Santosh Rath - Academia.edu (original) (raw)
Papers by Santosh Rath
Cureus
Background: Fragility hip fracture is a leading cause of death in the elderly and is common in po... more Background: Fragility hip fracture is a leading cause of death in the elderly and is common in postmenopausal women and elderly people. In the treatment of osteoporosis, bisphosphonates (BPs) are often considered first-line medications. Zoledronic acid is the most potent and long-acting BP in clinical use and is administered as an intravenous infusion. In the context of acute fractures, the use of BPs has been controversial due to conflicting reports of their positive and negative effects on fracture healing. The purpose of this study was to determine the effect of zoledronic acid on fracture healing in intertrochanteric (IT) fragility fractures. Methods: The study was conducted in a tertiary healthcare center after receiving scientific and ethical approval. The study included 136 patients of either gender over the age of 50 who presented with an IT femur fracture after minor trauma between November 2020 and November 2022. The total number of patients had been classified into two groups, and grouping involved random sampling: Group T (test group, n = 68; zoledronic acid injections were given on postoperative day 3) and Group C (control group, n = 68; interventions were given after fracture healing). Patients were evaluated using the Radiographic Union Score for Hip (RUSH) and Singh Index for radiological outcomes and the Harris Hip Score (HHS) for functional outcomes. The patients were followed for six months. Results: The overall mean age was 73.25 years; in Group T, it was 72.5 ± 11.9 years, and in Group C, it was 73.7 ± 11.8 years. Of 136 patients, 69 (51%) were males and 67 (49%) were females. The average fracture healing time in Group T was 12.2 ± 3.6 weeks, while it was 13.0 ± 2.8 weeks in Group C. Functional outcomes, including HHS, were found to be better in Group T than in Group C (p < 0.005). No significant difference was observed between the two groups with respect to the radiological union, the RUSH score, or Singh Index, implying no negative effect of zoledronic acid. Conclusions: This study demonstrates that postoperative intravenous zoledronic acid therapy does not retard fracture healing. Osteoporosis management is frequently neglected because of a surgeon's fear of ZOL retarding fracture healing and a lack of awareness among patients, resulting in low compliance. Thus, opportunistic administration of zoledronic acid postoperatively can be beneficial and will increase compliance for osteoporosis management and fracture prevention to 100%.
The Journal of Hand Surgery, 2009
Immobilization after tendon transfers has been the conventional postoperative management. A recen... more Immobilization after tendon transfers has been the conventional postoperative management. A recent study indicated beneficial effects of an immediate active motion protocol (IAMP) after tendon transfer for claw deformity correction compared with effects in a historical cohort. In this study, we further tested this hypothesis in a randomized clinical trial comparing the effectiveness of the IAMP with that of conventional immobilization. Fifty supple claw hand deformities were randomized postoperatively into 2 equal groups for IAMP and immobilization. Therapy began on the second postoperative day for the IAMP group and on the twenty-second postoperative day for the immobilization group. The primary outcome measures were deformity correction, active range of motion of digits, tendon transfer insertion pullout, and time until discharge from rehabilitation. Secondary outcome measures were swelling, pain, hand strength, and dexterity. Both groups were compared at discharge from rehabilitation and at the last clinical follow-up (at least 1 year postoperatively). Assessments were available for all 50 patients at discharge and for 23 patients in each group at follow-up. The average follow-up was 18 months for the IAMP group and 17 months for the immobilization group. Deformity correction, range of motion, swelling, dexterity, and hand strength were similar for both groups at discharge and a follow-up. There was no evidence of tendon insertion pullout in any patient of either group. Relief of pain was achieved significantly earlier with IAMP. Morbidity was reduced by, on average, 22 days with IAMP. We found that the immediate active motion protocol is safe and has similar outcomes compared with those of immobilization, with the added advantage of earlier pain relief and quicker restoration of hand function. Immediate motion after tendon transfer can significantly reduce morbidity and speed up the rehabilitation of paralytic limbs, and it may save expense for the patients.
According to the World Health Organization (WHO), there are currently one billion people living w... more According to the World Health Organization (WHO), there are currently one billion people living with disabilities, of which 80 per cent live in low-and middle-income countries (L&MICs). Physical, intellectual, mental or sensory impairments affect people's active participation in society. Disabled people are often stigmatised, and lack social and economic opportunities, potentially leading them further into poverty. A focus on disability-related issues is therefore key for a holistic approach to international development with a human rights perspective. What is community-based rehabilitation? Community-based rehabilitation (CBR) is a WHO-endorsed strategy for rehabilitation, poverty reduction, equalisation of opportunities and social inclusion of people living with disabilities. Inspired by participatory development approaches, CBR is designed to work by including people with disabilities in existing services as well as by creating new interventions. CBR initiatives are delivered at the community level using local resources to ensure they are adapted to local needs and are cost-effective. Does community-based rehabilitation improve lives of people with disabilities? andy isaacson/dfat Main findings Impact of CBR on physical disabilities Home-based healthcare and rehabilitation and education interventions were effective for stroke survivors. Impact of CBR on mental disabilities Effective in lowering relapse and repeated hospitalisation among people with schizophrenia in China, India and South Africa. Significant improvement in the clinical status and quality of life for the caregivers of dementia patients. Livelihood and social inclusion outcomes Increased occupational activity among people living with schizophrenia. No encouraging results for social inclusion.
Journal of Hand Therapy, 2013
Pilot and Feasibility Studies, 2016
Background: Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 mil... more Background: Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 million in 2050. In India, conservative estimates suggest an annual incidence of 600,000 osteoporotic hip fractures and this is expected to increase significantly due to ageing and increase life expectancy. Protocol-based 'care pathways' for the management of adults, over 60 years of age, with hip fractures in high-income countries has resulted in decreased mortality rates, early hospital discharge, improved quality of life and reduction in healthcare costs. The study objectives are to determine appropriateness, acceptability and feasibility of adopting best-practice guideline or protocol-based care for the management of hip fractures among older adults in India. The study will also identify barriers and facilitators in recruiting patients and retention till the agreed follow-up period. Methods: This will be a mixed-methods prospective cohort study. The quantitative data collection will involve recruitment of consecutive patients aged >50 years with an X-ray-confirmed hip fracture admitted in four tertiary care hospitals in Delhi, India, over a 2-month period. The quantitative data will be collected at three points: from patients at admission to hospital, from medical records at discharge and by telephone interviews with patients at 30 days post hip fracture. Qualitative data collection will involve key informant interviews, conducted with clinical leads and focus group discussions, conducted with groups of healthcare providers and patients and/or their carers. COMB theoretical framework (capability, opportunity, motivation and behaviour) will be used to explore healthcare providers' behaviour in order to facilitate development and implementation of appropriate integrated care pathway for management of older adults with hip fractures in India. Discussion: The proposed study will identify gaps in best practice in the management of older people with hip fractures in tertiary care hospitals in Delhi and document barriers and facilitators to the implementation of protocol-based care through recording the contextual realities of the health systems and care-seeking behaviours. Insights into these factors will be used to facilitate the development of protocol-based management of older people with hip fractures that is appropriate, context specific and acceptable by stakeholders in a low-and middle-income country setting, such as India.
Osteoporosis International, 2015
Despite the high burden of hip fracture in China, there is limited information on its management.... more Despite the high burden of hip fracture in China, there is limited information on its management. This study investigated the management of hip fractures in a Beijing tertiary hospital and compared practice with that in 180 hospitals in the UK. The findings show a significant gap exists between the countries. The purpose of this study was to determine if the management of older people with hip fractures in a Beijing tertiary hospital is comparable with the UK best practice guidelines for hip fracture management and the UK National Hip Fracture Database 2012, obtained from 180 hospitals. A retrospective audit was undertaken in a large tertiary care hospital in Beijing. Data were compared with the National Hip Fracture Database 2012 collected in 180 hospitals in the UK on the proportion of patients managed according to the UK Blue Book standards. Sixty-six percent of patients were admitted to an orthopaedic ward within 24 h of fracture, while 100 % of patients in the UK were admitted to an orthopaedic ward within 24 h of arrival to an accident and emergency department. Only 8 % of patients received surgery within 48 h of admission compared with 83 % in the UK; 10 % received no surgery compared with 2.5 % in the UK; and 27 % received orthogeriatrician assessment compared with 70 % in the UK. New pressure ulcers developed in 2 % of patients compared with 3.7 % of those in the UK; whereas, 0.3 % of patients were assessed for osteoporosis treatment and 3.8 % received falls assessment, and comparable figures for the UK were 94 and 92 %, respectively. Significant gaps exist in hip fracture management in the Beijing hospital compared with the best practice achieved in 180 UK hospitals, highlighting the need to implement and evaluate proactive strategies to increase the uptake of best practice hip fracture care in China.
Clinical Orthopaedics and Related Research®, 2010
Background Immobilization after tendon transfers has been the conventional postoperative manageme... more Background Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout. Questions/purposes To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems. Methods We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups. Results We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups. Conclusion In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking. Level of Evidence Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. The investigation was performed at the LEPRA Funded Leprosy
The Journal of Hand Surgery, 2006
Purpose: To test the hypothesis that immediate postoperative active mobilization of the hand afte... more Purpose: To test the hypothesis that immediate postoperative active mobilization of the hand after opposition tendon transfer will achieve outcomes similar to those of the standard practice of cast immobilization. Methods: Five hands with isolated lower median nerve paralysis prospectively had opposition tendon transfer followed by immediate postoperative active mobilization for rehabilitation of the transfer. Historical records of 7 identical paralyses with opposition tendon transfers immobilized after surgery in a cast for 3 weeks were used for comparison. Outcomes were assessed by (1) the status of tendon transfer attachment to the thumb during immediate mobilization to detect tendon pullout, (2) the results of the opposition transfers for both groups using identical outcome measures (range of postoperative active abduction of the thumb, pinch pattern, pinch strength), and (3) comparison of the results from both groups. Results: There were no incidences of tendon pullout during immediate active mobilization of opposition tendon transfer. There were no differences in outcome between the 2 groups at late follow-up evaluations, with all opposition transfers achieving good results. Immediate postoperative active mobilization reduced rehabilitation time by an average of 19 days. An earlier return to activities of daily living was a further benefit to patients. Conclusions: This study supports the hypothesis and suggests that similar outcomes can be achieved in reduced time by immediate active mobilization of opposition tendon transfer.
Archives of osteoporosis, 2017
Evidence-based management can reduce deaths and suffering of older adults with hip fractures. Thi... more Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India. Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India. This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospi...
Patient and carer focus group discussion. (DOCX 780 kb)
Focus group discussion for healthcare providers. (DOCX 781 kb)
Leprosy Review, 2008
To identify the most common functional problems caused by ulnar nerve palsy. This study is the fi... more To identify the most common functional problems caused by ulnar nerve palsy. This study is the first phase in the process of developing a patient-centred hand function questionnaire specific for ulnar palsy. Twenty-five participants with complete irreversible ulnar nerve palsy were asked to record the five main problems they had because of their hand deformity in the week before they came to hospital. They ranked these problems in order of priority. The participants had all been referred to LEPRA-HOINA Leprosy Reconstructive Surgery Hospital, Muniguda, Orissa, India for tendon transfer surgery. Thirty-nine problems were experienced by the participants; 37 of these were functional problems. Five problems had a prevalence of > or =40%, these were holding soap (68%), eating (56%), buttoning (48%), holding a glass (44%) and lifting small objects (44%). Further analysis according to whether the left or right hand was affected was performed; 92% of participants with right ulnar nerve p...
Care seeking pathways of older adults with hip fracture in India: exploratory study protocol
Journal of Patient Care
Background: Hip fractures among older adults is a serious public health issue in India due to inc... more Background: Hip fractures among older adults is a serious public health issue in India due to increase in ageing population. Availability and timely access to surgical care is essential for reduction of mortality and morbidity from hip fractures and thereby decreasing inequalities among older adults. The notion of access to care is multi-dimensional and the "three-delay" framework can be applied to understand the causes for delay between sustaining a hip fracture and receipt of appropriate care. The aim of this study is to determine the processes in decision-making, identify cause for delays in obtaining care, and the potential barriers and facilitators to seeking appropriate care in time. Methods: A qualitative study was conducted (30 in-depth interviews) in seven healthcare facilities (4 public; 2 private and 1 alternative care center) in two administrative district of Odisha, India. The study was undertaken by George Institute for Global Health, India, in collaboration with Indian Institute of Public Health-Bhubaneswar from July 2014 to January 2015.Participants were aged 50 years or older with hip fracture including males and females. Data was categorized using NVIVO software and analyzed by thematic analysis. Results: Majority of participants perceived hip fracture injury will heal on its own and does not require surgery. They were not aware of the consequences of such an injury, comorbid conditions and available healthcare facilities. Family/community members played a significant role in the choice of surgeon and in accessing health care facility. Participants who had an injury outside their home were taken immediately to the hospital whereas those who fell inside home get delayed in reaching hospital. The delay from time of injury till access of care varied from few hours to months. People with a hip fracture and their relatives had strong faith and belief in traditional health care system, i.e. Traditional bonesetters within their local community. Conclusion: Our study findings emphasize on the need for quick decision-making to access nearest health facility with the provision of surgical care. We recommended further research studies to be conducted in varied settings to widen our knowledge in care pathways for the management of hip fractures in India. therefore essential for reduction of mortality and morbidity associated with hip fracture injury [11,12]. However, access to safe, affordable surgical and anesthesia care in a developing country like India is a big challenge, where nine of ten people cannot access basic surgical care [11]. Recently published hip fracture audit conducted in Odisha indicates high numbers of conservative treatment and great delays in surgery [13]. Often, patients turn to traditional health practitioners, as they are easily accessible, trusted and cheap compared to modern medical care [14,15]. Studies have shown that about 70% of primary health care needs of the Indian population are met with traditional medicine and similar trends are observed in other parts of Asia such as China, Thailand and Indonesia [16]. Currently there
Practical Issues in Geriatrics, 2016
Protocol-based ‘Integrated Care Pathways’ for the management of older adults with hip fractures i... more Protocol-based ‘Integrated Care Pathways’ for the management of older adults with hip fractures in high-income countries has resulted in decreased mortality rates, early hospital discharge, improved quality of life and significant reduction in healthcare costs. An epidemic of fragility hip fracture looms on the horizon, primarily due to ageing populations and increased life expectancy in China and India, such that by 2050, nearly half the projected 6.5 million hip fractures globally will occur in Asia. Health policy makers and care workers in China and India have the potential to prevent the looming social and financial burden of hip fractures in the burgeoning older population by learning from the experience of ICP based care in the UK. This chapter analyses present evidence–practice gaps in the management of fragility hip fractures in China and India; the barriers and facilitators to implementation of ICP and summarises the hurdles for knowledge translation of best practices. The authors draw upon current care-seeking behaviour studies, implementation and health systems research to determine appropriateness, acceptability and feasibility of adopting best practice and protocol-based care of hip fractures among older adults. Early findings from studies on knowledge diffusion and ICP for hip fractures have underlined the need for a systems approach and contextually relevant ICP to improve management of hip fractures in India and China. Finally, the importance of generating political priority for fragility hip fractures and global collaboration to support health systems strengthening is emphasised as a prerequisite to enable an environment to adopt ICP.
Cureus
Background: Fragility hip fracture is a leading cause of death in the elderly and is common in po... more Background: Fragility hip fracture is a leading cause of death in the elderly and is common in postmenopausal women and elderly people. In the treatment of osteoporosis, bisphosphonates (BPs) are often considered first-line medications. Zoledronic acid is the most potent and long-acting BP in clinical use and is administered as an intravenous infusion. In the context of acute fractures, the use of BPs has been controversial due to conflicting reports of their positive and negative effects on fracture healing. The purpose of this study was to determine the effect of zoledronic acid on fracture healing in intertrochanteric (IT) fragility fractures. Methods: The study was conducted in a tertiary healthcare center after receiving scientific and ethical approval. The study included 136 patients of either gender over the age of 50 who presented with an IT femur fracture after minor trauma between November 2020 and November 2022. The total number of patients had been classified into two groups, and grouping involved random sampling: Group T (test group, n = 68; zoledronic acid injections were given on postoperative day 3) and Group C (control group, n = 68; interventions were given after fracture healing). Patients were evaluated using the Radiographic Union Score for Hip (RUSH) and Singh Index for radiological outcomes and the Harris Hip Score (HHS) for functional outcomes. The patients were followed for six months. Results: The overall mean age was 73.25 years; in Group T, it was 72.5 ± 11.9 years, and in Group C, it was 73.7 ± 11.8 years. Of 136 patients, 69 (51%) were males and 67 (49%) were females. The average fracture healing time in Group T was 12.2 ± 3.6 weeks, while it was 13.0 ± 2.8 weeks in Group C. Functional outcomes, including HHS, were found to be better in Group T than in Group C (p < 0.005). No significant difference was observed between the two groups with respect to the radiological union, the RUSH score, or Singh Index, implying no negative effect of zoledronic acid. Conclusions: This study demonstrates that postoperative intravenous zoledronic acid therapy does not retard fracture healing. Osteoporosis management is frequently neglected because of a surgeon's fear of ZOL retarding fracture healing and a lack of awareness among patients, resulting in low compliance. Thus, opportunistic administration of zoledronic acid postoperatively can be beneficial and will increase compliance for osteoporosis management and fracture prevention to 100%.
The Journal of Hand Surgery, 2009
Immobilization after tendon transfers has been the conventional postoperative management. A recen... more Immobilization after tendon transfers has been the conventional postoperative management. A recent study indicated beneficial effects of an immediate active motion protocol (IAMP) after tendon transfer for claw deformity correction compared with effects in a historical cohort. In this study, we further tested this hypothesis in a randomized clinical trial comparing the effectiveness of the IAMP with that of conventional immobilization. Fifty supple claw hand deformities were randomized postoperatively into 2 equal groups for IAMP and immobilization. Therapy began on the second postoperative day for the IAMP group and on the twenty-second postoperative day for the immobilization group. The primary outcome measures were deformity correction, active range of motion of digits, tendon transfer insertion pullout, and time until discharge from rehabilitation. Secondary outcome measures were swelling, pain, hand strength, and dexterity. Both groups were compared at discharge from rehabilitation and at the last clinical follow-up (at least 1 year postoperatively). Assessments were available for all 50 patients at discharge and for 23 patients in each group at follow-up. The average follow-up was 18 months for the IAMP group and 17 months for the immobilization group. Deformity correction, range of motion, swelling, dexterity, and hand strength were similar for both groups at discharge and a follow-up. There was no evidence of tendon insertion pullout in any patient of either group. Relief of pain was achieved significantly earlier with IAMP. Morbidity was reduced by, on average, 22 days with IAMP. We found that the immediate active motion protocol is safe and has similar outcomes compared with those of immobilization, with the added advantage of earlier pain relief and quicker restoration of hand function. Immediate motion after tendon transfer can significantly reduce morbidity and speed up the rehabilitation of paralytic limbs, and it may save expense for the patients.
According to the World Health Organization (WHO), there are currently one billion people living w... more According to the World Health Organization (WHO), there are currently one billion people living with disabilities, of which 80 per cent live in low-and middle-income countries (L&MICs). Physical, intellectual, mental or sensory impairments affect people's active participation in society. Disabled people are often stigmatised, and lack social and economic opportunities, potentially leading them further into poverty. A focus on disability-related issues is therefore key for a holistic approach to international development with a human rights perspective. What is community-based rehabilitation? Community-based rehabilitation (CBR) is a WHO-endorsed strategy for rehabilitation, poverty reduction, equalisation of opportunities and social inclusion of people living with disabilities. Inspired by participatory development approaches, CBR is designed to work by including people with disabilities in existing services as well as by creating new interventions. CBR initiatives are delivered at the community level using local resources to ensure they are adapted to local needs and are cost-effective. Does community-based rehabilitation improve lives of people with disabilities? andy isaacson/dfat Main findings Impact of CBR on physical disabilities Home-based healthcare and rehabilitation and education interventions were effective for stroke survivors. Impact of CBR on mental disabilities Effective in lowering relapse and repeated hospitalisation among people with schizophrenia in China, India and South Africa. Significant improvement in the clinical status and quality of life for the caregivers of dementia patients. Livelihood and social inclusion outcomes Increased occupational activity among people living with schizophrenia. No encouraging results for social inclusion.
Journal of Hand Therapy, 2013
Pilot and Feasibility Studies, 2016
Background: Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 mil... more Background: Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 million in 2050. In India, conservative estimates suggest an annual incidence of 600,000 osteoporotic hip fractures and this is expected to increase significantly due to ageing and increase life expectancy. Protocol-based 'care pathways' for the management of adults, over 60 years of age, with hip fractures in high-income countries has resulted in decreased mortality rates, early hospital discharge, improved quality of life and reduction in healthcare costs. The study objectives are to determine appropriateness, acceptability and feasibility of adopting best-practice guideline or protocol-based care for the management of hip fractures among older adults in India. The study will also identify barriers and facilitators in recruiting patients and retention till the agreed follow-up period. Methods: This will be a mixed-methods prospective cohort study. The quantitative data collection will involve recruitment of consecutive patients aged >50 years with an X-ray-confirmed hip fracture admitted in four tertiary care hospitals in Delhi, India, over a 2-month period. The quantitative data will be collected at three points: from patients at admission to hospital, from medical records at discharge and by telephone interviews with patients at 30 days post hip fracture. Qualitative data collection will involve key informant interviews, conducted with clinical leads and focus group discussions, conducted with groups of healthcare providers and patients and/or their carers. COMB theoretical framework (capability, opportunity, motivation and behaviour) will be used to explore healthcare providers' behaviour in order to facilitate development and implementation of appropriate integrated care pathway for management of older adults with hip fractures in India. Discussion: The proposed study will identify gaps in best practice in the management of older people with hip fractures in tertiary care hospitals in Delhi and document barriers and facilitators to the implementation of protocol-based care through recording the contextual realities of the health systems and care-seeking behaviours. Insights into these factors will be used to facilitate the development of protocol-based management of older people with hip fractures that is appropriate, context specific and acceptable by stakeholders in a low-and middle-income country setting, such as India.
Osteoporosis International, 2015
Despite the high burden of hip fracture in China, there is limited information on its management.... more Despite the high burden of hip fracture in China, there is limited information on its management. This study investigated the management of hip fractures in a Beijing tertiary hospital and compared practice with that in 180 hospitals in the UK. The findings show a significant gap exists between the countries. The purpose of this study was to determine if the management of older people with hip fractures in a Beijing tertiary hospital is comparable with the UK best practice guidelines for hip fracture management and the UK National Hip Fracture Database 2012, obtained from 180 hospitals. A retrospective audit was undertaken in a large tertiary care hospital in Beijing. Data were compared with the National Hip Fracture Database 2012 collected in 180 hospitals in the UK on the proportion of patients managed according to the UK Blue Book standards. Sixty-six percent of patients were admitted to an orthopaedic ward within 24 h of fracture, while 100 % of patients in the UK were admitted to an orthopaedic ward within 24 h of arrival to an accident and emergency department. Only 8 % of patients received surgery within 48 h of admission compared with 83 % in the UK; 10 % received no surgery compared with 2.5 % in the UK; and 27 % received orthogeriatrician assessment compared with 70 % in the UK. New pressure ulcers developed in 2 % of patients compared with 3.7 % of those in the UK; whereas, 0.3 % of patients were assessed for osteoporosis treatment and 3.8 % received falls assessment, and comparable figures for the UK were 94 and 92 %, respectively. Significant gaps exist in hip fracture management in the Beijing hospital compared with the best practice achieved in 180 UK hospitals, highlighting the need to implement and evaluate proactive strategies to increase the uptake of best practice hip fracture care in China.
Clinical Orthopaedics and Related Research®, 2010
Background Immobilization after tendon transfers has been the conventional postoperative manageme... more Background Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout. Questions/purposes To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems. Methods We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups. Results We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups. Conclusion In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking. Level of Evidence Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. The investigation was performed at the LEPRA Funded Leprosy
The Journal of Hand Surgery, 2006
Purpose: To test the hypothesis that immediate postoperative active mobilization of the hand afte... more Purpose: To test the hypothesis that immediate postoperative active mobilization of the hand after opposition tendon transfer will achieve outcomes similar to those of the standard practice of cast immobilization. Methods: Five hands with isolated lower median nerve paralysis prospectively had opposition tendon transfer followed by immediate postoperative active mobilization for rehabilitation of the transfer. Historical records of 7 identical paralyses with opposition tendon transfers immobilized after surgery in a cast for 3 weeks were used for comparison. Outcomes were assessed by (1) the status of tendon transfer attachment to the thumb during immediate mobilization to detect tendon pullout, (2) the results of the opposition transfers for both groups using identical outcome measures (range of postoperative active abduction of the thumb, pinch pattern, pinch strength), and (3) comparison of the results from both groups. Results: There were no incidences of tendon pullout during immediate active mobilization of opposition tendon transfer. There were no differences in outcome between the 2 groups at late follow-up evaluations, with all opposition transfers achieving good results. Immediate postoperative active mobilization reduced rehabilitation time by an average of 19 days. An earlier return to activities of daily living was a further benefit to patients. Conclusions: This study supports the hypothesis and suggests that similar outcomes can be achieved in reduced time by immediate active mobilization of opposition tendon transfer.
Archives of osteoporosis, 2017
Evidence-based management can reduce deaths and suffering of older adults with hip fractures. Thi... more Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India. Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India. This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospi...
Patient and carer focus group discussion. (DOCX 780 kb)
Focus group discussion for healthcare providers. (DOCX 781 kb)
Leprosy Review, 2008
To identify the most common functional problems caused by ulnar nerve palsy. This study is the fi... more To identify the most common functional problems caused by ulnar nerve palsy. This study is the first phase in the process of developing a patient-centred hand function questionnaire specific for ulnar palsy. Twenty-five participants with complete irreversible ulnar nerve palsy were asked to record the five main problems they had because of their hand deformity in the week before they came to hospital. They ranked these problems in order of priority. The participants had all been referred to LEPRA-HOINA Leprosy Reconstructive Surgery Hospital, Muniguda, Orissa, India for tendon transfer surgery. Thirty-nine problems were experienced by the participants; 37 of these were functional problems. Five problems had a prevalence of > or =40%, these were holding soap (68%), eating (56%), buttoning (48%), holding a glass (44%) and lifting small objects (44%). Further analysis according to whether the left or right hand was affected was performed; 92% of participants with right ulnar nerve p...
Care seeking pathways of older adults with hip fracture in India: exploratory study protocol
Journal of Patient Care
Background: Hip fractures among older adults is a serious public health issue in India due to inc... more Background: Hip fractures among older adults is a serious public health issue in India due to increase in ageing population. Availability and timely access to surgical care is essential for reduction of mortality and morbidity from hip fractures and thereby decreasing inequalities among older adults. The notion of access to care is multi-dimensional and the "three-delay" framework can be applied to understand the causes for delay between sustaining a hip fracture and receipt of appropriate care. The aim of this study is to determine the processes in decision-making, identify cause for delays in obtaining care, and the potential barriers and facilitators to seeking appropriate care in time. Methods: A qualitative study was conducted (30 in-depth interviews) in seven healthcare facilities (4 public; 2 private and 1 alternative care center) in two administrative district of Odisha, India. The study was undertaken by George Institute for Global Health, India, in collaboration with Indian Institute of Public Health-Bhubaneswar from July 2014 to January 2015.Participants were aged 50 years or older with hip fracture including males and females. Data was categorized using NVIVO software and analyzed by thematic analysis. Results: Majority of participants perceived hip fracture injury will heal on its own and does not require surgery. They were not aware of the consequences of such an injury, comorbid conditions and available healthcare facilities. Family/community members played a significant role in the choice of surgeon and in accessing health care facility. Participants who had an injury outside their home were taken immediately to the hospital whereas those who fell inside home get delayed in reaching hospital. The delay from time of injury till access of care varied from few hours to months. People with a hip fracture and their relatives had strong faith and belief in traditional health care system, i.e. Traditional bonesetters within their local community. Conclusion: Our study findings emphasize on the need for quick decision-making to access nearest health facility with the provision of surgical care. We recommended further research studies to be conducted in varied settings to widen our knowledge in care pathways for the management of hip fractures in India. therefore essential for reduction of mortality and morbidity associated with hip fracture injury [11,12]. However, access to safe, affordable surgical and anesthesia care in a developing country like India is a big challenge, where nine of ten people cannot access basic surgical care [11]. Recently published hip fracture audit conducted in Odisha indicates high numbers of conservative treatment and great delays in surgery [13]. Often, patients turn to traditional health practitioners, as they are easily accessible, trusted and cheap compared to modern medical care [14,15]. Studies have shown that about 70% of primary health care needs of the Indian population are met with traditional medicine and similar trends are observed in other parts of Asia such as China, Thailand and Indonesia [16]. Currently there
Practical Issues in Geriatrics, 2016
Protocol-based ‘Integrated Care Pathways’ for the management of older adults with hip fractures i... more Protocol-based ‘Integrated Care Pathways’ for the management of older adults with hip fractures in high-income countries has resulted in decreased mortality rates, early hospital discharge, improved quality of life and significant reduction in healthcare costs. An epidemic of fragility hip fracture looms on the horizon, primarily due to ageing populations and increased life expectancy in China and India, such that by 2050, nearly half the projected 6.5 million hip fractures globally will occur in Asia. Health policy makers and care workers in China and India have the potential to prevent the looming social and financial burden of hip fractures in the burgeoning older population by learning from the experience of ICP based care in the UK. This chapter analyses present evidence–practice gaps in the management of fragility hip fractures in China and India; the barriers and facilitators to implementation of ICP and summarises the hurdles for knowledge translation of best practices. The authors draw upon current care-seeking behaviour studies, implementation and health systems research to determine appropriateness, acceptability and feasibility of adopting best practice and protocol-based care of hip fractures among older adults. Early findings from studies on knowledge diffusion and ICP for hip fractures have underlined the need for a systems approach and contextually relevant ICP to improve management of hip fractures in India and China. Finally, the importance of generating political priority for fragility hip fractures and global collaboration to support health systems strengthening is emphasised as a prerequisite to enable an environment to adopt ICP.