The Epidemiology of Major Joint Contractures

Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 04/2007; 456(456):22-9. DOI: 10.1097/BLO.0b013e3180308456
Source: PubMed


Current knowledge on the epidemiology of major joint contractures is limited. We systematically reviewed the literature to identify studies examining the epidemiology of joint contracture regardless of clinical condition. Epidemiologic measures of interest were prevalence, incidence, and prognostic risk factors. We used Medline to identify all epidemiologic studies of major joint contractures published from 1966 to March 2005. There was a high prevalence of major joint contractures. Most studies focused on one joint rather than including all relevant major contractures. However, most studies did provide a definition of a contracture or the measures used to assess contractures. Immobility is a highly prevalent disability in at-risk populations, and constitutes a tremendous burden to patients in nursing homes, hospitals, and the outpatient community. The lack of epidemiologic data is a major impediment to providing appropriate treatment.

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    • "The importance of diverse aspects of mobility is in line with several studies which identified walking (Fischer, Bartoszek et al., 2014; Fischer et al., 2014a, 2014b; Fergusson et al., 2007; Wagner et al., 2008), sitting upright (Wagner et al., 2008), kneeling and driving human-powered transportation (Fischer et al., 2014b) as key issues for patients with joint contractures. Mobility was also reported to be closely associated to autonomy and independence in activities of daily living (Bourret, Bernick, Cott, & Kontos, 2002; Fergusson et al., 2007; Gnass et al., 2010; Rush & Ouellet, 1998). "
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    ABSTRACT: Joint contractures are characterized as impairment of the physiological movement of joints due to deformity, disuse or pain and have major impact especially for older individuals in geriatric care. Some measures for the assessment of the impact of joint contractures exist. However, there is no consensus on which aspects should constantly be measured. Our objective was to develop a standard-set based on the ICF for describing functioning and disability in older individuals with joint contractures in geriatric care settings, giving special emphasis to activities and participation. The ICF-based standard set was developed in a formal decision-making and consensus process and based on an adapted version of the protocol to develop ICF Core Sets. These are sets of categories from the ICF, serving as standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management. Twenty-three experts from Germany and Switzerland selected 105 categories of the ICF component Activities and Participation for the ICF-based standard set. The largest number of categories was selected from the chapter Mobility (50 categories, 47.6%). The standard set for older individuals with joint contractures provides health professionals with a standard for describing patients' activity limitations and participation restrictions. The standard set also provides a common basis for the development of patient-centered measures and intervention programs. The preliminary version of the ICF-based standard set will be tested in subsequent studies with regard to its psychometric properties. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Mar 2015 · Archives of gerontology and geriatrics
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    • "The cross-sectional nature of our study prevented us from apprehending the temporal sequence behind the onset of one or more ADHs in a given individual. Nevertheless, this sequence is certainly influenced by the number and type of associated pathologies specifically of the locomotor system and central nervous system [24] [6]. The restricted mobility and loss of autonomy triggered by these associated pathologies represent a major factor for the development of these ADHs. "
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    ABSTRACT: By proposing a new terminology (acquired deforming hypertonia or ADH) and a new definition for contractures, the main objective of this study was to establish their prevalence among institutionalized elderly patients. Secondary objectives were to analyze the negative impact of ADH and collect the opinions of clinicians on the possible treatments available. A multicenter cross-sectional study was conducted among residents of 39 geriatric institutions (29 EHPAD and 10 USLD). All subjects presenting at least one ADH were surveyed over a one-week period. Among 3145 observed patients (mean age 88.9±9.7years) 22% (n=692) presented at least one ADH. In average, each patient presented 4.4±3.2 ADHs. Negative consequences on self-care, nursing and difficulties in getting dressed were most frequently observed. Only 25.4% of clinicians considered the ADH to be potentially reversible. Physical therapy was the therapeutic option most frequently chosen over medication and surgery. This study confirms the important prevalence of ADH among elderly institutionalized patients. Consequences on the level of dependence were significant. It seems relevant to elaborate hierarchical therapeutic strategies in order to counter these disorders and the fatalism that ensues.
    Full-text · Article · Dec 2013 · Annals of physical and rehabilitation medicine
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    • "Epidemiological studies indicate a wide range of prevalence of joint contractures in older individuals between 20% and 80% [2-4]. This variation is due to different definitions of contracture and varying diagnostic criteria or data collection methods, different research settings, sample size and study participants’ characteristics [5]. The aetiology of joint contractures is multifaceted. "
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    ABSTRACT: Background Joint contractures are frequent in older individuals in geriatric care settings. Even though they are used as indicator of quality of care, there is neither a common standard to describe functioning and disability in patients nor an established standardized assessment to describe and quantify the impact of joint contractures on patients’ functioning. Thus, the aim of our study is (1) to develop a standard set for the assessment of the impact of joint contractures on functioning and social participation in older individuals and (2) to develop and validate a standardized assessment instrument for describing and quantifying the impact of joint contractures on the individuals’ functioning. Methods The standard set for joint contractures integrate the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development of this set follows the methodology to develop an International Classification of Functioning Disability and Health (ICF) Core Set and involves a formal decision-making and consensus process. Evidence from four preparatory studies will be integrated including qualitative interviews with patients, a systematic review of the literature, a survey with health professionals, and a cross sectional study with patients affected by joint contractures. The assessment instrument will be developed using item-response-theory models. The instrument will be validated. Discussion The standard set for joint contractures will provide a list of aspects of functioning and health most relevant for older individuals in geriatric care settings with joint contractures. This list will describe body functions, body structures, activities and participation and related environmental factors. This standard set will define what aspects of functioning should be assessed in individuals with joint contractures and will be the basis of the new assessment instrument to evaluate the impact of joint contractures on functioning and social participation.
    Full-text · Article · Feb 2013 · BMC Geriatrics
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