Severe spastic contractures and diabetes mellitus independently predict subsequent minimal trauma fractures among long-term care residents
File(s)
Published version
Author(s)
Lam, Kuen
Leung, Man Fuk
Kwan, Chi Wai
Kwan, Joseph
Type
Journal Article
Abstract
Objective
The study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents.
Design
This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death.
Setting
A 300-bed long-term care hospital in Hong Kong.
Participants
All long-term care residents who were in need of continuous medical and nursing care for their activities of daily living.
Measurements
Information on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF.
Results
Three hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8–56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3–12.7).
Conclusions
Severe spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings.
The study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents.
Design
This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death.
Setting
A 300-bed long-term care hospital in Hong Kong.
Participants
All long-term care residents who were in need of continuous medical and nursing care for their activities of daily living.
Measurements
Information on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF.
Results
Three hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8–56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3–12.7).
Conclusions
Severe spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings.
Date Issued
2016-11-01
Date Acceptance
2016-11-01
Citation
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2016, 17 (11), pp.1025-1030
ISSN
1525-8610
Publisher
ELSEVIER SCIENCE INC
Start Page
1025
End Page
1030
Journal / Book Title
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
Volume
17
Issue
11
Copyright Statement
©2016 AMDAeThe Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000389063300009&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Geriatrics & Gerontology
Contractures
minimal trauma fracture
spasticity
long-term care
diabetes mellitus
risk factors
NURSING-HOME RESIDENTS
RISK-FACTORS
HIP FRACTURE
BONES
DEFINITION
LIKELIHOOD
PEOPLE
Publication Status
Published
Date Publish Online
2016-11-01