The Design And Application Of Household Music Rehabilitation Exercise In The Postoperation Of Elderly Patient With Hip Fracture

BackgroundHip (usually refers to femoral neck and intertrochanteric fracture) is a kind of osteoporotic fracture, accounting for about 23.79% of all fractures. Its high rate of morbidity and mortality serious threats to the life and living quality of the elderly. Statistics show that:about 34 million over the age of 65 residents had a hip fracture in each year in the United States, Europe every year about 40 million women had a hip fracture; Gullber B reported that by the year 2050, each year in the United States about 70 million, around the world each year about 4 million residents had a hip fracture, of which the vast majority of the elderly. Thus, the incidence of hip fracture mostly upward trend, has attracted the attention of governments.China is entering the aging society, that from 1980 to 2020, the elderly population will grow exponentially, the elderly fracture incidence increased by 30% every 10 years, the number of hip fractures was 4 times increase in the number of. In the next 50 years the world’s 50% of the total number of osteoporotic fractures in Asia. Due to hip fracture patient age is large, and many patients with cardiovascular disease or other diseases in the elderly, bedridden after fracture can cause a variety of complications, the mortality rate is higher. Hip fracture has become one of the causes of death among the elderly and disabled the main.In recent years, scholars at home and abroad for the treatment of hip fracture in the elderly are increasingly inclined to surgical treatment. With the continuous improvement of surgical techniques, although the patient activities as soon as possible, reduce complications and reduce mortality, but reported in the literature, patients in the postoperative 4 months to 1 year of hip joint function and daily activity ability still cannot be restored to the level before fracture 25%-75% of elderly patients with hip fracture, postoperative activity of daily living (ADL) barriers seriously affect the quality of life of elderly patients. Braithwaite reported that the elderly patients with hip fracture after discharge if there is one or more lasting ability of daily life disorder, the life expectancy of 2.6 years will be reduced. Bass E survey, a year in the United States in 16%-32% of death in patients with hip fracture. In addition, due to the rehabilitation of patients with hip length, often need to take care of the family, the cost is high and the United States each year costs of treatment and rehabilitation of hip fracture patients 140-$20 billion. According to the survey by 2020, China’s medical expenses for hip fracture will reach $60 billion in 2040 to about $240 billion. The cost of treatment and rehabilitation expenses of elderly hip fracture of any country is not a small burden. Therefore, for elderly patients with hip fracture, in addition to surgery, postoperative rehabilitation nursing science has aroused the domestic and foreign medical care industry more and more attention.In the United States and Europe, in order to meet the needs of patients with recovery techniques, patients before 1-2 days to attend the training rehabilitation clinic, rehabilitation guidance after training. Rehabilitation places patients at acute stage after discharge of American hip fracture is mainly rehabilitation agencies. When the patients discharged from the hospital by the medical staff under review oral confessed after discharge time, drug usage and simple rehabilitation method for most of China’s elderly hip fracture. After functional rehabilitation training of patients most at home and most of the patients who sit or lie in bed rest at home. Family rehabilitation exercise mainly depends on non-professional families, with the families of patients can take the initiative to exercise is worthy of further research. Its effectiveness is questionable. Some scholars reported that hospital nurse specialist on-site guidance, health education and rehabilitation guidance, can promote functional recovery of patients, improve the quality of life, but this guide is intermittent, at home most of the hospital nurse manpower shortage, its continued needs to be further explored.In recent years, Europe and the United States music therapy has been widely used in many hospitals, nursing homes and rehabilitation facilities, in the field of senile disease, mental illness, children, psychological and behavioral disorders such as music therapy has good effect. On the music therapy in orthopedic applications. Domestic scholars of related research, Liu Jing in the total hip arthroplasty in the application of music therapy, music therapy can not only relieve the preoperative anxiety of patients with nervousness, stable patients heart rate and blood pressure, and other psychological and physiological reaction, can also reduce postoperative pain and decrease the analgesic drug dosage, is conducive to the smooth operation. Music therapy is a simple and economical method, as an effective means of rehabilitation treatment recognized by health care workers and wide application. Therefore, the application of music intervention to elderly patients with hip fracture functional exercise, which can help patients as far as possible to restore to the best state.To sum up, rehabilitation time after elderly hip patients discharged abroad are performed by physical therapists, professional therapists under the guidance of the occupation. Problems existing in our country’s medical system control, hospitalization time shorter, and the medical costs and community rehabilitation hospitalization costs and the development of community rehabilitation service system is not perfect etc., the foreign successful hip fracture rehabilitation can selective reference, and cannot be copied directly into our country. Therefore, the study of the a suitable for China’s national conditions of the elderly hip fracture Methods of rehabilitation nursing for patients after discharge is imminent.ObjectiveComprehensive domestic and foreign elderly hip fracture patients with rehabilitation of the status quo, proposed in this study, to discharge after hip fracture surgery in elderly patients was designed and applied to a set of professional and easy home music rehabilitation gymnastics, finding the right hip fracture after operation in elderly patients with functional recovery of the best home rehabilitation method to orthopedic clinical medical staff provides standardized postoperative patients rehabilitative technology, to maximize the recovery of the function of the patients, reduce the postoperative complications and mortality, improve patient postoperative quality of life.MethodsChoose June 2014 to 2015 December in a top three hospital according to the case into the criteria of cases and exclusion criteria, the selection of 100 cases of hip fracture patients after discharged after recovery period in elderly patients as research object, using computer generated random sequences were randomly divided into experimental group and control group, each 50.The object of study inclusion criteria:(1) patients aged 60 years and volunteered to participate in this study; (2) in elderly patients with hip fracture has been discharged home patients to postoperative wound second week stitches discharged patients home); (3) to understand and accept rehabilitation guidance and implementation; (4) and family status, can play DVD equipment, such as computers, relatives or caregivers to assist with rehabilitation training.Study exclusion criteria:(1) caused by osteomyelitis and malignant tumor pathological hip fractures; (2) cognitive impairment (in this study using the mini mental state examination (MMSE) to exclude patients with cognitive dysfunction); (3) known final end-stage renal disease or with expected survival within 1 year; (4) before fracture loss of weight-bearing and walking ability; (5) affect the activity of body disease, such as hemiplegia, unstable angina, acute decompensated heart failure etc..The experimental group received music rehabilitation intervention. Rehabilitation gymnastics participation by experts in medical care, rehabilitation, nursing majors, after consulting relevant literature based on and to summarize the experience of functional exercise in a tertiary hospital for the treatment of hip fracture, designed for a panel of experts to the bed rehabilitation gymnastics and walking rehabilitation gymnastics the set of actions, with background music, recording into DVD CD and making Chengkang complex operation manual. Intervention of the specific operation steps:qualified by training and assessment of nurses in patients discharged the same day play and rehabilitation gymnastics CD and Manual issued demonstration to explain the action essentials, on-site guidance to patients and their families do rehabilitation gymnastics, the nurse on duty in experimental group patients after discharge of the one month per week,2 months every two weeks,3 months a telephone follow-up of track record of implementation of rehabilitation gymnastics.The control group is for the current family nursing, without any intervention. When the patients discharged from the hospital by the medical staff under review oral confessed after discharge time, drug usage and some simple methods of rehabilitation. Patients at home by family or relatives and other non-professional personnel with the help of rehabilitation training.The observation index and effect evaluationObserved daily activity using the Barthel index score table, the table is ADL daily activities of the most commonly used assessment scale. The scale has the advantages of simple operation, high reliability, high sensitivity, wide use. Score:100 points:to take care of themselves; 61-99 points:good, basic life self-care; 41: moderate disability, daily life need help; 21-40 minutes:severe functional defects, daily life significantly dependent on; less than or equal to 20 points:very serious defect, daily life completely dependent. In two groups of patients discharged after first and 3 months of telephone follow-up ability of daily life of nurses.The function of hip joint were observed by Harris hip score table, this table includes pain, joint function, joint range of motion, malformation, a total of 100 points, the higher the score that hip joint function recovery better. Harris scores in the Department of orthopedics in discharged patients in the two groups after 1 months and 3 months of follow-up.Function exercise compliance evaluation scale, evaluation criteria:full compliance:active, consciousness and enthusiasm high equal to or above 3 times/ day and more than or equal to 30 minutes each time; partial compliance:active consciousness and general,2 times/day and is more than or equal to 30 minutes each time; noncompliance:conflict or reject and less than or equal to 1 times/day or< 30 minutes each time. Family members of patients daily fill in elderly hip functional exercise compliance evaluation table fracture nurse in two patients discharged from third months after the telephone survey in patients with postoperative functional exercise compliance.Nursing satisfaction from service attitude, exercise guidance, psychological support and care of patients is with the four aspects of evaluation. Third nurses in two patients discharged from the month after the telephone survey of patients to nursing staff job satisfaction.Statistical methodsThe collected case observation data, evaluation data and other information entered into the database, check the spss20.0 statistical software were statistically analyzed, measurement data to+s said count data using chi square test. P< 0.05 said there were statistically significant differences.Results1) functional exercise compliance in two groups of patients were discharged after 3 month functional exercise compliance differences have statistical significance (P< 0.05), the number of experimental group the compliance of the patients and partial compliance cases were higher than those of the control group, patients compliance number less than the control group.2) the function of hip joint in the measurement of two phase (discharged after 1 month,3 months), the differences in two groups of patients have statistical significance, the scores of the experimental group than in control group (P< 0.05), time and group there is no interaction (P> 0.05).3) activities of daily living (ADL) in the measurement of two phase (discharged after 1 month,3 months), the differences of scores of between the two groups of patients were statistically significant, the experimental group scored higher than control group (P< 0.05), time and group there is no interaction (P> 0.05).4) nursing satisfaction of two groups of patients discharged after 3 months of nursing satisfaction difference was statistically significant (P< 0.05), experimental group in the service attitude, exercise guidance, psychological support and care for patients with four cases number were higher than control group.Conclusions1) rehabilitation of patients with hip fracture surgery can improve the functional exercise compliance and nursing satisfaction. The results of this study show that:the full compliance of patients in the experimental group, the number of partial compliance cases were higher than the control group, the number of cases of non-compliance is lower than the control group. The experimental group in the service attitude, exercise guidance, psychological support, four aspects of patient care cases were higher than the control group. Results show that:the music intervention applied to functional exercise and alleviate the anxiety of patients with nervous mentality, and alleviate pain of functional exercise, the optical disk can be broadcast repeatedly, the patients are easy to adhere to, families daily supervision and responsibility nurse regular tracking patients were instructed to perform rehabilitation gymnastics in the situation of, so as to improve the postoperative functional exercise compliance and nursing satisfaction.2) rehabilitation exercise can improve the hip fracture in elderly patients after hip joint function and ability of daily life. The results of this study show that point in the intervention group after 1 months and 3 months, Harris score and Barthel score were significantly higher than those in control group (P<0.05), the difference was statistically significant. Results show that under the guidance of the nursing staff, patients according to the rehabilitation gymnastics DVDs and rehabilitation Handbook were functional exercise can improve the elderly hip fracture of hip joint function after operation, can as soon as possible to restore the normal life ability of the elderly patients.3) rehabilitation can standardize rehabilitation guidance behavior of nursing staff. The nurse in accordance with the provisions of the methods, essentials, time of rehabilitation for patients with demonstration, standardize the behavior of rehabilitation nurses. In summary, rehabilitation gymnastics can solve many problems in our country, the existing elderly hip fracture home rehabilitation for patients with existing methods are difficult to grasp, is not easy to adhere to, manpower needs more and can save the largest professional. Rehabilitation has a good application prospect, is worthy of further clinical promotion.