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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
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
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
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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
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)
11
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)
12
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)
13
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)
14
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)
15
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)
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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)
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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!
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Mild Disabled Group Go Home
MBI at Discharge
Mild: 84.16+10.52 Moderate: 59.41+19.56 Severe: 24.92+17.69
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Length of Stay
Severe
Moderate
Mild
24.3+10.7 Days
22.9+9.2 Days
21.1+11.9 Days
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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
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Conclusion Recover at different rates
Intensive training for me
please!
Better to let me know how to
take care of her!
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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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