Page 137 - Hospital Authority Convention 2018

Service Enhancement Presentations

F4.3 Clinical Safety and Quality Services II 16:15 Room 421

Hip Pain during Walking and Cognitive Status Early Post-operation Predict Discharge Destination in Men with
Hip Fracture: A Prospective Study
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Chow IHW , Chan ACM , Chan DWL , Yung BPK , Lee KB , Li WWY , Pang MYC 3
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1 Physiotherapy Department, Queen Elizabeth Hospital, Department of Orthopaedics and Traumatology, Queen Elizabeth HOSPITAL AUTHORITY CONVENTION 2018
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Hospital, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
Introduction
Hip fracture is a well-known geriatric fracture that requires hospitalisation. Some elderly demonstrated permanent disability
and failed to return to their original residency despite successful surgery and adequate rehabilitation. Early prediction of
discharge destination of hip fractured patients would allow healthcare disciplines to have a better discharge planning and
communication. Health status, functional status and activity of daily living (ADL) state in pre-fracture phase, post-operative
complications, time to surgery and length of hospital stay were shown to be predictors. However, scientific evidence related
to the usefulness of variables such as the level of hip pain, cognitive function, self-efficacy of patients on performing exercise
for prediction of discharge destination is still limited.
Objectives
To identify potential predictors of returning home at early hospitalisation stage after hip fracture in community-dwelling older
men and women.

Methodology
80 community-dwelling older subjects (mean age 84.26.0 years; 32 men), with unilateral hip fracture managed operatively
were recruited from the orthopaedic wards of Queen Elizabeth Hospital. All recruited subjects were managed under a
standardised integrated multidisciplinary clinical pathway for fragility hip fracture. The following potential predictors were Monday, 7 May 2018
assessed at the second ambulatory training session: (1) level of hip pain during walking by Numeric Pain Rating Scale, (2)
mobility function by Elderly Mobility Scale, (3) cognitive status by Mini-mental State Examination, (4) functional status by
Modified Barthel Index, and (5) self-efficacy by Self-efficacy for Exercise Scale. Final discharge destination was evaluated via
telephone interview at six-week post-operation. Multivariate logistic regression analysis was used for statistical analysis.
Results
In the sixth week, 50% and 69.6% of men and women were able to return to home respectively. After adjusting for age, less
hip pain during walking (men: p=0.04, OR=0.47, 95%CI=0.23-0.97; women: p=0.844, OR=0.97, 95%CI=0.69-1.35) and better
cognitive status (men: p=0.045, OR=1.43, 95%CI=1.01-2.03; women: p=0.706, OR=1.03, 95%CI=0.89-1.20) at the second
ambulatory training session were found to be significant predictors for returning home. None of the other potential predictors
assessed were found to be able to predict discharge destination in both men and women (p≥0.182). Pain management early
post-operation maybe important to facilitate men with hip fracture to return to home. Early placement arrangement may be
required for men with poorer cognitive status to facilitate earlier discharge.

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