early hip fracture rehabilitation - noca · hip, hop & happening! early hip fracture...
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Hip, Hop & Happening!
Early Hip Fracture Rehabilitation
Michelle Fitzgerald BSc, MSc, MISCP
Senior Physiotherapist, Tallaght Hospital, Dublin
Irish Hip Fracture Meeting
RCSI 8th November 2017
Overview
1. Early acute rehabilitation
2. Preparation of 2016 IHFD rehab data-fields
3. 2016 IHFD results overview
4. Goals for 2017-2017
My Background
• Senior Physiotherapist, Tallaght Hospital
• Hip fracture clinical audit & research
• National hip fracture governance committee
• Fragility Fracture Network
A ‘Hip’
Attack
Surgery ASAP ED flow
Medically optimise
Delirium
Hip Attack
“Mobilise with
physio”
Early
mobility
Early Rehab is Important
(Boonen et al., 2004, Dubljanin-Raspopovic et al., 2013, Hirose et al., 2010)
Post-Op Long-Term
Mobility
Survival
+
Function
Active Acute Rehabilitation
• Maximises recovery
• Successful discharge home
• Decreases length of stay
• Reduce overall cost
• Acute wards perceive rehabilitation and discharge
planning as not being their responsibility
• Accumulate patients “waiting for rehabilitation”
• Fail to progress in the crucial postoperative days
(British Orthopaedic Association 2007, NICE 2012)
“Rehabilitation of hip
fractures is the central
challenge for trauma
services”
(British Orthopaedic Association 2007)
Review of Rehabilitation Internationally
• Amount of rehab varies in acute hospitals
• Confidence in rehabilitation progression?
• What type of post-operative physio?
• Barriers exist e.g. staffing
• No Irish data
• Time for change
Time for Rehab Change!
• In order to get better we need to measure what
we are currently doing.
• First step in effecting change:
• Add function specific data-fields to the IHFD
– Functional progress
– Rehabilitation service provision
– Effect of hospital approaches
Databases
Direct Communication
International Guidelines
Care Standard Guideline Synopsis
Physio assessment First postoperative day
Frequency of mobilisation Daily (7days)
Rehabilitation Early, MDT
Discharge planning Early, MDT, individualised
Type of physiotherapy Multidimensional
IHFD Rehabilitation Data-fields
First postoperative
day
DischargeLonger term
Baseline function
New Mobility Score
NMS Category Score Functional ability
0 Not at all
1 Assistance of one person
2 With an aid
3 No difficulty/no aid
Indoor walking, outdoor walking, shopping
Cumulated Ambulatory Score (CAS)
CAS Category Score Functional Ability
0 Not at all
1 Assistance 1-2 people
2 Independent
Bed mobility, STS, mobilisation
Baseline
• New Mobility Score (0-9)
1st post-op Day
• Physio assessment (Yes/No)
• Mobilisation (Yes physio/Yes other/No)
• Cumulated Ambulatory Score (0-6)
Discharge
• Cumulated Ambulatory Score (0-6)
Hip, Hop and Happening !!
Local
Data
Irish data
Guideline adherence
Physio service
provision
Leading hip
fracture care
Hip, Hop and Happening !!
Rehab
Guideline adherence Physio
Service provision
No extra work
Leading hip
fracture care
Irish data
Data accuracy
Data completeness
Hip Fracture
Conference
Oct 2015
Communication
Data Collection
1st Jan 2016Communication
IHFD Visits2016
Data Analysis
PRE-FRACTURE FUNCTION
New Mobility Score
NMS Category Score Functional ability
0 Not at all
1 Assistance of one person
2 With an aid
3 No difficulty/no aid
Indoor walking, outdoor walking, shopping
FIRST POSTOPERATIVE
DAY
Physiotherapy Assessment
78% received a
physiotherapy assessment
day one postoperatively
Physiotherapy Assessment
78% received a
physiotherapy assessment
day one postoperatively
(Every 5th patient didn’t)
2017 FACILITIES AUDIT
Physiotherapy Assessment
• 78% received physiotherapy assessment day one
postoperatively
?
Staffing
Weekend
Docu-mented
Other
“Rehabilitation of hip
fractures is the central
challenge for trauma
services”
(British Orthopaedic Association 2007)
This is YOUR data on YOUR patients!!
Baseline
• New Mobility Score (0-9)
1st post-op Day
• Physio assessment (Yes/No)
• Mobilisation (Yes physio/Yes other/No)
• Cumulated Ambulatory Score (0-6)
Discharge
• Cumulated Ambulatory Score (0-6)
30day
& 120 day
• New Mobility Score (0-9)
Hip, Hop and Happening !!
Local
Data
Irish data
Guideline adherence
Physio service
provision
Leading hip
fracture care
2017-2018
IHFD REHAB DATA
2017-2018: IHFD Data Collection
• Accurate
2017-2018: IHFD Data Collection
• Accurate
• Complete
2017-2018: IHFD Data Collection
• Accurate
• Complete
• ….. Especially CAS !!!
2017-2018: IHFD Data Collection
• Accurate
• Complete
• ….. Especially CAS !!!
2017-2018: Physio Service Provision
Day 1 Physio Assessment
7 days a week
2017-2018: Advocate for Rehab!!
2017-2018: Advocate for Rehab!!
• Local hip fracture working group
• Regular local reports and meetings
• Physiotherapy/Rehab team-work &
networking between hospitals
Hip, Hop and Happening !!
Rehab
Guideline adherence Physio
Service provision
No extra work
Leading hip
fracture care
Irish data
Physiotherapy Specialist Interest Group Workshop
Wed 4th July 2018 (TBC)
Acknowledgements
• All the orthopaedic physiotherapists & physiotherapy
managers nationally for their support and enthusiasm
• National hip fracture governance committee
• Physiotherapy hip fracture working group
• National Orthopaedic Care Programme
• Hip fracture patients
Thank You !
A ‘Hip’
Attack
References
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