Hip, Hop & Happening!

Early Hip Fracture Rehabilitation

Michelle Fitzgerald BSc, MSc, MISCP

Senior Physiotherapist, Tallaght Hospital, Dublin

Irish Hip Fracture Meeting

RCSI 8th November 2017

Overview

1. Early acute rehabilitation

2. Preparation of 2016 IHFD rehab data-fields

3. 2016 IHFD results overview

4. Goals for 2017-2017

My Background

• Senior Physiotherapist, Tallaght Hospital

• Hip fracture clinical audit & research

• National hip fracture governance committee

• Fragility Fracture Network

A ‘Hip’

Attack

Surgery ASAP ED flow

Medically optimise

Delirium

Hip Attack

“Mobilise with

physio”

Early

mobility

Early Rehab is Important

(Boonen et al., 2004, Dubljanin-Raspopovic et al., 2013, Hirose et al., 2010)

Post-Op Long-Term

Mobility

Survival

+

Function

Active Acute Rehabilitation

• Maximises recovery

• Successful discharge home

• Decreases length of stay

• Reduce overall cost

• Acute wards perceive rehabilitation and discharge

planning as not being their responsibility

• Accumulate patients “waiting for rehabilitation”

• Fail to progress in the crucial postoperative days

(British Orthopaedic Association 2007, NICE 2012)

“Rehabilitation of hip

fractures is the central

challenge for trauma

services”

(British Orthopaedic Association 2007)

Review of Rehabilitation Internationally

• Amount of rehab varies in acute hospitals

• Confidence in rehabilitation progression?

• What type of post-operative physio?

• Barriers exist e.g. staffing

• No Irish data

• Time for change

Time for Rehab Change!

• In order to get better we need to measure what

we are currently doing.

• First step in effecting change:

• Add function specific data-fields to the IHFD

– Functional progress

– Rehabilitation service provision

– Effect of hospital approaches

Databases

Direct Communication

International Guidelines

Care Standard Guideline Synopsis

Physio assessment First postoperative day

Frequency of mobilisation Daily (7days)

Rehabilitation Early, MDT

Discharge planning Early, MDT, individualised

Type of physiotherapy Multidimensional

IHFD Rehabilitation Data-fields

First postoperative

day

DischargeLonger term

Baseline function

New Mobility Score

NMS Category Score Functional ability

0 Not at all

1 Assistance of one person

2 With an aid

3 No difficulty/no aid

Indoor walking, outdoor walking, shopping

Cumulated Ambulatory Score (CAS)

CAS Category Score Functional Ability

0 Not at all

1 Assistance 1-2 people

2 Independent

Bed mobility, STS, mobilisation

Baseline

• New Mobility Score (0-9)

1st post-op Day

• Physio assessment (Yes/No)

• Mobilisation (Yes physio/Yes other/No)

• Cumulated Ambulatory Score (0-6)

Discharge

• Cumulated Ambulatory Score (0-6)

Hip, Hop and Happening !!

Local

Data

Irish data

Guideline adherence

Physio service

provision

Leading hip

fracture care

Hip, Hop and Happening !!

Rehab

Guideline adherence Physio

Service provision

No extra work

Leading hip

fracture care

Irish data

Data accuracy

Data completeness

Hip Fracture

Conference

Oct 2015

Communication

Data Collection

1st Jan 2016Communication

IHFD Visits2016

Data Analysis

PRE-FRACTURE FUNCTION

New Mobility Score

NMS Category Score Functional ability

0 Not at all

1 Assistance of one person

2 With an aid

3 No difficulty/no aid

Indoor walking, outdoor walking, shopping

FIRST POSTOPERATIVE

DAY

Physiotherapy Assessment

78% received a

physiotherapy assessment

day one postoperatively

Physiotherapy Assessment

78% received a

physiotherapy assessment

day one postoperatively

(Every 5th patient didn’t)

2017 FACILITIES AUDIT

Physiotherapy Assessment

• 78% received physiotherapy assessment day one

postoperatively

?

Staffing

Weekend

Docu-mented

Other

“Rehabilitation of hip

fractures is the central

challenge for trauma

services”

(British Orthopaedic Association 2007)

This is YOUR data on YOUR patients!!

Baseline

• New Mobility Score (0-9)

1st post-op Day

• Physio assessment (Yes/No)

• Mobilisation (Yes physio/Yes other/No)

• Cumulated Ambulatory Score (0-6)

Discharge

• Cumulated Ambulatory Score (0-6)

30day

& 120 day

• New Mobility Score (0-9)

Hip, Hop and Happening !!

Local

Data

Irish data

Guideline adherence

Physio service

provision

Leading hip

fracture care

2017-2018

IHFD REHAB DATA

2017-2018: IHFD Data Collection

• Accurate

2017-2018: IHFD Data Collection

• Accurate

• Complete

2017-2018: IHFD Data Collection

• Accurate

• Complete

• ….. Especially CAS !!!

2017-2018: IHFD Data Collection

• Accurate

• Complete

• ….. Especially CAS !!!

2017-2018: Physio Service Provision

Day 1 Physio Assessment

7 days a week

2017-2018: Advocate for Rehab!!

2017-2018: Advocate for Rehab!!

• Local hip fracture working group

• Regular local reports and meetings

• Physiotherapy/Rehab team-work &

networking between hospitals

Hip, Hop and Happening !!

Rehab

Guideline adherence Physio

Service provision

No extra work

Leading hip

fracture care

Irish data

Physiotherapy Specialist Interest Group Workshop

Wed 4th July 2018 (TBC)

Acknowledgements

• All the orthopaedic physiotherapists & physiotherapy

managers nationally for their support and enthusiasm

• National hip fracture governance committee

• Physiotherapy hip fracture working group

• National Orthopaedic Care Programme

• Hip fracture patients

Thank You !

A ‘Hip’

Attack

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