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Arch Phys Med Rehabil. 2019 Jan;100(1):32-38. doi: 10.1016/j.apmr.2018.06.012. Epub 2018 Jul 4.

Inadequate Postoperative Energy Intake Relative to Total Energy Requirements Diminishes Acute Phase Functional Recovery From Hip Fracture.

Author information

1
Department of Rehabilitation, Nishi-Kobe Medical Center, Kojidai, Nishiku, Kobe, Hyogo, Japan; Department of Community Health Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Sumaku, Kobe, Japan. Electronic address: inosumi1029@gmail.com.
2
Department of Community Health Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Sumaku, Kobe, Japan; Department of Rehabilitation, Kobe City Medical Center West Hospital, Ichiban-Cho, Nagataku, Kobe, Japan.
3
Department of Rehabilitation, Nishi-Kobe Medical Center, Kojidai, Nishiku, Kobe, Hyogo, Japan.
4
Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Sumaku, Kobe, Japan.
5
Department of Community Health Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Sumaku, Kobe, Japan; Department of Rehabilitation, Kobe City Medical Center General Hospital, Minatojima Minami-Cho, Chuoku, Kobe, Japan.
6
Department of Rehabilitation, Saiseikai Hyogoken Hospital, Fujiwaradai Nakamachi, Kitaku, Kobe, Japan.
7
Department of Community Health Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Sumaku, Kobe, Japan.

Abstract

OBJECTIVE:

To investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase.

DESIGN:

Prospective cohort study.

SETTING:

Three acute care hospitals.

PARTICIPANTS:

Hip fracture patients (N=200) who were consecutively admitted to 3 acute hospitals because of falling.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Patients were stratified into 3 groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE<0.7), intermediate (0.7≤EI/TEE<1), and adequate (EI/TEE≥1) groups. The functional status was evaluated using the motor domain of a FIM. We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation.

RESULTS:

The median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median EI/TEE, 0.54; interquartile range, 0.42-0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE, 0.87; interquartile range, 0.78-0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE, 1.10; interquartile range, 1.04-1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P<.01). After adjustment for potential confounders, a significant association between postoperative EI/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized β =-0.14; reference: adequate group; P=0.03; R2 for the entire model =0.25).

CONCLUSIONS:

Postoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture.

KEYWORDS:

Activities of daily living; Energy intake; Hip fractures; Rehabilitation

PMID:
30585154
DOI:
10.1016/j.apmr.2018.06.012
[Indexed for MEDLINE]

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