Authors (including presenting author) :
Wong H(1), Lam CS(1), Ho SM(1), Chan LC(1)
Affiliation :
(1) Physiotherapy Department, Pok Oi Hospital
Introduction :
Post-operative physiotherapy is important to patients with lower limb fracture and arthroplasty. Early mobilization and timely exercise therapy assist patients to restore their functions and reduce their length of stay in hospital. However, post-operative mobilization during weekend and public holiday was basically not available in HA hospitals. The rehabilitation progress gained from physiotherapy training during weekday may be lost with the bedbound period during weekend or public holiday. This imposes negative effect on the patient condition and delays their discharge from hospital. The introduction of 365-day physiotherapy for patients with lower limb fracture and arthroplasty in orthopedic setting thus aims to reduce length of stay and facilitate early discharge.
Objectives :
To investigate the effect of a 365-day physiotherapy service program on length of stay in geriatric patients with hip fracture
Methodology :
In Pok Oi Hospital, a 365-day physiotherapy service program was launched for patients with hip fractures since 1 October 2018. Hip fracture patients with 365-day service program from October 2018 to September 2019 were recruited as study group whereas patients without 365-day service program from April to September 2018 were recruited as control group. All the data was retrieved from CDARS. Outcome measures included the mobility level as measured by Elderly Mobility Scale (EMS), ambulatory status as charted by Modified Functional Ambulation Classification (MFAC) and length of stay (LOS). The data of EMS and MFAC were collected at the first attendance after operation (Initial) and before discharge (Final). The demographic data was analyzed using the Mann-Whitney U Test and Chi-Square Test while the data of LOS, EMS and MFAC were analyzed using the Mann-Whitney U Test, IBM SPSS Statistics Version 18.
Result & Outcome :
A total of 216 patients’ data was retrieved from CDARS. 141 patients [42 males (29.8%) and 99 females (70.2%); mean age= 80.9 ± 10.45 years old] were recruited as study group and 70 patients [27 males (38.6%) and 43 females (61.4%); mean age= 80.6 ± 8.37 years old] were recruited as control group. 5 patients were excluded due to death and missing data. Demographic data including age, gender and premorbid MFAC had no significant difference between study and control groups (p>0.05).
The length of stay of patients with hip fracture decreased after the start of the program. The mean of post-op LOS for study group was 13.64 ± 10.99 days while the mean of post-op LOS for control group was 16.66 ± 8.11 days. The LOS for patient in study group are 3.02 days shorter than that in control group (p< 0.001).
The ambulatory status and mobility level at discharge were not compromised despite the decreased length of stay. The final MFAC and EMS of study group were 3.93 ± 1.61 and 6.74 ± 5.53 respectively while the final MFAC and EMS of control group were 3.99 ± 1.57(p=.840) and 7.55 ± 5.55 (p=.387) respectively.
A 365-day service program for fracture hip patients shortened the length of stay of hospitalization while the similar level of mobility and ambulatory status could be achieved in a shorter period of time.
