Pilot 365-day restorative rehabilitation program for hip fragility fractures in extended care hospital to triumph over long-term hospitalization upon discharge

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Abstract Description
Submission ID :
HAC779
Submission Type
Authors (including presenting author) :
Cheung KWS, Cheung EYY, Chan RWY, Lau ACH, So JKW, Leung KKL
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Hip fragility fracture(HFF) incurs significant morbidity, mortality and medical costs. Local adoption of 365-day restorative rehabilitation program for HFF was launched in acute care settings to cope with an increasing demands of HFF cases in this aging society and was found to reduce length of stay(LOS) upon evaluation. However, local evidence of effectiveness of a 365-restorative rehabilitation program in an extended care setting is yet to be explored.
Objectives :
This study aims to evaluate and compare the effectiveness of 365-day restorative rehabilitation on HFF in Kowloon Hospital(KH) with ongoing conventional weekday physiotherapy rehabilitation services in terms of LOS and functional outcomes.
Methodology :
HFF cases transferring to KH from October 2023 to September 2024 were screened and recruited. Recruited patients were split into 365-group and non-365-group. Data was collected upon admission and discharge. Outcome measures included LOS, admission and discharge Modified Functional Ambulation Classification(MFAC) and Elderly Mobility Scale(EMS) and discharge destination.
Result & Outcome :
60 pairs of age- and gender-matched HFF patients(365-group and non-365-group) were identified. Mean age was 81.03±8.747. No statistical differences were identified in fracture site(p=0.661), types of operation(p=0.171), premorbid residence(p=0.243), premorbid MFAC(p=0.105) and premorbid walking aids(p=0.261) upon admission. Both groups showed significant improvement in EMS(p<0.001) and MFAC(p<0.001). The improvement of EMS also exceeded minimally clinically important difference(MCID). Significantly shorter LOS was found in 365-group than non-365-group(22.10±6.64vs27.12±15.75,p=0.025). A significantly larger proportion of HFF patients discharged home in 365-group(p=0.009).

The result showed that 365-day restorative rehabilitation program on HFF in an extended care settings can significantly reduce LOS without compromising functional outcomes. 365-day restorative rehabilitation program provides a continuous and condensed training regime during hospitalization with minimal disruption during weekends. Adequate training volumes were guaranteed with a shorter period of hospitalization. A reduced LOS also implies a more rapid turnover rate of rehabilitation beds to soothe access block in acute hospitals to abide with the surging demands of fragility fracture cases in aging population. A greater proportion of HFF patients returned home upon discharge in 365-group could be contributed by daily specific rehabilitation to promote confidence as well as easily accessible carer education programs for safer home care activities and support. The results introduce the possibility of pioneering a similar 365-day restorative rehabilitation program on other types of common orthopedic conditions.
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