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

Orouba Almilaji; Salma Ayis; Aicha Goubar; Lauren Beaupre; Ian D Cameron; Rhian Milton-Cole; Celia L Gregson; Antony Johansen; Morten Tange Kristensen; Jay Magaziner; Finbarr C Martin; Catherine Sackley; Euan Sadler; Toby O Smith; Boris Sobolev; Katie J Sheehan

doi:10.1016/j.physio.2023.03.002

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

Physiotherapy. 2023 Sep:120:47-59. doi: 10.1016/j.physio.2023.03.002. Epub 2023 Mar 29.

Authors

Orouba Almilaji¹, Salma Ayis², Aicha Goubar², Lauren Beaupre³, Ian D Cameron⁴, Rhian Milton-Cole², Celia L Gregson⁵, Antony Johansen⁶, Morten Tange Kristensen⁷, Jay Magaziner⁸, Finbarr C Martin², Catherine Sackley⁹, Euan Sadler¹⁰, Toby O Smith¹¹, Boris Sobolev¹², Katie J Sheehan¹³

Affiliations

¹ Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK; Department of Health Service Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
² Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK.
³ Department of Physical Therapy, Faculty of Rehabilitation Medicine University of Alberta,Canada.
⁴ John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health,University of Sydney, Australia.
⁵ Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, UK.
⁶ Cardiff Trauma Unit, University Hospital of Wales, Cardiff, UK.
⁷ Department of Physical & Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁸ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
⁹ Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK; Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, UK & Southern Health NHS Foundation Trust, UK.
¹⁰ Faculty of Medicine and Health Sciences, University of Nottingham, UK.
¹¹ Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
¹² School of Population and Public Health, University of British Columbia, Vancouver, Canada.
¹³ Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK. Electronic address: Katie.sheehan@kcl.ac.uk.

PMID: 37369161
DOI: 10.1016/j.physio.2023.03.002

Abstract

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.

Keywords: Audit; Hip fracture; National Hip Fracture Database; Physiotherapy; Recovery; Rehabilitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aftercare
Female
Frailty*
Hip Fractures* / surgery
Humans
Male
Patient Discharge
Patient Readmission
Physical Therapy Modalities
United States

Grants and funding

22086/VAC_/Versus Arthritis/United Kingdom