Authors (including presenting author) :
Ho OLL(1), Yuen TSJ(1), Yeung HTJ(1), Tse CWE(1), Wong KH(1), Ma FCB(1), Mak MYM(1), Tsui HF(2), Lam CY(2)
Affiliation :
(1) Physiotherapy Department, Tuen Mun Hospital, (2)Department of Orthopaedics and Traumatology, Tuen Mun Hospital
Introduction :
Hip fracture after falls in the elderly is common in Hong Kong. It is a significant threat to individual’s functional independence and ability to live in the community. Comprehensive 365-day in-patient physiotherapy rehabilitation program, which provides daily physiotherapy service within first seven days post-operatively, was implemented to improve patient’s mobility and facilitate discharge process since October 2017 in Tuen Mun Hospital.
Objectives :
To investigate the physical and rehabilitation profile and identify possible factors influencing functional recovery and discharge destination of post-operative hip fracture elderly who received 365-day rehabilitation service.
Methodology :
Patients underwent hip operations under Integrated Patient Care Pathway (IPCP) Hip Fracture Program in orthopedics units were recruited retrospectively. Socio-demographic data and pre-morbid status were reviewed. Primary outcomes included: (1) Elderly Mobility Scale (EMS); (2) Modified Functional Ambulation Category (MFAC); (3) Time-Up and Go Test (TUGT); (4) Numeric Pain Rating Scale (NPRS); were collected initially after operation and before discharge. Discharge destination, home or institutionalization, was used as secondary outcome. Data were analyzed using IBM SPSS (version 24).
Result & Outcome :
Results and Outcomes: From October 2017 to October 2018, a total of 396 patients (116 male and 280 female; mean age = 83.4 ± 8.0 years old) were recruited. The mean of Length of Stay (LOS) was 25.6 ± 8.8 days. 312 patients (79%) could walk independently before admission. After a course of rehabilitation, improvements were demonstrated in the following outcomes: (1) Mean of EMS improved from 0.18 ± 0.93 to 6.67 ± 4.73 (p = 0.001) ; (2) Median of MFAC changes from Category I to Category IV (p = 0.001) ; (3) All patients failed in TUGT initially and 30.3% (n = 120) could complete before discharge ; (4) Mean NPRS score improved from 5.00 ± 3.84 to 1.71 ± 1.81 (p = 0.001). There was 61.4% (n = 243) of patients whom could return to original home upon discharge. Spearman rank correlation analysis showed that pre-morbid MFAC is positively correlated with final EMS score (rs = 0.468 ; p < 0.00) and final MFAC (rs = 0.463 ; p < 0.00). Chi-Square analysis also demonstrated a significant correlation between premorbid MFAC and discharge destination. (X2 =27.4, p = 0.017). Conclusion:
Comprehensive 365-day physiotherapy rehabilitation is effective in improving functional status in elderly after hip fractures. Premorbid mobility status plays a significant role in functional recovery and contribute to discharge destination. Further exploration on factors other than physical profile, patients’ rehabilitation regime during hospitalization and follow-up on functional progress after discharge are warranted to review a more holistic rehabilitation program for post-operative hip fracture elderly.
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