Community-based rehabilitation after hip-fracture surgery. a national questionnaire survey

Transcription

1 Community-based rehabilitation after hip fracture in Denmark a national questionnaire survey Lise Kronborg, Msc 1,2, Thomas Bandholm, PhD 1, 2, 3, 4, Henrik Kehlet, PhD 5, Morten Tange Kristensen, PhD1, 2, 4 1 Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), 2 Department of Physiotherapy, 3 Clinical Research Centre, 4 Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark, 5 Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Denmark.

2 Background - Why Cochrane review: There is insufficient evidence from randomised trials to establish the best strategies for enhancing mobility after hip fracture surery (Handoll et al, 2011) Great variety in the rehabilitation provided (Artz et al, 2012, Kronborg et al, 2011) Patients are capable and can benefit from rehabilitation (Sherrington et al 2011, Buddingh et al, 2013)

3 Purpose To describe the specifics of community-based physical rehabilitation provided to patients following hip fracture surgery in Denmark.

4 How 56 municipalities randomly allocated 62 rehabilitation units 10 questions regarding structure of rehabilitation Online questionnaire sent by Performed in February to April 2012

5 Particpating municipalities (N=56)

6 Method 2 municipalities per (hip-fracture) operating hospital in each region were allocated by lot to participate (N= 56) Rehabilitation units such as rehabilitation centers, residential rehabilitation units, nursing home facilities and home-based rehabilitation were identified in these municipalities (N=62) An electronic questionnaire was sent to the physical therapist or the official of each unit 3 reminders were sent over a period of 3 months Total number of participants was: N=51 (91%) municipalities N=60 (97%) rehabilitation units

7 Make it simple Iprix Online questionnaire

8 Results provided by Iprix

9 Results Structure of rehabilitation 99% of the rehabilitation units initiated rehabilitation 1-2 weeks after receiving a prescription (N=58) The duration of the rehabilitation period was mainly between 8-12 weeks (60%) or 4-7 weeks (25%) Most units offered 1-2 rehabilitation sessions per week. The rehabilitation was mainly conducted as both class- and one-to-one exercise therapy (78%)

10 Results Description of rehabilitation 29 (57%) municipalities answered to have a dedicated description of procedure and/or a specific exercise program for patients with a hip fracture 21 (72%) returned the program 15 (71%) of these had formulated a general purpose of the intervention 6 (29%) referred to a local program, possibly more detailed than the descriptions sent forward

11 Results Content of rehabilitation 16 (76%) of the programs described the content of the intervention. Programs were fully or partly aimed at: Functional exercise (N=23, 96%) Strength, balance, joint movement (N=22, 92%) Other aims (stability, reduction of edema, outdoor mobility) 18 (86%) programs lacked specific description of the intervention regarding intensity, repetitions and progression of the exercises.

12 Conclusion Just more than half of the participating municipalities in the survey had a formal description or specific program for rehabilitation following hip fracture surgery About 30% of the descriptions lacked information on purpose of the rehabilitation 1 out of 7 assessed programs described the rehabilitation intervention specifically

13 Hvordan er status i dag?

14 Thanks to the supporting institutions The IMK Foundation The Research Foundation of the Capital Region The Research Foundation of the Danish Physical Therapy Organization The Research Foundation of Hvidovre Hospital The UCSF Lundbeck Foundation. The funding agencies had no influence on the study design, methods, subjects, data collection, analyses or manuscript.