Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters)

Background: Rehabilitation programmes are used to improve hip fracture outcomes. There is little published trial clinical trial or population-based data on the effects of the type or provider of rehabilitation treatments on hip fracture outcomes. We evaluated the associations of rehabilitation inter...

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Main Authors: Su, Bowen, Newson, Roger, Soljak, Harry, Soljak, Michael
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2018
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Online Access:https://hdl.handle.net/10356/88152
http://hdl.handle.net/10220/45617
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Institution: Nanyang Technological University
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spelling sg-ntu-dr.10356-881522020-11-01T05:32:37Z Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters) Su, Bowen Newson, Roger Soljak, Harry Soljak, Michael Lee Kong Chian School of Medicine (LKCMedicine) Centre for Population Health Sciences Hip Fracture DRNTU::Science::Medicine Rehabilitation Background: Rehabilitation programmes are used to improve hip fracture outcomes. There is little published trial clinical trial or population-based data on the effects of the type or provider of rehabilitation treatments on hip fracture outcomes. We evaluated the associations of rehabilitation interventions with post-operative hip fracture outcomes. Methods: Cross-sectional (2013–2015) analysis of data from the English (NHFD) from all 191 English hospitals treating hip fractures. Of 62,844 NHFD patients, we included 17,708 patients with rehabilitation treatment and 30-day mobility data, and 34,142 patients with rehabilitation treatment and discharge destination data. The intervention was early mobilisation rehabilitation treatments delivered by a physiotherapist (PT, physical therapist in North America) or other clinical staff as identifiable in NHFD. We used ordinal logistic and propensity scoring regression models to adjust for confounding variables including age, sex, pre-fracture mobility, operative delay, and cognitive function and peri-operative risk scores. Results: In both the adjusted multivariate and propensity-weighted analyses, mobilisation on the day or the day following surgery is associated with better mobility function 30 days after discharge. However patients mobilised by a PT did not have better mobility compared to mobilisation by other professionals. Patients who received a PT assessment were not protected from poorer mobility 30 days after discharge, compared with those who did not receive an assessment. The discharge destination outcome is also better in mobilised than unmobilised patients, whether done by a PT or another health professional, and the difference persists, slightly attenuated, after propensity weighting. Conclusions: In addition to the type of health professional initiating mobilisation, data on rehabilitation treatment activity and post-operative gait speed is needed to determine optimum rehabilitation dosage and functional outcome. After adjustment patients mobilised by non-PTs did as well as patients mobilised by PTs, suggesting that PTs’ current roles in very early rehabilitation should be reconsidered, with a view to redeploying them to more specialised later rehabilitation activity. Published version 2018-08-20T04:43:47Z 2019-12-06T16:57:12Z 2018-08-20T04:43:47Z 2019-12-06T16:57:12Z 2018 Journal Article Su, B., Newson, R., Soljak, H., & Soljak, M. (2018). Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters). BMC Musculoskeletal Disorders, 19, 211. doi:10.1186/s12891-018-2093-8 https://hdl.handle.net/10356/88152 http://hdl.handle.net/10220/45617 10.1186/s12891-018-2093-8 en BMC Musculoskeletal Disorders © 2018 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 9 p. application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Hip Fracture
DRNTU::Science::Medicine
Rehabilitation
spellingShingle Hip Fracture
DRNTU::Science::Medicine
Rehabilitation
Su, Bowen
Newson, Roger
Soljak, Harry
Soljak, Michael
Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters)
description Background: Rehabilitation programmes are used to improve hip fracture outcomes. There is little published trial clinical trial or population-based data on the effects of the type or provider of rehabilitation treatments on hip fracture outcomes. We evaluated the associations of rehabilitation interventions with post-operative hip fracture outcomes. Methods: Cross-sectional (2013–2015) analysis of data from the English (NHFD) from all 191 English hospitals treating hip fractures. Of 62,844 NHFD patients, we included 17,708 patients with rehabilitation treatment and 30-day mobility data, and 34,142 patients with rehabilitation treatment and discharge destination data. The intervention was early mobilisation rehabilitation treatments delivered by a physiotherapist (PT, physical therapist in North America) or other clinical staff as identifiable in NHFD. We used ordinal logistic and propensity scoring regression models to adjust for confounding variables including age, sex, pre-fracture mobility, operative delay, and cognitive function and peri-operative risk scores. Results: In both the adjusted multivariate and propensity-weighted analyses, mobilisation on the day or the day following surgery is associated with better mobility function 30 days after discharge. However patients mobilised by a PT did not have better mobility compared to mobilisation by other professionals. Patients who received a PT assessment were not protected from poorer mobility 30 days after discharge, compared with those who did not receive an assessment. The discharge destination outcome is also better in mobilised than unmobilised patients, whether done by a PT or another health professional, and the difference persists, slightly attenuated, after propensity weighting. Conclusions: In addition to the type of health professional initiating mobilisation, data on rehabilitation treatment activity and post-operative gait speed is needed to determine optimum rehabilitation dosage and functional outcome. After adjustment patients mobilised by non-PTs did as well as patients mobilised by PTs, suggesting that PTs’ current roles in very early rehabilitation should be reconsidered, with a view to redeploying them to more specialised later rehabilitation activity.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Su, Bowen
Newson, Roger
Soljak, Harry
Soljak, Michael
format Article
author Su, Bowen
Newson, Roger
Soljak, Harry
Soljak, Michael
author_sort Su, Bowen
title Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters)
title_short Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters)
title_full Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters)
title_fullStr Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters)
title_full_unstemmed Associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters)
title_sort associations between post-operative rehabilitation of hip fracture and outcomes : national database analysis (90 characters)
publishDate 2018
url https://hdl.handle.net/10356/88152
http://hdl.handle.net/10220/45617
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