Frequency, duration, and type of physiotherapy in the week after hip fracture surgery – analysis of implications for discharge home, readmission, survival, and recovery of mobility
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Purpose: To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery. Methods: A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence. Results: Overall, 73% were female and 40% had high frailty risk. Patients who received ≥2 hours of physiotherapy (versus less) had 3% (95% Confidence Interval: 0–6%), 4% (2–6%), and 6% (1–11%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 3% (0–6%) lower adjusted probability of readmission. Recipients of exercise (versus mobilisation alone) had 6% (1–12%), 3% (0–7%), and 11% (3–18%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 6% (2–10%) lower adjusted probability of readmission. Recipients of 6–7 days physiotherapy (versus 0–2 days) had 8% (5–11%) higher adjusted probability of survival. For patients with dementia, improved probability of survival, discharge home, readmission and indoor mobility recovery were observed with greater physiotherapy access. Conclusion: Greater access to physiotherapy was associated with a higher probability of positive outcomes. For every 100 patients, greater access could equate to an additional eight patients surviving to 30-days and six avoiding 30-day readmission. The findings suggest a potential benefit in terms of home discharge and outdoor mobility recovery. Contribution of the Paper: • To substantiate a case for additional physiotherapy, evidence for an association with improved outcomes is needed. • Analysis of 5383 patients suggests greater access to physiotherapy was associated with higher probability of positive outcomes. • For every 100 patients, this could equate to six more patients avoiding 30-day readmission and eight more patients surviving to 30-days. • The association between access to physiotherapy and survival persisted irrespective of dementia diagnosis. • For other outcomes, associations varied by the presence/absence of dementia and should be explored by future cohort studies.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Physiotherapy |
| Vol/bind | 120 |
| Sider (fra-til) | 47-59 |
| Antal sider | 13 |
| ISSN | 0031-9406 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
We are grateful to NHS Digital, NHS Wales Informatics Service, and the Royal College of Physician's Falls and Fragility Fracture Audit programme for providing the data used in this study. The views expressed in this publication are those of the authors and do not necessarily reflect those of the NHS or the Department of Health and Social Care. This publication is based on data collected by or on behalf of Healthcare Quality Improvement Partnership, who have no responsibility or liability for the accuracy, currency, reliability and/or correctness of this publication. The study did not require NHS Research Ethics Committee approval as it involves secondary analysis of linked pseudo-anonymised data. The authors have received grants from the Chartered Society of Physiotherapy Charitable Trust related to this work (Grant No: PRF/18/A24). The Chartered Society of Physiotherapy Charitable Trust funding provides salary support for AG, and partial salary support for SA. KS also received funding from the NIHR Research for Patient Benefit and UKRI Future Leaders Fellowship for hip fracture health services research. KS is the Chair and AJ and CG are members of the Scientific and Publications Committee of the Falls and Fragility Fracture Audit Programme which managed the National Hip Fracture Database audit at the Royal College of Physicians. FCM was the funded (2012–2018) board chair and AJ is funded clinical lead of the Falls and Fragility Fracture programme. SA is funded by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust, King's College London. CS received funding from the National Institutes of Health Research for research not related to the current study. TS received funding from the National Institutes of Health Research for research not related to the current study. CLG receives funding from Versus Arthritis (ref 22086). ES is supported by the NIHR Applied Research Collaboration Wessex. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care. OA, LB, IDC, BS, RMC, JM and MTK declare no conflicts of interest.
Funding Information:
The authors have received grants from the Chartered Society of Physiotherapy Charitable Trust related to this work (Grant No: PRF/18/A24 ).
Funding Information:
The Chartered Society of Physiotherapy Charitable Trust funding provides salary support for AG, and partial salary support for SA. KS also received funding from the NIHR Research for Patient Benefit and UKRI Future Leaders Fellowship for hip fracture health services research. KS is the Chair and AJ and CG are members of the Scientific and Publications Committee of the Falls and Fragility Fracture Audit Programme which managed the National Hip Fracture Database audit at the Royal College of Physicians. FCM was the funded (2012–2018) board chair and AJ is funded clinical lead of the Falls and Fragility Fracture programme. SA is funded by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust, King's College London. CS received funding from the National Institutes of Health Research for research not related to the current study. TS received funding from the National Institutes of Health Research for research not related to the current study. CLG receives funding from Versus Arthritis (ref 22086). ES is supported by the NIHR Applied Research Collaboration Wessex. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care. OA, LB, IDC, BS, RMC, JM and MTK declare no conflicts of interest.
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© 2023 The Author(s)
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