Mobility Outcomes At 2 Small Hospitals in the Mid North Coast of NSW Stephen Downs Jodie Marquez...
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![Page 1: Mobility Outcomes At 2 Small Hospitals in the Mid North Coast of NSW Stephen Downs Jodie Marquez Pauline Chiarelli.](https://reader035.fdocuments.in/reader035/viewer/2022062409/56649c945503460f94950a15/html5/thumbnails/1.jpg)
Mobility Outcomes At 2 Small Hospitals in the Mid North Coast of NSW
Stephen DownsJodie Marquez
Pauline Chiarelli
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Research Questions• Change in balance
• Relationship between diagnosis and change in balance
• Accuracy of physiotherapist’s estimates of change
• Relationship between balance and discharge destination
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Mid North Coast NSW
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Exclusions: • <16 years old• Orthopedically unable to FWB on both legs• Medically unfit to test balance testing• Unable to understand balance testing instructions• Unable to provide informed consent• Expected to have a very short length of stay.
Ethics: Approved by the North Coast Area Health Service and the University of Newcastle Human Research Ethics Committees
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• Baseline and Discharge Balance Score
• Physiotherapist’s Estimate of Change
• Clinically Significant conditions
• Discharge Destination
• Number of Physio interventions
Recorded
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Clinically Significant Conditions
• Condition affects mobilityOr
• Condition was reason for admission
Carer availability also noted
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Berg Balance Scale (BBS)• 14 parts each 0-4
(possible total 56 higher score is better)
• Reliable– Berg, et al 1989; Liaw et al (2008)
• Minimal detectable change (95%) 4.6-6.3 – Donoghue et al (2009)
• Predicts Falls – Hall et al (2001)
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173 Potential participants
131 Met Criteria30 Declined
101 Enrolled
42 didn’t meet criteria
12 Lost
89 Completed Study
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42 Patients did not meet the inclusion criteria:
• 2 were acutely unwell• 2 were end stage palliative care• 15 were not fully weight bearing• 9 were too confused to follow
instructions• 14 were expected to be discharged after
such a short time that the baseline and discharge measures could not be reasonably expected to change
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173 Potential participants
131 Met Criteria30 Declined
101 Enrolled
42 didn’t meet criteria
12 Lost
89 Completed Study
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12 were lost from the study
• 1 became acutely unwell and was transferred to an acute care hospital
• 1 was too acutely unwell on the day of discharge to allow BBS testing
• 7 were lost to follow up• 1 had too short a length of stay• 3 withdrew
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0
5
10
15
20
25
Age distribution of participants (mean = 80.95)
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Conditions• 40 Fall • 33 Dementia• 33
Cardiac/Resp/ Vascular
• 24 Infection • 20
Musculoskeletal • 20 Delirium• 19 Other
Neurological• 13 Depression
• 13 Stroke• 9 Joint
Replacement• 9 # Proximal
Femur • 6 Palliative Care• 1 # Pelvis
None of these conditions predicted how much the BBS would change or accuracy of physiotherapist’s estimate
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Pre Admission Status
D/C to Communi
ty
D/C to
Hostel
D/C to Nursing Home
Community (81)
64 (79%) 4 (5%)
13 (16%)
Hostel (5) 0 2(40%)
3(60%)
Nursing Home (3)
0 0 3(100%)
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Mean Change in BBSBaseline
Mean (sd)Discharge Mean (sd)
Mean change in BBS (sd)
22.38(5.86)
30.85 (15.10)
8.47(10.37)
95% CI 6.32-10.63
The change was significant at p<0.001 but the 2 hospitals did not have significantly different changes in BBS (p=0.45)
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Describing physiotherapy intervention (average intervention rate 3.65 per
week)
05
101520253035404550
0 20 40 60 80 100
Number of days under physiotherapy care
Occ
asio
ns
of
ph
ysio
ther
apy
serv
ice
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Accuracy of initial physiotherapist prediction of discharge BBS (n=83)
On average physio estimates were underestimates
Average error
1.73(sd 9.4)
95% CI -0.29 - 3.08
6.99(sd 6.49)
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Probability of discharge to nursing home compared to Baseline BBS
• Observed
—— Predicted
……. 95% confidence limit
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Probability of discharge to nursing home compared to Final BBS
• Observed
—— Predicted
……. 95% confidence limit
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-20
020
40
Ch
an
ge
in B
BS
0 20 40 60Days under physiotherapy care
Fitted values
Days Under Care / Change in BBS
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What Does This Study Add?
• Relationship between BBS and D/C destination
• Number of physio interventions• How BBS changes• Prevalence of various conditions• Physios provide useful estimates
of change
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Limitations
• Generalisability• No follow up• Causality not shown• Not enough power to predict
changes from diagnosis
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So What?• We have an ageing population• BBS-Nursing home connection• Variable change – wait before placing
• Physio predictions of change useful