Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Limb Restoration Rehabilitation
In this research article, we evaluated the effectiveness of an early integrated hip fracture pathway for hip fracture post-surgical patients. Inpatient rehabilitation improved functional outcomes and streamlined the rehabilitation referral process.
To assess the effectiveness of Early Integrated Rehabilitation Hip Fracture Pathway(HFP) implemented in April 2013 for hip fracture post-surgical patients in Singapore General Hospital(SGH).
Retrospective data was collected through computer record system for Functional Independence Measure(FIM) and outcome measures. Mean(95%CI) reported for continuous variables; frequency(proportion) reported for categorical data. Student’s t-test performed for continuous variables; Fisher’s exact test performed for categorical data. Data analysis done on R version3.4.2(significance level 0.05).
Hospitalised care in a Singapore tertiary hospital.
Participants (or Animals, Specimens, Cadavers) : All cases admitted to SGH department of Orthopaedic Surgery for hip fracture, underwent surgical intervention, assessed and transferred to department of Rehabilitation Medicine(RMD) from 2010-2016 were recruited. Data included patients admitted 3 years before and 3 years after HFP implementation.
Interventions : Not applicable.
Main Outcome Measure(s):
FIM score(total, motor), complication rate, length of hospital stay(total, in RMD).
Total 293 cases were reviewed, 27 before HFP implementation(group 1) and 266 that went through HFP(group 2). Total FIM for all cases increased from 83.90(95%CI 82.37-85.42) on admission to 93.91(95%CI 92.00-95.82) at discharge(p<0.0001). Motor FIM for all cases increased from 47.13(95%CI 45.83-48.44) on admission to 56.10(54.91-57.30) at discharge(p<0.0001). FIM gain was 10.7(95%CI 6.42-14.97) in group 1 and 10.26(95%CI 8.56-11.96) in group 2(p=0.8815). No difference in FIM change(total, motor) or length of stay(total, in RMD) noted between the groups. After HFP implementation, the number of cases receiving inpatient rehabilitation increased. Patients with better premorbid ADLs and weight bearing status followed HFP but length of stay, complication rate, and functional gain were unchanged.
Post-operative inpatient rehabilitation improved patients with hip fracture functional outcomes(p<0.0001). Although patient outcomes under HFP is comparable to previous models, it has streamlined the rehabilitation referral process. A better model should be explored.