NeuRA Magazine #23


The Australian and New Zealand Hip Fracture Registry based at NeuRA, released its 2017 report highlighting hip fracture as the most serious and costly fall-related injury suffered by older Australians. In 2016, there were approximately 22,000 hip fractures in Australia with an estimated combined direct and indirect cost of $908 million.

Commenting on the seriousness of these statistics, Prof Jaqueline Close, Geriatrician and Co-Chair of the Australian and New Zealand Hip Fracture Registry said “the number is set to rise to more than 30,000 by 2022, with a projected cost of $1.126 billion”.

“Most importantly, the human cost from this injury is high: 5% will die in hospital; over 10% will be newly discharged to an aged care facility; more than 50% will still experience a mobility-related disability 12 months after injury; and up to 25% will have died in the year after discharge from hospital.” The report highlighted the performance against national clinical care standards which have the potential to alter the outcome for some of the frailest members of our society.

Commenting on the findings, Prof Ian Harris, orthopaedic surgeon and Co-Chair of the Australian and New Zealand Hip Fracture Registry said, “This report continues to show variation in the way we deliver care to people with a hip fracture. Some of this variation between hospitals can markedly change the experience for the older person including how we manage their pain, timing of the surgery and the opportunity to start walking again after surgery”.

Further commenting, Prof Close said, “there remain huge opportunities to further improve care including the prevention of future falls and fractures. Strong evidence exists to support treatment of osteoporosis in this population yet there remains a care gap between what we are and should be doing.”

This care gap leaves hip fracture survivors with an increased risk of subsequent falls and fractures that are associated with loss of independence or ultimately increased risk of death.

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Abdominal muscle stimulation to improve bowel function in spinal cord injury

Bowel complications, resulting from impaired bowel function, are common for people living with a spinal cord injury (SCI). As a result, people with a SCI have high rates of bowel related illness, even compared with those with other neurological disorders. This includes high rates of abdominal pain, constipation, faecal incontinence and bloating. These problems lower the quality of life of people with a SCI and place a financial burden on the health system. A treatment that improves bowel function for people with a SCI should reduce illness, improve quality of life and lead to a large cost saving for health care providers. Bowel problems have traditionally been managed with manual and pharmacological interventions, such as digital rectal stimulation, enemas, and suppositories. These solutions are usually only partially effective, highlighting the need for improved interventions. The abdominal muscles are one of the major muscle groups used during defecation. Training the abdominal muscles should improve bowel function by increasing abdominal pressure. During our previous Abdominal FES research with people with a SCI, we observed that Abdominal FES appeared to lead to more consistent and effective bowel motion. However, this evidence remains anecdotal. As such, we are going to undertake a large randomised controlled trial to investigate the effectiveness of Abdominal FES to improve the bowel function of people with a SCI. This study will make use of a novel measurement system (SmartPill, Medtronic) that can be swallowed to measure whole gut and colonic transit time. We will also assess whether Abdominal FES can change constipation-related quality of life and the use of laxatives and manual procedures, as well as the frequency of defecation and the time taken. A positive outcome from this study is likely to lead to the rapid clinical translation of this technology for people living with a SCI.