Page 115 - Hospital Authority Convention 2018

Service Enhancement Presentations

F1.2 Better Manage Growing Demands 10:45 Room 421

Golden Bullet Trigger for Old Engine-sustaining Benefit of 365-day Physiotherapy Service for Frail Elderly with
Hip Fracture in Kowloon Central Cluster
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Cheung EYY , Chan ACM , Wong EYW , Pow LWS , So JKW , Chan BTW , Lam CPY , Chau RMW 1
1 Physiotherapy Department, Kowloon Hospital, Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2018
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Introduction
Meta-analysis supported the benefits of additional physiotherapy in decreasing hospital stay and enhancing clinical
outcomes. 365-day physiotherapy service for lower limb fracture and arthroplasty in acute setting was implemented in Queen
Elizabeth Hospital (QEH) since October 2017 in accordance to Strategic Service Framework (SSF).
Objectives
To evaluate the sustaining benefits downstream in extended care setting.
Methodology
Patients with hip fracture admitted to QEH and being transferred to Kowloon Hospital (KH) for rehabilitation were recruited.
Patients provided with 365-day physiotherapy service were identified via Clinical Management System. Clinical outcomes
including Numeric Pain Rating Scale (NPRS) for pain measurement, Modified Functional Ambulation Classification (MFAC)
and Elderly Mobility Scale (EMS) for functional independence, walking aid used, and length of stay (LOS) in QEH post-
operation and in KH were collected. Sex-, age-, diagnosis-, and operation-matched patients who stayed over weekend in
QEH post-operation prior to the implementation of 365-day physiotherapy service were selected as controlled group.

Results Monday, 7 May 2018
18 eligible hip fracture patients receiving 365-day physiotherapy service in QEH and being discharged from KH were
identified from October to December 2017. 11 (61.1%) of them were female with mean age of 84.3±5.29 years old. The LOS
in QEH post-operation did not differ between groups (8.5±4.0 vs 7.7±3.2). Nonetheless, there were considerably reduction in
mean LOS in KH (4.1days; 25.2±6.2 vs 29.3±12.7) and total LOS post-operation (3.2days;33.7±7.6 vs 36.9±12.3) for patients
receiving 365-day acute physiotherapy service. Although with decreased hospital stay, these patients also achieved earlier
and similar significant clinical improvements (NPRS-4.06±2.2 to 1.4±2.2, MFAC-median of 3 to 4 and 33% achieving walking
without manual assistance, EMS-4.0±1 to 8.4±4) exceeding minimally clinically important difference (MCID) at the time of
admission to KH and pre-discharge from KH. Patients who lived home prior to injury were discharged to home at a similar
percentage as controlled group.
The result was in accord with meta-analysis findings with worthy note of relatively frail elder in our cohort demonstrating
sustaining downstream benefits. The early patient engagement in acute care for therapeutic intervention provided in weekend
appeared to pull the golden trigger not just in acute rehabilitation but also in motivating (as reported in meta-analysis) and
tuning the frail elderly for continuing of physical training in rehabilitation setting. This preliminary review of 365-day acute
physiotherapy service reflected that even for frail elderly with compromised mobility still benefitted from the additional acute
physiotherapy services. This more cost-effective service model may promote recovery and facilitate early safe discharge in
matching the corporate direction stipulated in the Hospital Authority Annual Plan.

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