Authors (including presenting author) :
Tse HK(1), Ip KW(1), Wong SY(1), Chan TM(1), Lee WY(1), Ko KY(1), Lee SY(1), Liu YS(1), Wong CW(1), Leung YY(1), Liu YM(1), Tse TK(1)
Affiliation :
(1) Physiotherapy Department, Princess Margaret Hospital (PMH)
Introduction :
Clinical evidence and overseas service clinical guidelines support the need for early mobilization for lower limb (LL) fracture and arthroplasty cases. In existing clinical service, mainly chest physiotherapy and limited provision of restorative rehabilitation therapy during weekend and public holiday. The interruption of rehabilitation services during weekend and public holidays may affect patients’ continuity of care with prolonging the length of stay (LOS) in hospital. Streamlining of rehabilitation for patient with LL fracture and arthroplasty was implemented to provide better continuity of care and improve treatment efficacy.
Objectives :
(1) to improve functional independence of patient, (2) to improve continuity of care, (3) to facilitate patient flow, early and safe discharge
Methodology :
A “Pre-intervention” vs. “Post-intervention” design was employed. Two groups of subjects were (1) Hospitalized patient with a principal diagnosis of hip fracture and undergone fixation surgery or undergone total hip replacement (THR) in current admission, and (2) Hospitalized patient with a principal diagnosis of LL fracture other than hip fracture or undergone total knee replacement (TKR) in current admission. Included subjects should be successfully discharged from Princess Margaret Hospital (PMH) to rehabilitation hospital, home, or old aged homes. Outcome measures were categorized as: (1) LOS in PMH, (2) Mobility status in terms of Modified Functional Ambulation Classification (MFAC) and Elderly Mobility Scale (EMS).
Result & Outcome :
1012 patients were recruited from 1st Jan 2019 to 30th Sep 2019 as “pre-intervention” data with 373 patients were diagnosed with fracture hip and undergone arthroplasty surgery or THR. Majority of them were female (69%). And the remaining 639 patients (53% female) were diagnosed with other LL fractures. In comparison, 885 patients were recruited from 1st Oct 2019 to 30th June 2020 with 336 patients were diagnosed with fracture hip and undergone arthroplasty surgery or THR, remaining 549 patients were diagnosed with other LL fractures. Proportion of female in these groups were 63% and 58% respectively. Upon the LOS after program implementation, it was slightly decreased from 11.7 to 11.5 days for hip fracture group (p>0.05) and from 13.2 to 12.0 days (p>0.05) in other LL fracture group. For the mobility status, proportion of patients without manual assistance (MFAC ≥5) increased from 18% to 21% (p>0.05) in hip fracture with arthroplasty group and from 65% to 70% (p>0.05) in other LL fracture group. On the other hand, EMS at discharge of hip fracture group slightly decreased from 5.8 to 5.3 (p>0.05). To conclude, the implementation of 365-day PT service for LL fracture and arthroplasty case may be effective in improving mobility status and shorten LOS in acute setting for LL fracture case other than cases with fracture hip and undergone arthroplasty surgery or THR.
