In a prospective, consecutive study conducted at a university teaching hospital, we evaluated the effects of Parkinson's disease (PD) on hip fracture outcomes. We followed 920 community-dwelling patients, aged 65 or older, who sustained a hip fracture that was operatively treated between July 1, 1987, and June 30, 1998. Presence or absence of PD had no bearing on type of surgery performed. Examined outcomes were postoperative complication rates; in-hospital mortality; length of hospital stay; discharge status (to home or to a skilled nursing facility); and mortality rate, place of residence, recovery of prefracture ambulatory ability, and return to prefracture activities of daily living (ADLs) 1 year after surgery Thirty-one patients (3.4%) had a history of PD before hip fracture. Patients with PD were more likely to be male, to live with another person, to have less ambulatory ability, and to be dependent in ADLs before hip fracture. Compared with patients without PD, they were hospitalized significantly longer and were more likely to be discharged to a skilled nursing facility. In addition, they declined more in level of independence in basic ADLs but not as much in instrumental ADLs at 1-year follow-up. Rates of postoperative complications, recovery of ambulatory ability within 1 year, and mortality within 1 year did not differ. These findings may guide orthopedic surgeons in counseling patients with PD and a hip fracture.
"Of the 36 survivors, 87% had experienced falls and 35% had sustained multiple fractures. Hip fractures are associated with considerable morbidity and even an increased mortality in patients with PD, and are a leading reason for nursing home admission (Idjadi et al., 2005; Coughlin & Templeton, 1980). "
[Show abstract][Hide abstract] ABSTRACT: To study the influence of physical impairments on hip bone mineral density in women with Parkinson's disease.
Thirty-four women with Parkinson's disease and 30 age-matched healthy controls.
Patients with Parkinson's disease underwent a hip scan using dual-energy X-ray absorptiometry and total hip bone mineral density values were obtained. Motor Examination III of the Unified Parkinson Disease Rating Scale was used to assess leg tremor, leg agility, leg rigidity and postural stability. In addition, all subjects were evaluated for walking speed, walking endurance, and leg muscle strength.
Based on the hip bone mineral density values, 12 patients with Parkinson's disease (35%) had osteopaenia and another 3 patients (9%) had osteoporosis. Patients with Parkinson's disease had significantly lower walking velocity (p = 0.002), walking endurance (p < 0.001) and leg muscle strength (p = 0.047) than controls. Multiple regression revealed that leg muscle strength alone accounted for 8.8-10.6% of the variance in hip bone mineral density among patients with Parkinson's disease, after controlling for body mass index, post-menopausal years, Hoehn and Yahr stage, and postural stability (p < 0.05).
Hip bone mineral density is independently associated with leg muscle strength in women with Parkinson's disease.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 03/2009; 41(4):223-30. DOI:10.2340/16501977-0311 · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study aimed to examine whether fear of falling (FoF) could independently predict recurrent falls in people with Parkinson's disease (PD). Seventy patients with PD completed the study. Thirty-two patients had fallen at least once in the previous 12 months. Most of patients with PD had moderate disease severity (Hoehn and Yahr stage III). FoF was assessed by the activities-specific balance confidence (ABC) scale. PD specific motor and balance impairment was determined by Unified PD rating scale (UPDRS). Functional mobility was measured by timed-up-and-go (TUG) test. All patients were followed for 12 months by phone interview to register monthly fall incidence. Results of stepwise discriminant analysis showed that after adjusting for the fall history (F = 32.57, P < 0.001) and UPDRS motor score (F = 25.23, P < 0.001), ABC score (F = 18.84, P < 0.001) remained as a significant predictor of recurrent falls. We further established that a cut-off ABC score of 69 (i.e. 0-100, 0 indicates no confidence and 100 indicates full confidence) demonstrated the best sensitivity (93%) in predicting future falls in PD patients. The results indicate that those with an ABC score <69 at baseline had significantly higher risk of sustaining recurrent falls in the next 12 months. Findings of the present study highlight the importance of considering FoF during fall risk assessment in patients with PD.
Journal of Neurology 05/2009; 256(10):1689-95. DOI:10.1007/s00415-009-5184-5 · 3.38 Impact Factor
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