Authors (including presenting author) :
Tse CWE(1), Chow LYD(1), Ho OLL(1), Yuen TSJ(1), Yu WSC(1), Kwan WSA(1), Tsui HF(2), Lam CY(2), Mak MYM(1)
Affiliation :
(1) Physiotherapy Department, Tuen Mun Hospital, (2)Department of Orthopaedics and Traumatology, Tuen Mun Hospital
Introduction :
Clinical evidence and overseas service clinical guidelines support the need for early physiotherapy and mobilization for patients with lower limb fracture and arthroplasty. However, physiotherapy with early post-operative mobilization is interrupted on weekend and public holiday. Usually, only very limited restorative rehabilitation is provided. This situation impedes the patient flow along the clinical pathway. 365-day physiotherapy for patients with lower limb fracture in acute orthopaedic setting is thus introduced to facilitate patient flow, enhance safety and early discharge.
Objectives :
To evaluate the effectiveness of the 365-day physiotherapy restorative rehabilitation program for hip fractures.
Methodology :
365-day physiotherapy restorative rehabilitation program for hip fractures in acute ward setting was started since 1 October 2017 in Tuen Mun Hospital. Service was provided to patients in the 1st week post-operation. Socio-demographic data, physical and ambulatory status were reviewed from 1 July 2017 to 31 October 2018. Outcome measures were compared between the 365-day program group (October 2017 to October 2018) and pre-365-day program group (July to September 2017) as control group. Length of stay (LOS) of these patients was the primary outcome. Secondary outcomes included: (1) Elderly Mobility Scale (EMS); and (2) Modified Functional Ambulation Category (MFAC); which were collected at the first visit and upon discharge. Data of LOS were analyzed using the independent sampled t-test, whereas data of EMS and MFAC were analyzed using the Mann-Whitney U test, IBM SPSS Statistics (version 20).
Result & Outcome :
From July 2017 to October 2018, 504 patients (153 male and 351 female; mean age = 83.5 ± 8.0 years old) were recruited. 108 patients (37 male and 71 female; mean age = 83.7 ± 8.2 years old) were recruited in pre-365-day program group. 396 patients (116 male and 280 female; mean age = 83.4 ± 8.0 years old) were recruited in 365-day program group. There are no significant differences in gender, age, initial EMS and MFAC between both pre-365-day and 365-day program groups (gender, p=0.345, age, p=0.706, initial EMS, p=0.054 and initial MFAC, p=0.052). The mean LOS of pre-365-day program group was 28.7 ± 10.1 days and the mean LOS of 365-day program group was 25.6 ± 8.8 days. There were 3.1 days shorter in LOS in the 365-day program and was statistically significant (p=0.012). For the perspective of the function and ambulation, the mean EMS on the discharge of pre-365-day program group was 8.0 ± 0.8 and that of 365-day program group was 7.1 ± 0.3. The mean MFAC on discharge of pre-365-day program group was 4.0 ± 0.2 and that of 365-day program group was 4.0 ± 0.1. There are no significant differences in both EMS and MFAC between the two groups (EMS, p=0.401 and MFAC, p=0.683). Conclusion: For hip fracture patients, the review of the one-year implementation of 365-day rehabilitation program illustrated a reduction the length of stay with statistical significance. Shortening the mean LOS of 3.1 days will enhance the efficiency of patient flow and ameliorating the pressure on inpatient rehabilitation service, in particular in the winter surge period, without compromising the physical and functional outcomes as reflected from EMS and MFAC values.
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