Functional status of patients with fractured hip at ...€¦ · Based on ADL status in terms of...

$: Functional status of patients with fractured hip at ...€¦ · Based on ADL status in terms of Modified Barthel Index ... Shah S, Vanclay F, Cooper B ... Shed light on rehabilitation$
Functional Status of Patients with Fractured Hip at Admission:

Shedding Light on Rehabilitation Outcomes and Resource Allocation

Dr. Brian AU, PhD. Senior Occupational Therapist

Tai Po Hospital

1

Introduction

2

5000

5500

6000

6500

7000

7500

8000

8500

9000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Number of Fractured Hip Patients Admitted to HA Hospitals

Increased by 24.7% in 10 Years

3

200

300

400

500

600

700

800

900

1000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Number of Fractured Hip Patients Admitted to Tai Po Hospital

Increased by 73.2% in 10 Years

4

Rehab Program in Hip Fracture

Physiotherapy

Nursing Care

5

Objectives

Help to Develop Triage System

Functional Status at Admission

Recovery Profiles

6

Severely Disabled

Moderate Disabled

Mild Disabled

Based on ADL status in terms of Modified Barthel Index (MBI) at admission (Shah et al., 1989)

(0<MBI<20) (21<MBI<60)

(61<MBI<90)

Methodology • Retrospective • All hip fractured patients • Discharge in 2013 - 2014

7

Analyses

Demographic Data

Functional Gain

8

Results

We were from 1,245 patients with age

81.9+27.2 years old Female covered 75%

9

Severe Disabled

Moderate Disabled

Mild Disabled

Severe Moderate Mild P-Value Percentage 18.74 54.36 26.90

Age 84.7+10.8 83.8+34.8 75.9+13.3 F(1, 1227)=19.07, p<0.001

MMSE 8.9+6.3 15.0+7.0 19.8+7.9 F(1,1243)=2774.24, p<0.001

LOS 21.1+11.9 24.3+10.7 22.9+9.2 F(1, 1243)=27.66, p<0.001

Functional Gain (MBI Gain)

11.8+17.1

19.4+15.7 15.1+10.1

F(1, 1240)=129.45, p<0.001

Efficiency of MBI Gain (MBI Gain Per Day)

0.5+0.8 0.8+0.8

0.7+0.6 F(1, 1237)=83.61, p<0.001

Back to Community for Community Dweller

65.0% 79.1% 92.2% H(2)=50.25, p<0.001 (with Bonferroni adjustment)

10

Severe Disabled

Moderate Disabled

Mild Disabled


Age 84.7+10.8 83.8+34.8 75.9+13.3 F(1, 1227)=19.07, p<0.001

MMSE 8.9+6.3 15.0+7.0 19.8+7.9 F(1,1243)=2774.24, p<0.001

LOS 21.1+11.9 24.3+10.7 22.9+9.2 F(1, 1243)=27.66, p<0.001


11.8+17.1

19.4+15.7 15.1+10.1

F(1, 1240)=129.45, p<0.001


0.5+0.8 0.8+0.8

0.7+0.6 F(1, 1237)=83.61, p<0.001



11

Severe Disabled

Moderate Disabled

Mild Disabled


Age 84.7+10.8 83.8+34.8 75.9+13.3 F(1, 1227)=19.07, p<0.001

MMSE 8.9+6.3 15.0+7.0 19.8+7.9 F(1,1243)=2774.24, p<0.001

LOS 21.1+11.9 24.3+10.7 22.9+9.2 F(1, 1243)=27.66, p<0.001


11.8+17.1

19.4+15.7 15.1+10.1

F(1, 1240)=129.45, p<0.001


0.5+0.8 0.8+0.8

0.7+0.6 F(1, 1237)=83.61, p<0.001



12

Severe Disabled

Moderate Disabled

Mild Disabled


Age 84.7+10.8 83.8+34.8 75.9+13.3 F(1, 1227)=19.07, p<0.001

MMSE 8.9+6.3 15.0+7.0 19.8+7.9 F(1,1243)=2774.24, p<0.001

LOS 21.1+11.9 24.3+10.7 22.9+9.2 F(1, 1243)=27.66, p<0.001


11.8+17.1

19.4+15.7 15.1+10.1

F(1, 1240)=129.45, p<0.001


0.5+0.8 0.8+0.8

0.7+0.6 F(1, 1237)=83.61, p<0.001



13

Severe Disabled

Moderate Disabled

Mild Disabled


Age 84.7+10.8 83.8+34.8 75.9+13.3 F(1, 1227)=19.07, p<0.001

MMSE 8.9+6.3 15.0+7.0 19.8+7.9 F(1,1243)=2774.24, p<0.001

LOS 21.1+11.9 24.3+10.7 22.9+9.2 F(1, 1243)=27.66, p<0.001


11.8+17.1

19.4+15.7 15.1+10.1

F(1, 1240)=129.45, p<0.001


0.5+0.8 0.8+0.8

0.7+0.6 F(1, 1237)=83.61, p<0.001



14

Severe Disabled

Moderate Disabled

Mild Disabled


Age 84.7+10.8 83.8+34.8 75.9+13.3 F(1, 1227)=19.07, p<0.001

MMSE 8.9+6.3 15.0+7.0 19.8+7.9 F(1,1243)=2774.24, p<0.001

LOS 21.1+11.9 24.3+10.7 22.9+9.2 F(1, 1243)=27.66, p<0.001


11.8+17.1

19.4+15.7 15.1+10.1

F(1, 1240)=129.45, p<0.001


0.5+0.8 0.8+0.8

0.7+0.6 F(1, 1237)=83.61, p<0.001



15

Severe Disabled

Moderate Disabled

Mild Disabled


Age 84.7+10.8 83.8+34.8 75.9+13.3 F(1, 1227)=19.07, p<0.001

MMSE 8.9+6.3 15.0+7.0 19.8+7.9 F(1,1243)=2774.24, p<0.001

LOS 21.1+11.9 24.3+10.7 22.9+9.2 F(1, 1243)=27.66, p<0.001


11.8+17.1

19.4+15.7 15.1+10.1

F(1, 1240)=129.45, p<0.001


0.5+0.8 0.8+0.8

0.7+0.6 F(1, 1237)=83.61, p<0.001



16

Discussion

Mild

Moderate Severe

Cognitive Function at Admission (Measured by MMSE)

High correlation between functional and cognitive statuses in patients with fracture hip

(Givens, et al., 2008; Milsen, et al., 1998; Samuelson, etl al., 2008)

17

Functional Recovery (Measured by MBI)

Moderate MBI Gain: 19.4+15.7 MBI Gain per Day: 0.8+0.8

Mild MBI Gain: 15.1+10.1 MBI Gain per Day: 0.7+0.6

Severe MBI Gain: 11.8+17.1 MBI Gain per Day: 0.5+0.8

I am the worst again in

functional recovery

I should have been the best

if no ceiling effect on me!

18

Mild Disabled Group Go Home

MBI at Discharge

Mild: 84.16+10.52 Moderate: 59.41+19.56 Severe: 24.92+17.69

19

Length of Stay

Severe

Moderate

Mild

24.3+10.7 Days

22.9+9.2 Days

21.1+11.9 Days

20

Good Rehab Potential Allow to Stay Longer

Good Rehab Potential ADL Independence Earlier

Outcome Predictors in Hip Fracture

Chin, Ng & Cheung, 2008; Cree et al., 2001; Feng, et al., 2010; Tarazona-Santabalbina, et al., 2012; Tseng, Shyu & Liang, 2012

21

Conclusion Recover at different rates

Intensive training for me

please!

Better to let me know how to

take care of her!

22

Conclusion Triage System

23

References Chin, P.H., Ng, H.P.B., Cheung, P.C.L. (2008). Factors predicting rehabilitation outcomes of elderly patients with hip fracture. HK Medical Journal, 14 (3), 209-215. Cree, M., Carriere, K. C., Soskolne, C. L., & Suarez-Almazor, M. (2001). Functional dependence after hip fracture. American Journal of Physical Medicine and Rehabilitation, 80, 736–743. Feng, L., Scherer, S.S., Tan, B.Y., Chan, G., Fong, N.P., Ng, T.P. (2010). Comorbid cognitive impairment and depression is a significant predictor of poor outcomes in hip fracture rehabilitation. International Psychogeriatrics, 22(2), 246-253. Givens, J., Sanfit, T.B., Marcantonio, E.R. (2008). Functional recovery after hip fracture: The combined effects of depressive symptoms, cognitive impairment, and delirium. Journal of American Geriatric Society, 56(6), 1075-1079. Milsen, K., Abraham, I.L., Broos, P.L.O. (1998). Postoperative variation in neurocognitive and functional status in elderly hip fracture patients. Advanced Nursing, 27(1), 59-67. Samuelson, B., Hedstrom, M.I., Ponzer, S., Soderqvist, A., Samnegard, E., Thorngren, K-G., Cederholm, T. Saaf, M., Dalen, M. (2008). Gendere differences and cognitive aspects on functional outcome after hip fracture – a 2 years follow-up of 2,134 patients. Age and Ageing, 38(6), 686-692. Shah S, Vanclay F, Cooper B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Clinical Epidemiology, 42, 703–709. Tarazona-Santabalbina, F. J., Belenguer-Varea, A ; Rovira-Daudi, E., Salcedo-Mahiques, E., Cuesta-Peredó, D., Doménech-Pascual, J.R., Salvador-Pérez, M. I., Avellana-Zaragoza, J.A. (2012). Early interdisciplinary hospital intervention for elderly patients with hip fractures- functional outcome and mortality. Clinic, 67(6), 547-555. Tseng, M.Y., Shyu, Y.I., Liang, J. (2012). Functional recovery of older hip-fracture patients after interdisciplinary intervention follows three distinct trajectories. Gerontologist, 52(6), 833-842. 24

Acknowledgment Occupational Therapy Department

Mr. Simon WONG, DM(OT) Ms. Carey POON, OTI Mr. Harry CHAN, OTI Ms. Coco JIM, OTII Ms. Jess TSUI, OTII Mr. Patrick CHANG, OTII Mr. Shun Yiu WONG, OTII Ms. Shadow NG, OTII Ms. Yvonne CHAN, OTII

Department of Orthopaedic Rehabilitation

Professor Bobby NG, COS Dr. Sheung Wai LAW, Consultant Dr. Wai Sing CHAN, SMO Dr. Simon LEUNG, AC Dr. Paul LIU, AC

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