Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Lam, BH(1), Lee SKW(1), Chui TKH(2), Tiu KL(2), Lee KB(2), Chan ACM(1)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital
(2)Department of the Orthopaedic and Traumatology, Queen Elizabeth Hospital
Introduction :
Aging population is a common phenomenon in modern society and fragility fracture is one of the major threats to elderly. Fragility fracture refers to fracture resulting from fall with standing height or less which commonly occurs at hip, spine, shoulder and wrist. Hip fracture was found to be associated with increased mortality and reduced functions. Therefore, rehabilitation should be provided to patients after fragility hip fracture (FHF) to improve their functional capabilities and prevention of repeated fall. Orthopaedic Day Rehabilitation Service (ODRS) for patients after fragility fractures in Queen Elizabeth Hospital (QEH) was implemented since October 2022. The aims are to maximize functional recovery of patients after fragility fracture, prevent secondary fracture and shorten the hospital length of stay through early supported discharge. It involves a multidisciplinary team including orthopaedic doctors, nurses, physiotherapists, occupational therapists and dietitians. Intensive rehabilitation training will be given to indicated patients after physical and fall risk assessment.
Objectives :
The aim of this article is to evaluate the functional performance of patient after FHF before and after the rehabilitation training under the ODRS in QEH.
Methodology :
This is a retrospective cohort review of the service. Physiotherapy records of patients with FHF within 6 months and completed rehabilitation training program under ODRS from October 2022 to November 2023 were reviewed and analyzed. Demographic data of patients, functional status in terms of Modified Functional Ambulatory Category (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI), walking speed and fear of falling by Falls Efficacy Scale – International (FES-I) were collected on admission and upon discharge of the training program.
Result & Outcome :
During the reviewed period, 98 patients completed the rehabilitation training program (mean age: 84.33±7.58) and 67% were female. Functional performance of the patients was compared before and after the training program. There were statistical significant improvement in the walking speed (pre: 0.38m/sec, post: 0.44m/sec, p<0.001), median score of EMS (pre: 11, post: 14, p<0.001) and MBI (pre: 74.5, post: 83.0, p<0.001). Although the ambulatory status of MFAC median score remained similar (pre & post: 5), the patients enjoyed higher functional independence in daily activities. In addition, their FES-I decreased significantly (pre: 41.0, post: 25.5, p<0.001) after the training program, which reflected their concern about falling decreased from high to moderate level. In conclusion, ODRP training could enhance the functional recovery of patient after FHF in terms of walking speed and functional independence in daily activities and resulted in decreasing patients’ perception of fear of falling.
