Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Enhancing Partnership with Patients and Community (Projects initiated to engage patients / carers / community to improve efficiency / quality of care)
Authors (including presenting author) :
Pang CG, Cheung EYY, Chow KKT, Lau ACH, Chan RWY, So JKW, Pow LWS, Leung KKL
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Hip fracture patients require intensive rehabilitation to regain functional independence. Recent studies have revealed that the number of hip fractures is projected to double by 2050 compared with 2018(1). Such predictions warrant a service revamp within the healthcare system to meet patient needs without compromising service quality after hip surgery. It is of paramount importance to identify the change in patient demographics to optimize service remodeling.
Objectives :
The objective of this review is to compare the change in demographics and rehabilitation potentials of hip fracture patients within the last decade.
Methodology :
Patients admitted to Kowloon Hospital(KH) diagnosed with hip fracture were recruited and divided into two groups based on their year of admission(Year2013-2018 and 2019-2023). In addition to comparing their length of stay(LOS) and age, admission and discharge data of the Numeric Pain Rating Scale(NPRS), Modified Functional Ambulation Classification(MFAC), and Elderly Mobility Scale(EMS), were also compared between the two groups.
Result & Outcome :
There were 965 and 926 patients in the cohort of Year2013-2018 and 2019-2023 respectively. The cohort of 2019-2023 showed significantly older patients(82.70±8.49 vs 83.47±8.73, p=0.045) with greater NPRS upon admission(4.36±2.63 vs 4.81±2.58, p<0.001) and discharge(1.23±1.61 vs 1.75±2.02, p<0.001), lower median MFAC upon admission(mean rank 1142 vs 912, p<0.001) and discharge(mean rank 1122 vs 929, p<0.001), and lower EMS upon admission(4.10±2.61 vs 3.36±2.28, p<0.001) and discharge(9.49±5.23 vs 7.70±5.16, p<0.001). Despite such unfavorable admission and discharge scores, this cohort had a shorter LOS(31.59±17.50 vs 29.88±16.53, p=0.024). The Year2019-2023 cohort showed lower EMS discharge scores(β=-0.855, p<0.001) when the linear regression model was used controlling age, admission EMS & NPRS, premorbid & admission MFAC.
Evidently, patients sustaining hip fractures have an aging trend with greater post-operation disability. The diminishing rehabilitation potential is reflected by a marked decline of EMS discharge scores regardless of post-operative ability and age. Positive factors contributing to reduced LOS could be the emergence of a prediction model on patient discharge mobility status and the seamless continuation of support provided beyond an in-patient setting(e.g. telehealth physiotherapy support, domiciliary physiotherapy and District Health Centres). With an aging population and evolving patient demographics, the forementioned provide insight to further optimize available resources in supporting hip fracture patients with reduced mobility to return to the community.
