Treatment outcome of Occupational Therapy in supported direct discharge service for fragility hip fracture patients

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Authors (including presenting author) :
Chu WH, Lee MHM, Ma WL, Tsang YN
Affiliation :
Occupational Therapy Department, Queen Elizabeth Hospital, Hong Kong
Introduction :
Fragility hip fracture program was first started in 2015 in Queen Elizabeth Hospital. The ultimate aim was to facilitate the patients to re-integrate into community after operation. Patients who received hip surgery with direct discharged home had a shorter length of stay of hospitalization when comparing to patients who had further rehabilitation in convalescent hospital after discharge from acute hospital. It is essential to early identify patients whom to receive supported direct discharge service in order to shorten the overall length of stay.
Objectives :
To analyze demographic and functional characteristics of patients who were discharged from acute setting after fragility hip fracture. To evaluate treatment outcomes of occupational therapy in supported direct discharge for fragility hip fracture patients.
Methodology :
This retrospective study was carried out with patients with over 65 years old who underwent hip surgery for fragility hip fracture and under fragility hip fracture clinical pathway in Queen Elizabeth Hospital from April 2017 to September 2018. Demographic and functional characteristics for patients who direct discharged home were analyzed. Meanwhile, treatment outcomes of occupational therapy in supported direct discharge service were evaluated.
Result & Outcome :
Fifty nine patients were eligible for the study. The mean age of these patients was 80. 5. More than 60% patients' AMT score was above 5. Their average premorbid MBI score was 90.8. Three-quaters of them live at home with full time carer. The average length of stay was nearly 20 days. All patients received ward based ADL training. Their performance on different activities in daily living were analyzed in the study and it was found that the functional tasks which required lower limb strength and coordination, for example transfer (p< 0.001, )dressing(p< 0.001), toileting(p< 0.001) and bathing(p< 0.001) showed significant improvement after post-operative ward-based ADL training. Nearly 30% of these patients received carer education on ADL and home safety, one-forth of them received assistive aids prescription and training and around 12% of them received home visit and modification. Home discharge readiness scale was used as a tool to screen the type of treatment needed, however, it was suggested to rate this scale again after patient receiving treatment to review the treatment outcome.

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