Transcript ICF nell`osteoporosi

ICF nell’Osteoporosi
Francesca Gimigliano
Seconda Universityà degli Studi di Napoli
Dopartimento di Scienze Ortopediche, Traumatologiche,
Riabilitative e Plastico-Ricostruttive
Osteoporosi
“… è una malattia dello scheletro
caratterizzata dalla bassa massa
ossea e da alterazioni della
microarchitettura del tessuto osseo,
che predispongono ad
un’aumentata fragilità ossea con un
conseguente aumento del rischio di
fratture.”
World Health Organization (WHO), 1994
Osteoporosi
•
•
•
•
malattia di notevole rilevanza sociale
disabilità complessa
presa in carico globale
progetto riabilitativo
– (finalizzato ad outcome globale funzionale/sociale)
• programma riabilitativo individuale specifico
– (comprendente obiettivi a breve, medio e lungo termine)
• lavoro in team
Osteoporosi
osteoporosi
osteoporosi
e riabilitazione
http://www.ncbi.nlm.nih.gov/pubmed
OSTEOPOROSI
Qual è l’impatto?
Invecchiamento della popolazione italiana
250,0
200,0
150,0
100,0
50,0
0,0
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
0-59
100,0
95,8
91,5
86,3
79,8
72,9
66,5
61,6
57,7
54,2
60-79
100,0
104,2
106,6
110,3
119,3
126,2
131,5
128,3
117,3
104,4
80-99
100,0
116,0
127,3
137,7
141,0
154,6
162,4
174,4
196,1
215,5
60+
100,0
106,5
110,6
115,6
123,6
131,8
137,7
137,5
132,8
126,2
Prevalenza di Osteopenia ed Osteoporosi
Popolazione femminile in Italia
Studio E.S.O.P.O. (n > 16.000)
70-79
60-69
50-59
15.0
43.1
24.4
47.6
41.9
28.0
46.4
20%
40%
normal
11.7
39.9
55.7
40-49
0%
41.9
60%
osteopenia
80%
osteoporosis
4.4
100%
Maggi et al , Osteop. Intern 2006
Fratture da fragilità: incidenza
4.000
Incidenza per 100.000 soggetti
3.500
3.000
2.500
2.000
1.500
1.000
500
0
35
40
45
50
55
60
65
70
75
80
85 Donne,
età in anni
Cooper et al. Calcif Tissue Int. 1992 Aug;51(2):100-4
Cooper et al. J Bone Miner Res. 1992 Feb;7(2):221-7
Incidenza annualedi patologie comuni
(x 000)
Fratture da osteoporosi
1.500
vertebrali
1.000
femore
500
polso
altri siti
degli arti
0
Fratture da
osteoporosi a
Infarto del
miocardio b
Ictus c
Cancro della
mammella d
Le fratture da osteoporosi sono più comuni dell’infarto del miocardio, dell’ictus
e del cancro della mammella valutati globalmente
Riggs BL et al., Bone 1995; Am Cancer Society, 1996
Fratture dell’estremo prossimale
del femore
• 81.400 fratture dell’estremo
superiore del femore in Italia nel
2001 (in >65 anni)
• 55% fratture laterali & 45% fratture
mediali
• quasi 40.000 protesi d’anca per
frattura dell’estremo prossimale del
femore
Impatto delle fratture dell’anca
• Entro 12 mesi da una frattura d‘anca
– 20-30% dei pazienti muore1
– 22% dei pazienti si trasferisce in casa di riposo2
– 24% dei pazienti recupera la piena mobilità2
1Cooper
C et al., Am J Epidemiol 1993; 137:1001-1005
2March L et al., Report of Northern Sydney Area Health Service 1996
Incidenza di fratture vertebrali in
Europa
• Tra i 155 Milioni di uomini e donne di età compresa tra 50 e 79 anni
in Europa*
–
–
–
–
1 400 000 fratture vertebrali ogni anno
3835
fratture vertebrali ogni giorno
160
fratture vertebrali ogni ora
3
fratture vertebrali ogni minuto
* in 19 participating EVOS/EPOS countries
Felsenberg et al. J Bone Miner Res 17: 716-724 (2002)
Mean QUALEFFO
total score
Qualità di Vita e fratture vertebrali
45
35
Age >71
25
Age 65–71
15
Age <65
*Age p = 0.020
*Fracture p < 0.001
Oleksik et al, J Bone Miner Res 15:1384–92 (2000)
Danno e disabilità nelle fratture
da fragilità
RISCHIO DI MENOMAZIONE
Fx femore
Fx vertebrali
Fx radio
piegarsi
2,7
3,1
1,2
sollevare
1,1
3,4
1,3
afferrare
1,5
0,7
1,8
camminare
3,6
2,7
1,6
salire le scale
2,6
2,2
1,8
scendere le scale
4,1
4,2
2,5
entrare e uscire dalla
macchina
1,3
2,1
1,3
1,6
1,7
1,1
11,1
6,9
10,2
fare shopping
4,6
5,2
3,3
fare i lavori domestici
2,8
2,1
1,6
MOVIMENTI
ATTIVITÀ
infilare le calze
cucinare
Ranchos of Los Amigos, California
ICF and Osteoporosis
ICF CORE SET FOR OSTEOPOROSIS
A. Cieza et al, J. Rehabil Med 2004; Suppl. 44: 81-86
PATO survey
1
Physiatric Approach To Osteoporosis
11
5
2
3
• 80 Centri di Riabilitazione
1
8
5
2
• Ogni centro doveva
raccogliere dati su:
• 50 pazienti
osteoporotici senza
fratture da fragilità
• 50 pazienti
osteoporotici con
almeno una frattura da
fragilità
10
3
1
1
7
6
1
5
7
PATO survey
• Dati anagrafici
• FRAX Assessment
Tool
• Brief ICF Core Set for
Osteoporosis
• Trattamento
PATO survey
Criteri d’inclusione
• Età ≥ 50 aa
• Diagnosi osteoporosi
confermata dalla presenza
di una frattura da fragilità o
da un valore di T-score alla
DXA o QUS al calcagno ≤ 2,5 oppure alla QUS alle
falangi ≤ -3,2
Criteri d’esclusione
• Presenza di altra patologia
prevalente che comporti
una disabilità o un
impairment motorio o
cognitivo
PATO survey
Schede ricevute
(n=5.238)
Escluse (n=650)
Non rispettavano i
criteri d’inclusione
Schede analizzate
(n=4.588)
Pazienti
osteoporotici senza
fratture (n=1.945)
Pazienti
osteoporotici con
almeno una
frattura (n=2.643)
PATO survey
1200
1000
800
600
400
200
0
obiettivo
tot schede raccolte
tot schede valide
PATO survey
4,588
males
females
9%
Mean age 70.42
(min 50, max 104)
91%
No osteoporotic fractures
males
females
95%
Mean age 67.39
(min 50, max 96)
5%
Osteoporotic fractures
males
females
11%
89%
Mean age 72.65
(min 50, max 104)
FRAX
10 years probability of fracture
Kanis OI 2005
PATO survey - FRAX
FRAXMAJ
FRAXHIP
20
17,24
8,5
3
FRAXMAJ
FRAXHIP
PATO survey - FRAX
FRAX MAJ
NO FX
FRAX HIP
FX
NO FX
22,45
FX
11,6
10,36
4,4
NO FX
FX
NO FX
FX
Brief ICF Core Set for Osteoporosis
BODY FUNCTIONS
• b152 - Emotional functions
• b280 - Sensation of pain
• b710 - Mobility of joint
functions
• b730 - Muscle power functions
BODY STRUCTURES
• s750 - Structure of lower
extremity
• s760 - Structure of trunk
ACTIVITIES AND PARTICIPATION
• d430 - Lifting and carrying
objects
• d450 - Walking
• d920 - Recreation and leisure
ENVIROMENTAL FACTORS
• e110 - Products or substances
for personal consumption
• e355 - Health professionals
• e580 - Health services, systems
and policies
A. Cieza et al. ICF Core Sets for Osteoporosis. J Rehabil Med 2004.
BODY FUNCTIONS
First Qualifier: Extent of impairments
0
No impairment means the person has no problem
1
Mild impairment means a problem that is present less than 25% of the time, with an
intensity a person can tolerate and which happens rarely over the last 30 days.
2
Moderate impairment means that a problem that is present less than 50% of the time, with
an intensity, which is interfering in the persons day to day life and which happens
occasionally over the last 30 days.
3
Severe impairment means that a problem that is present more than 50% of the time, with
an intensity, which is partially disrupting the persons day to day life and which happens
frequently over the last 30 days.
4
Complete impairment means that a problem that is present more than 95% of the time,
with an intensity, which is totally disrupting the persons day to day life and which happens
every day over the last 30 days.
8
Not specified means there is insufficient information to specify the severity of the
impairment.
9
Not applicable means it is inappropriate to apply a particular code (e.g. b650 Menstruation
functions for woman in pre-menarche or post-menopause age).
1800
1600
1400
1200
1000
800
600
400
200
0
b280
Sensation of pain
Sensation of unpleasant feeling
indicating potential or actual
damage to some body
structure.
Inclusions: sensations of
generalized or localized pain in
one or more body part, pain in
a dermatome, stabbing pain,
burning pain, dull pain, aching
pain; impairments such as
myalgia, analgesia and
hyperalgesia
9
0
1
8
2
4
3
1000
b280
Sensation of pain
Sensation of unpleasant feeling
indicating potential or actual
damage to some body
structure.
Inclusions: sensations of
generalized or localized pain in
one or more body part, pain in
a dermatome, stabbing pain,
burning pain, dull pain, aching
pain; impairments such as
myalgia, analgesia and
hyperalgesia
0
800
9
1
600
400
200
0
8
2
4
3
no fx
fx
b280
Sensation of pain
Sensation of unpleasant feeling
indicating potential or actual
damage to some body
structure.
Inclusions: sensations of
generalized or localized pain in
one or more body part, pain in
a dermatome, stabbing pain,
burning pain, dull pain, aching
pain; impairments such as
myalgia, analgesia and
hyperalgesia
BODY STRUCTURES
First Qualifier: Extent of impairments
0
No impairment means the person has no problem
1
Mild impairment means a problem that is present less than 25% of the time, with an
intensity a person can tolerate and which happens rarely over the last 30 days.
2
Moderate impairment means that a problem that is present less than 50% of the time, with
an intensity, which is interfering in the persons day to day life and which happens
occasionally over the last 30 days.
3
Severe impairment means that a problem that is present more than 50% of the time, with
an intensity, which is partially disrupting the persons day to day life and which happens
frequently over the last 30 days.
4
Complete impairment means that a problem that is present more than 95% of the time,
with an intensity, which is totally disrupting the persons day to day life and which happens
every day over the last 30 days.
8
Not specified means there is insufficient information to specify the severity of the
impairment.
9
Not applicable means it is inappropriate to apply a particular code (e.g. b650 Menstruation
functions for woman in pre-menarche or post-menopause age).
1.600
S760
0
1.400
Structure of trunk
1.200
9
1
1.000
800
600
400
200
0
8
2
4
3
1000
S760
0
800
Structure of trunk
9
1
600
400
200
0
8
2
4
3
no fx
fx
S760
Structure of trunk
ACTIVITIES AND PARTICIPATION
Extent of Activity limitation and Participation Restriction
0
No difficulty means the person has no problem
1
Mild difficulty means a problem that is present less than 25% of the time, with an intensity
a person can tolerate and which happens rarely over the last 30 days.
2
Moderate difficulty means that a problem that is present less than 50% of the time, with an
intensity, which is interfering in the persons day to day life and which happens occasionally
over the last 30 days.
3
Severe difficulty means that a problem that is present more than 50% of the time, with an
intensity, which is partially disrupting the persons day to day life and which happens
frequently over the last 30 days.
4
Complete difficulty means that a problem that is present more than 95% of the time, with
an intensity, which is totally disrupting the persons day to day life and which happens every
day over the last 30 days.
8
Not specified means there is insufficient information to specify the severity of the
impairment.
9
Not applicable means it is inappropriate to apply a particular code (e.g. b650 Menstruation
functions for woman in pre-menarche or post-menopause age).
1.600
d450
Walking
Moving along a surface on foot,
step by step, so that one foot
is always on the ground, such
as when strolling, sauntering,
walking forwards, backwards,
or sideways.
Inclusions: walking short or
long distances; walking on
different surfaces; walking
around obstacles.
Exclusions: transferring oneself
(d420); moving around
(d455)
0
1.400
1.200
9
1
1.000
800
600
400
200
0
8
2
4
3
800
700
d450
Walking
Moving along a surface on foot,
step by step, so that one foot
is always on the ground, such
as when strolling, sauntering,
walking forwards, backwards,
or sideways.
Inclusions: walking short or
long distances; walking on
different surfaces; walking
around obstacles.
Exclusions: transferring oneself
(d420); moving around
(d455)
0
600
9
1
500
400
300
200
100
0
8
2
4
3
no fx
fx
d450
Walking
Moving along a surface on foot,
step by step, so that one foot
is always on the ground, such
as when strolling, sauntering,
walking forwards, backwards,
or sideways.
Inclusions: walking short or
long distances; walking on
different surfaces; walking
around obstacles.
Exclusions: transferring oneself
(d420); moving around
(d455)
ENVIROMENTAL FACTORS
Barriers
Facilitator
0
No barriers
0
No facilitator
1
Mild barriers
+1
Mild facilitator
2
Moderate barriers
+2
Moderate facilitator
3
Severe barriers
+3
Substantial facilitator
4
Complete barriers
+4
Complete facilitator
8
Not specified
9
Not applicable
2.500
e110
9
Products or substances for
personal consumption
Any natural or human-made
object or substance gathered,
processed or manufactured for
ingestion.
Inclusions: food, drink and
drugs
FACILITATOR
4+
3+
2.000
1.500
8
2+
1.000
500
0
4
1+
3
0
2
BARRIERS
1
1.400
e110
Products or substances for
personal consumption
Any natural or human-made
object or substance gathered,
processed or manufactured for
ingestion.
Inclusions: food, drink and
drugs
9
FACILITATOR
4+
3+
1.200
1.000
800
8
2+
600
400
200
0
1+
4
0
3
2
BARRIERS
1
no fx
fx
FACILITATOR
e110
Products or substances for
personal consumption
Any natural or human-made
object or substance gathered,
processed or manufactured for
ingestion.
Inclusions: food, drink and
drugs
BARRIERS
Terapia pregressa: Ca++ e vit.D
no fx
67,99%
yes
36%
fx
62,28%
33,01%
no
64%
no
37,72%
yes
Terapia pregressa per l’OP
no fx
fx
75%
66%
yes
30%
no
70%
34%
25%
no
yes
Take home message
• L’osteoporosi è una malattia disabilitante
• Un approccio fisiatrico è raccomandato
• Il FRAX anche con i suoi limiti può esserci utile
per identificare i pz a più alto rischio di
fratturarsi
• Il Brief ICF Core Set può essere uno strumento
utile ad identificare il bisogno riabilitativo dei
pazienti osteoprotici
GRAZIE:
Addevico Marco
Agostini Lorenzo
Albergati
Ammirati Caterina
Ballotta Massimo
Bertolini Carlo
Bloccari Laura
Boiani Loretta
Bombace Vincenzo
Cagnana Annalisa
Campagnoli Giovanni
Capezza Maria
Caraffa Giorgio
Carnesalini Giancarlo
Cattaneo Maria Grazia
Cattozzo Margherita
Celestini Marcello
Ceppatelli Simone
Cisari Carlo
Colarossi
Consolandi Alberto
Contrino Luciano
Coppadoro Franca
D’amico Maria
Dalla Toffola Elena
De Buono Donatella
De Chiara Raffaele
De Marchi Massimo
De Martino Eduardo
De Simone Giovanni
Dell'Imbergoli
Di Girolamo Livia
Di Pietro Gioconda
Farina Stefano
Fasani Marcella
Fenoggio Claudia
Ferlini Gregorio
Finizio Carmine
Fiorani Claudio
Fiore Piero
Fletzer David
Gimigliano Francesca
Gimigliano Raffaele
Giorgio Chiara
Groppelli Caterina
Hartmann Emma
Iolascon Giovanni
Lavacca Maria
Lavarra Francesco
Lecce Aldo
Letizia Giulia
Listrani Alessandro
Lobbia Luciana
Lorenzini Michela
Magagni Gianandrea
Maggiolini Francesca
Magnani Gainnandrea
Manfredini
Mangone Giuseppe
Marchese Angela
Marchesi Gianfranco
Mauri Angelo
Mazzei Rosa
Megna Gianfranco
Menconi Agnese
Mercante Oriano
Milano Edoardo
Mileto Antonio
Moretti
Olivieri Maurizio
Panuccio Antonio
Pasquetti Pietro
Pellegrini Simonetta
Pellizzon Massimo
Pepe Antonio
Peron Paola
Pestelli Germano
Piazzini Diana
Posteraro Giuseppe
Puglisi Claudio
Raffaetà Gloria
Rizzo Daniele
Romaniello Vitina
Romeo Alfredo
Roncato Andrea
Ronconi Gianpaolo
Saraceni Vincenzo
Scaglione Giuseppe
Schieroni Maria Pia
Sciacca Rosario
Seminara Carmelo
Sguazzini Giovanni
Silvestrin Roberto
Smiderle
Specchia Alessandro
Sterzi Silvia
Tabarrini Laura
Tontodonati Chiara
Tuvo Stefano
Uliano Domenico
Vena Salvatore
Vuza Maria
Zambuto Alfredo
Zampolini Mauro
Zannato Rosangela
Zucchi Francesca
Zucchini Elisabetta