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Erworbene Kontrakturen der Gelenke im höheren Lebensalter

Eine systematische Literaturanalyse

Joint contractures in older age

A systematic literature review

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Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die freie Beweglichkeit in den Gelenken, insbesondere der Extremitäten, ist eine Grundlage ungehinderter Mobilität und Autonomie im hohen Alter. In internationalen Publikationen wird eine Kontrakturprävalenz von 15% bis über 70% bei älteren Patienten im Krankenhaus genannt. Die spezifischen Merkmale der untersuchten Populationen und Settings, aber auch unterschiedliche Definitionen und Methoden der Datenerhebung dürften für diese Variation verantwortlich sein. Kontrakturen führen zu zusätzlichem Pflegeaufwand. Die unlängst verabschiedeten Transparenzkriterien für die Qualitätsbeurteilung der stationären Altenhilfe beinhalten auch Items zur Einschätzung des Kontrakturrisikos und zur Kontrakturprophylaxe. Hierzu bedarf es einer einheitlichen Definition der Kontraktur. Die Literaturanalyse hatte zum Ziel, die in klinischen Studien zugrunde gelegte Definition der Kontraktur zu sichten.

Methoden

Es erfolgte eine systematische Literaturrecherche in den Datenbanken PubMed, CINAHL, Embase und Cochrane Library nach kontrollierten Studien, die Kontraktur als primären, sekundären oder unerwünschten Ergebnisparameter definierten, in englischer oder deutscher Sprache verfasst und nach 1985 publiziert wurden. Zwei Reviewer sichteten die Abstracts und Volltexte unabhängig voneinander und extrahierten die Daten. Fehlende Übereinstimmungen wurden im Konsensusverfahren unter Einbeziehung eines dritten Reviewers gelöst.

Ergebnisse

Insgesamt 37 kontrollierte Studien entsprachen den Einschlusskriterien. Die Studien waren vorwiegend im Krankenhaus durchgeführt worden und hatten Patienten im Alter von 18 bis über 90 Jahren eingeschlossen. In nur 5 Publikationen wurde eine Kontraktur präzise definiert. Jedoch wichen diese Definitionen bezüglich der Merkmale zur Erfassung einer Kontraktur voneinander ab. In 31 Studien wurden vorwiegend diagnostische Kriterien angeführt. Eine Studie nannte weder eine Definition noch diagnostische Merkmale.

Schlussfolgerung

Die Mehrheit der kontrollierten Studien, die eine Kontraktur als Ergebnisparameter untersuchten, verwendeten keine präzise Definition. Diese Diversität von Definitionen und Erhebungsmerkmalen macht eine Vergleichbarkeit von präventiven und therapeutischen Therapieeffekten unmöglich. In diesem Zusammenhang erscheint es außerordentlich problematisch, den nicht definierten Zustand der Kontraktur im Rahmen von Qualitätssicherungsprogrammen nach § 113 SGB XI in Heimen zu erfassen.

Abstract

Background

Free movement of the limbs is a prerequisite of mobility and autonomy in old age. The prevalence of contractures in international studies has been reported to range between 15% and 70%. The wide variation might be explained by different definitions and diagnostic criteria, settings, and participants’ characteristics. Contractures lead to additional nursing demands. In Germany, contracture risk assessment and prevention have been recently defined as a quality indicator of nursing home care that should be regularly monitored by expert raters of the statutory health insurance system. Therefore, it is necessary to have a clear definition of contracture. The goal of this literature review was to identify definitions of contractures used in controlled trials.

Methods

A systematic literature search of controlled trials investigating contracture as primary, secondary, or adverse outcome was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. The search was limited to articles published after 1985 and written in English or German language. Publications were excluded, if animals, children, or congenital contracture were investigated. Two reviewers independently screened the abstracts and extracted data from full publications. Disagreement was solved by consensus involving a third reviewer.

Results

Initially, 544 publications were identified; 37 controlled studies fulfilled the inclusion criteria and were included. A total of 33 studies investigated contracture as primary outcome, three as secondary outcome, and one as adverse outcome. Five studies clearly defined the term contracture. However, all these definitions are different. In 31 studies, only the diagnostic criteria were mentioned and one study mentioned neither a definition nor specific diagnostic criteria.

Conclusion

The majority of clinical trials investigating contracture as outcome parameter do not provide a clear definition. However, the success of contracture prevention and treatment in clinical trials and practice can only be judged in the presence of a clear definition. Thus, it appears especially difficult to use contracture as a quality indicator for nursing homes.

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Gnass, I., Bartoszek, G., Thiesemann, R. et al. Erworbene Kontrakturen der Gelenke im höheren Lebensalter. Z Gerontol Geriat 43, 147–157 (2010). https://doi.org/10.1007/s00391-009-0089-6

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