Authors (including presenting author) :
Lou LKK(1), Yung PK(1), Luk KY(1), Chan CM(1)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital
Introduction :
Rehabilitation post hip fracture is important to prevent decline in functional and physical performance and future institutionalization. Integrated Care Model (ICM), a multidisciplinary outreach service, in Kowloon Central Cluster has expanded its service to hip fracture patients since October 2023. Physiotherapists would provide screening for hip fracture patients in the Queen Elizabeth Hospital (QEH) and recruit indicated patients for outreach physiotherapy service under ICM care. Physiotherapists provided timely post discharge intensive physiotherapy services and assisted in coordinating medical or social support to recruited patients if indicated. The aims were to maximize functional recovery and prevent secondary falls for patients with hip fracture at the early phase after discharge.
Objectives :
To review the roles of physiotherapists and the effectiveness of physiotherapy rehabilitation for hip fracture patients under ICM service.
Methodology :
This was a retrospective service review. Hip fracture patients, with either operative or conservative management, who received physiotherapy ICM service from October 2023 to December 2024 were analyzed. Functional assessments including Modified Functional Ambulation Classification (MFAC) and Modified Barthel Index (MBI) were performed at the first and final session, Wilcoxon signed-rank test was used for statistical analysis.
Result & Outcome :
Sixty-three patients were recruited under the review period. Four patients were excluded due to readmission to hospital for various complications, not related to fall, before completion of ICM service. Fifty-nine patients (83.1% female; mean age 84.34±7.36) were reviewed. Patients received on average 7±3.00 weekly physiotherapy sessions. Both MFAC and MBI scores showed significant improvement. This was illustrated in MFAC, 25th percentile improved from category IV (Assisted walker) to category VI (Indoor walker), the median improved from category V (Supervised walker) to category VI (Z=-6.296, p<0.05). There was a mean score increase in MBI of 13.3 when compared to that at initial session, with a final session mean score of 87.24±20.77 (Z=-5.923, p<0.05). 98.3% of them did not sustain a fall resulting in readmission three months post discharge from hospital. Therefore, early outreach physiotherapy service could enhance functional recovery and reduce secondary falls for hip fracture patients. With this service, physiotherapists as case managers can provide timely screening to patients that require medical and social support and provide intensive community-based physiotherapy for hip fracture patients upon discharge.
