Using the National Hip Fracture Database (NHFD) to define the impact of physiotherapist assessment on early mobilisation after hip fracture

Johansen, Antony; Boulton, Chris; Burgon, V; Rai, Sunil; Hove, Ruth ten; Wakeman, R.

doi:10.1016/j.physio.2017.11.053

Cited by 2 publications

(19 citation statements)

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“…There is a positive correlation between the presence of physiotherapist and patients being more likely to be successfully mobilised earlier/early 29. Patients not assessed by a physiotherapist were three times less likely to mobilise day 1 than those who were assessed by a physiotherapist 29.…”

Section: Discussionmentioning

confidence: 93%

“…Of these, 5 of the 13 prospective studies were of high quality,19 23 24 27 30 and 8 were of moderate quality 18 21 24 26 31 32 34. Two of the five retrospective studies were of high quality,20 22 two were of moderate quality28 33 and one was of low quality 29…”

Section: Resultsmentioning

confidence: 99%

“…A summary of the search results is presented in the PRISMA flow diagram15 (figure 1). From 3337 citations, 23 met eligibility criteria and were included in the analysis 16–37…”

Section: Resultsmentioning

confidence: 99%

“…Data were included from 23 studies recruiting 210 811 patients. The average patient age was 81.9 years in the 17 papers that included these data 16–19 21–24 26 27 29–31 35–38. 73% of patients were female, in the 19 papers that stated sex,17–27 29–31 35–38 and 38% of patients had dementia or cognitive impairment, in the 12 papers that included these data19 21–23 27 29 30 34–37 (online supplemental file 5: table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The universally accepted definition is provided by the NHFD; however, only seven studies in this systematic review used this definition 28 30 32–34 36 37. Others used the Cumulated Ambulation Score (CAS)16 22 23 31 35 or their own self-defined criteria 17–21 24 25 27 29 38. This impacts on the ability to identify barriers to mobilisation which is important because a barrier in one study which defines early mobilisation as being able to walk two metres may not be a barrier in a study which defines the same as being able to hoist from a bed to a chair.…”

Section: Discussionmentioning

confidence: 99%

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What factors affect early mobilisation following hip fracture surgery: a scoping review

Gray,

Lacey,

Whitehouse

et al. 2023

BMJ Open Qual

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ObjectivesIdentify and evaluate factors affecting early mobilisation on the day following hip fracture surgery.DesignMixed methods, scoping review.Data sourcesMEDLINE, AMED, CINAHL, APA PsycINFO, APA PsycArticles, ISRCTN, Clinical Trials registry and grey literature accessed in November 2022 with publication dates between 2001 and November 2022.Eligibility criteriaEnglish language publications that:1. Include patient populations who sustain a fragility hip fracture managed surgically2. Include patient populations who are mobilised out of bed on the day following their hip fracture surgery3. Report factors which influence the ability to undergo early mobility postsurgeryData extraction and synthesisOne reviewer screened all titles and abstracts for inclusion. Two reviewers performed data extraction and quality assessments using the relevant Critical Appraisal Skills Programme tools and the Mixed Methods Appraisal Tool.Results3337 papers were identified, of which 23 studies were eligible for review, representing 210 811 patients. The heterogeneity in the types of study included, the definition of early mobilisation and the outcome measures used precluded meta-analysis. 13 factors were identified as having an effect on whether people were mobilised on day 1 post-hip fracture surgery, grouped into 5 principal themes: (1) healthcare setting or worker-related factors, (2) patient psychological factors, (3) acute patient health factors, (4) non-acute patient health factors and (5) surgical factors.ConclusionsThere was a paucity of robust research investigating day 1 mobilisation post-hip fracture surgery.Each of the five factors identified is potentially modifiable through service improvement change and innovation strategies. There is an opportunity to explore how service provision change could be implemented to improve outcomes for all patients following hip fracture surgery demonstrating the clinical and cost benefits of these changes against the cost of delivering the change.

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Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

“…A summary of the search results is presented in the PRISMA flow diagram15 (figure 1). From 3337 citations, 23 met eligibility criteria and were included in the analysis 16–37…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

What factors affect early mobilisation following hip fracture surgery: a scoping review

Gray,

Lacey,

Whitehouse

et al. 2023

BMJ Open Qual

View full text Add to dashboard Cite

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Orthopaedic Out of Bed Project (OOBP): improving early mobilisation following femoral fracture using a therapy-led education programme

Gray,

Taylor,

Bullock

2023

BMJ Open Qual

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Delayed mobilisation following hip fracture surgery is detrimental to patients and health systems. Prolonged hospital stay additionally results in decreased function and increased mortality. Our hospital was underperforming against the national metric for mobilisation by the day after surgery and physiotherapists were the primary healthcare professionals expected to do this. The therapy team therefore undertook a service improvement to increase the number of patients mobilised by the day after their femoral fracture surgery. This was through a ward-based education programme aimed at increasing confidence and competence of the trauma ward healthcare assistants (HCAs) to complete this task when appropriate instead of physiotherapists.The model for improvement was used, with two Plan-Do-See-Act cycles completed between 2020 and 2022. On completion of the therapy-led intervention, the percentage of patients mobilised by the day after surgery was shown to have increased from a mean average of 60% in 2019 to 79% in 2022. The number of patients mobilised by HCAs prior to physiotherapy assessment increased from 2% prior to and 30% following the intervention.The programme improved HCA confidence and competence using a rehabilitation ethos to mobilise patients following hip fracture surgery. It also showed a clinically significant improvement in the percentage of patients with hip fracture mobilising by the day after surgery and a large increase in the number of patients mobilised by our trauma ward HCAs prior to an initial physiotherapy assessment. This work has demonstrated implications for orthopaedic trauma services and the patients who receive them. It reduces the single point of failure of relying on a physiotherapist to mobilise a patient through increasing multidisciplinary confidence and capability on the ward to perform the task. In turn, this increases physiotherapy capacity to provide acute rehabilitation, which is another important part of femoral fracture recovery.

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Using the National Hip Fracture Database (NHFD) to define the impact of physiotherapist assessment on early mobilisation after hip fracture

Cited by 2 publications

References 0 publications

What factors affect early mobilisation following hip fracture surgery: a scoping review

What factors affect early mobilisation following hip fracture surgery: a scoping review

Orthopaedic Out of Bed Project (OOBP): improving early mobilisation following femoral fracture using a therapy-led education programme

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