Authors (including presenting author) :
Chan RWY(1), Woo CW(1), Chan ACM(2), Chau RMW(1), Chan JSP(1), Wong EYW(1), Cheung EYY(1), Cheung LPC(3), Cheng WKH(3), Li KK(3), Li W(3)
Affiliation :
(1)Physiotherapy Department, Kowloon Hospital, (2)Physiotherapy Department, Queen Elizabeth Hospital, (3)Department of Orthopedics and Traumatology, Queen Elizabeth Hospital
Introduction :
For elder with a fragility fracture, often with complex medical disorders which surgery and rehabilitation are unnecessarily delayed leading to additional sequelae of prolonged immobilization, deconditioning, and worsened outcome. The current management in the Queen Elizabeth Hospital(QEH) basically complies with the Six Standards for Hip Fracture Care advocated by the British Orthopedic Association with essence of specialist led orthogeriatric model of care and structured clinical pathway. For medically unfit elders with delay surgery(>48 hours), the patient referenced management model, with clinical pathway adjusted according to each patient’s medical condition was adopted alternatively.
Objectives :
To evaluate the effectiveness of patient referenced management model for frail elders requiring delayed surgery.
Methodology :
A retrospective analysis was conducted to evaluate the patient referenced management model. 132 elders(age 83.8±7.0) with delayed surgery due to medically unfit was sampled with outcomes compared to other fragility fracture cases (comparison group) admitted to QEH in 2016.
Result & Outcome :
The demographic data, pre-op pain and cognition was comparable to other fragility fracture cases except for comorbidity(Charlson Comorbidity index of sampled group versus control group: 6.1±2.1 vs 5.6±1.8). Although the sampled group demonstrated significant longer hospitalization(25.3±17.9 vs 12.3±8.5), there was significant within group improvement in pain reduction and functional score upon discharge. The improvement was comparable to the comparison group in pain reduction measured by Numerical Pain Rating Scale(NPRS from 5.9±1.5 to 2.4±1.3 vs from 5.7±1.5 to 2.0±1.4). Both groups also regained similar mobility level measured by Modified Functional Ambulation Classification(median 3vs4) and Modified Barthel Index(46.8±14.8 vs 48.5±17.5) upon discharge.
The patient referenced management model, which provided routine access to orthogeriatric medical support, aims to identify and manage co-morbidities immediately, which could minimize surgery delayed time and promote earlier rehabilitation. From admission, the multidisciplinary team provided assessment and tailor-made rehabilitation for these frail patients succeeded in management of pain, improved functional mobility, preventing complications and future falls. Rehabilitation program targeted obstacles that hinder them from returning to normal daily living was adopted. Hence hospitalization could be shortened. The model was an effective management approach for frail elders requiring delayed surgery.
Co-location with:
