Page 118 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP3.1 Clinical Safety and Quality Service I 14:30 Room 221

Monday, 18 May Functional Status of Patients with Fractured Hip at Admission: Shedding Light on Rehabilitation Outcomes and
Resource Allocation
Au KMB, Poon MYC, Chan WKH, Jim CHC, Tsui WMJ, Chang WKP, Wong SY, Ng HWS, Chan CYY, Wong KMS
Occupational Therapy Department, Tai Po Hospital, Hong Kong

Introduction

The ever-increasing demand on rehabilitation services due to ageing population has been a perplexing issue in recent years.
Hence, better understanding of the recovery profiles of patients may help to develop a triage system for utilising resources
more efficiently under existing constraints. Approximately 600 hip fractured patients are referred to Occupational Therapy
Department of Tai Po Hospital for rehabilitation each year. Distinct characteristics of recovery profiles were identified
primarily based on their functional status being assessed at admission. The patient group with lowest functional scores at
admission was found to improve the least and with lowest rate. On the other hand, patients with midstream of functional
status showed the greatest extent and fastest rate of recovery.

Objectives

This study aimed to investigate the characteristics of recovery profiles of patients with fractured hip based on their functional
status at admission, which may provide the groundwork for determining a reasonable resource allocation by developing a
triage system.

Methodology

It was a retrospective study which recruited all patients with fractured hip discharged from Tai Po Hospital between 2013
and 2014. They were classified into three different categories (severe, moderate and mild disabled) according to their activity
of daily living (ADL) status in terms of Modified Barthel Index (MBI) at admission. With this classification, their demographic
data, cognitive status at admission and rehabilitation outcomes such as length of stay (LOS), extents and rates of functional
gain in terms of MBI as well as discharge placement were compared by Kruskal Wallis Test and One-way ANOVA.

Results

1,245 patients were recruited during the study period. Their age was 81.9+27.2 years old and 75% of them were female.
Group differences were found in rehabilitation outcomes such as LOS, F(2, 1240)=162.70, p<0.001, MBI gain, F(2,
1239)=25.85, p<0.001, efficiency of MBI gain in terms of MBI gain per day, F(2, 1236)=14.63, p<0.001 and rate of back to
home for the community dweller, H(2)=50.25, p<0.001 after Bonferroni adjustment. Post-hoc tests showed that the moderate
group (24.3+10.7) was longer in LOS than severe (21.1+11.9) but no difference with mild disabled group (22.9+9.2). MBI gain
was the greatest and the least in moderate (19.4+15.7) and severe disabled groups (11.8+17.1) respectively. Similar order was
also found in the efficiency of MBI gain: moderate (0.8+0.8), mild (0.7+0.6) and severe disabled groups (0.5+0.8). As expected,
most of the mild disabled community dwellers could return to community dwelling (92.2%) when compared to the moderate
(79.1%) and severe disabled community dwellers (65.0%).

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