and 60 minutes per day thereafter) intensity regimens were used as exposures. The outcomes were Barthel Index (BI) scores at 14 and 30 days postoperatively. For per-protocol analysis, a target trial emulation framework with the sequential doubly robust estimator was used.

Results

Among patients without dementia (N = 11,461), no significant differences in BI scores were observed at 14 days postoperatively across regimens. At 30 days postoperatively, significant differences in BI scores were noted between highest- and low-intensity regimens and between gradually increasing intensity and low-intensity regimens, with additive BI scores of 15.2 (95% CI, 10.7–19.7) and 14.7 (95% CI, 9.2–20.2), respectively. In patients with dementia (N = 14,302), significant differences in BI scores were noted at 14 days postoperatively between highest- and low-intensity regimens and between gradually increasing intensity and low-intensity regimens, with additive BI scores of 8.7 (95% CI, 5.2–12.2) and 10.7 (95% CI, 5.8–15.6), respectively. At 30 days postoperatively, a significant difference in BI scores was observed between gradually increasing intensity and low-intensity regimens, with an additive BI score of 17.9 (95% CI, 11.3–24.5).

Conclusion

Early intensive in-hospital rehabilitation is highly relevant and beneficial for dementia patients.

查看原文本刊更多论文

髋部骨折术后痴呆症患者和非痴呆症患者的假定早期院内强化康复与日常生活活动的关联：利用医疗索赔数据模拟随机对照试验。

研究目的研究设计与环境：分析来自日本925家医院的医疗索赔数据：研究设计与背景：我们分析了来自日本 925 家医院的医疗报销数据。我们招募了 2018 年 4 月 1 日至 2019 年 12 月 31 日期间入院 2 天内接受髋部骨折手术的年龄≥50 岁的患者。低强度（从第 2 天开始每天 20 分钟）、高强度（从第 1 天开始每天 60 分钟）和逐渐增加强度（第 1 天 20 分钟，第 2-4 天 40 分钟，之后每天 60 分钟）的治疗方案被用作暴露。结果为术后 14 天和 30 天的巴特尔指数 (BI) 评分。在进行每方案分析时，采用了目标试验仿真框架和连续双稳健估计器：在没有痴呆症的患者中（N = 11,461），不同治疗方案在术后 14 天的 BI 评分无明显差异。术后 30 天，最高强度和低强度治疗方案之间以及强度逐渐增加和低强度治疗方案之间的 BI 评分存在显著差异，加和 BI 评分分别为 15.2（95% 置信区间 [CI]，10.7-19.7）和 14.7（95% CI，9.2-20.2）。在痴呆症患者中（N = 14,302），术后14天时，最高强度和低强度治疗方案之间以及逐渐增加强度和低强度治疗方案之间的BI评分存在显著差异，加和BI评分分别为8.7（95% CI，5.2-12.2）和10.7（95% CI，5.8-15.6）。术后30天，逐步增加康复强度和低强度康复方案的BI评分有显著差异，加和BI评分为17.9（95% CI，11.3-24.5）：结论：早期强化院内康复对痴呆症患者非常重要且有益。

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来源期刊

Journal of Clinical Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

12.00

自引率

6.90%

发文量

320

审稿时长

44 days

期刊介绍： The Journal of Clinical Epidemiology strives to enhance the quality of clinical and patient-oriented healthcare research by advancing and applying innovative methods in conducting, presenting, synthesizing, disseminating, and translating research results into optimal clinical practice. Special emphasis is placed on training new generations of scientists and clinical practice leaders.