Outcome of patients with hip fracture treated by physical therapy in an acute care hospital

Background Physical therapy has an important role in hip fracture rehabilitation to address issues of mobility and function, yet current best practice guidelines fail to make recommendations for specific physical therapy interventions beyond the first 24 hours postsurgery. Objectives The aims of this study were: (1) to gain an understanding of current physical therapist practice in an Australian acute care setting and (2) to determine what physical therapists consider to be best practice physical therapist management and their rationale for their assessment and treatment techniques. Design and Methods Three focus group interviews were conducted with physical therapists and physical therapist students, as well as a retrospective case note audit of 51 patients who had undergone surgery for hip fracture. Results Beyond early mobilization and a thorough day 1 postoperative assessment, great variability in what was considered to be best practice management was displayed. Senior physical therapists considered previous clinical experience to be more important than available research evidence, and junior physical therapists modeled their behavior on that of senior physical therapists. The amount of therapy provided to patients during their acute inpatient stay varied considerably, and none of the patients audited were seen on every day of their admission. Conclusions Current physical therapist management in the acute setting for patients following hip fracture varies and is driven by system pressures as opposed to evidence-based practice.

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Clinical Commentary on “Provision of Physical Therapy at a Long-Term Acute Care Hospital for Patients Awaiting Lung Transplantation

Cardiopulmonary Physical Therapy Journal ◽

10.1097/cpt.0000000000000036 ◽

2016 ◽

Vol 27 (4) ◽

pp. 131-132

Author(s):

Susan Scherer

Keyword(s):

Physical Therapy ◽

Lung Transplantation ◽

Acute Care ◽

Acute Care Hospital ◽

Care Hospital

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Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series

Physical Therapy ◽

10.1093/ptj/pzaa194 ◽

2020 ◽

Author(s):

Sabrina Eggmann ◽

Angela Kindler ◽

Andrea Perren ◽

Natalie Ott ◽

Frauke Johannes ◽

...

Keyword(s):

Physical Therapy ◽

Critically Ill ◽

Acute Care ◽

Physical Therapists ◽

Physical Therapist ◽

Treatment Strategies ◽

Acute Care Hospital ◽

Care Hospital ◽

Potential Treatment ◽

Prone Positioning

Abstract Objective The aim of this case series was to describe the experience of Swiss physical therapists in the treatment of patients with COVID-19 during their acute care hospital stay and to discuss challenges and potential strategies in the clinical management of these patients. Methods We report 11 cases of patients with COVID-19 from five Swiss hospitals that illustrate the various indications for physical therapy, clinical challenges, potential treatment methods and short-term response to treatment. Results Physical therapists actively treated patients with COVID-19 on wards and in the ICU. Interventions ranged from patient education, to prone positioning, to early mobilization and respiratory therapy. Patients were often unstable with quick exacerbation of symptoms and a slow and fluctuant recovery. Additionally, many patients who are critically ill developed severe weakness, post-extubation dysphagia, weaning failure or presented with anxiety or delirium. In this setting, physical therapy was challenging and required specialized and individualized therapeutic strategies. Most patients adopted the proposed treatment strategies and lung function and physical strength improved over time. Conclusion Physical therapists clearly have a role in the COVID-19 pandemic. Based on our experience in Switzerland, we recommend that physical therapists routinely screen and assess patients for respiratory symptoms and exercise tolerance on acute wards. Treatment of patients who are critically ill should start as soon as possible to limit further sequelae. More research is needed for awake prone positioning, early breathing exercises as well as post-COVID rehabilitation. Impact To date there are few data on the physical therapist management of patients with COVID-19. This article is among the first to describe the role of physical therapists in the complex pandemic environment and to describe the potential treatment strategies for countering the various challenges in the treatment of these patients.

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Nursing care for the elderly with hip fracture in an acute care hospital

Wiener Medizinische Wochenschrift ◽

10.1007/s10354-013-0247-8 ◽

2013 ◽

Vol 163 (19-20) ◽

pp. 468-475 ◽

Cited By ~ 2

Author(s):

Monique Weissenberger-Leduc ◽

Michaela Zmaritz

Keyword(s):

Hip Fracture ◽

Acute Care ◽

Nursing Care ◽

Acute Care Hospital ◽

The Elderly ◽

Care Hospital ◽

Care For The Elderly

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Accuracy of Assignment of Orthopedic Inpatients to Receive Weekend Physical Therapy Services in an Acute Care Hospital

Physiotherapy Canada ◽

10.3138/ptc.58.3.221 ◽

2006 ◽

Vol 58 (3) ◽

pp. 221-232

Author(s):

Lisa Taylor ◽

Kristen Goodman ◽

Daniela Soares ◽

Heather Carr ◽

Gina Peixoto ◽

...

Keyword(s):

Physical Therapy ◽

Acute Care ◽

Acute Care Hospital ◽

Care Hospital ◽

Therapy Services ◽

To Receive ◽

Physical Therapy Services

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Operationalising a conceptual framework for a contiguous hospitalisation episode to study associations between surgical timing and death after first hip fracture: a Canadian observational study

BMJ Open ◽

10.1136/bmjopen-2017-020372 ◽

2018 ◽

Vol 8 (12) ◽

pp. e020372

Author(s):

Katie Jane Sheehan ◽

Adrian R Levy ◽

Boris Sobolev ◽

Pierre Guy ◽

Michael Tang ◽

...

Keyword(s):

Hip Fracture ◽

Observational Study ◽

Conceptual Framework ◽

Acute Care ◽

Acute Care Hospital ◽

Secondary Outcome ◽

Care Hospital ◽

Surgical Timing ◽

Episodes Of Care ◽

Canadian Provinces

ObjectiveWe describe steps to operationalise a published conceptual framework for a contiguous hospitalisation episode using acute care hospital discharge abstracts. We then quantified the degree of bias induced by a first abstract episode, which does not account for hospital transfers.DesignRetrospective observational study.SettingAll acute care hospitals in nine Canadian provinces.ParticipantsWe retrieved acute hospitalisation discharge abstracts for 189 448 patients aged 65 years and older admitted to acute care with hip fracture between 2003 and 2013.Primary and secondary outcome measuresThe percentage of patients treated surgically, delayed to surgery (defined as two or more days after admission) and dying, between contiguous hospitalisation episodes and the first abstract episodes of care.ResultsUsing contiguous hospitalisation episodes, 91.6% underwent surgery, 35.7% were delayed two or more days after admission and 6.7% died postoperatively, whereas, using the first abstract only, these percentages were 83.7%, 32.5% and 6.5%, respectively.ConclusionWe demonstrate that not accounting for hospital transfers when evaluating the association between surgical timing and death underestimates reporting of the percentage of patients treated surgically and delayed to surgery by 9%, and the percentage who die after surgery by 3%. Researchers must be aware of this potential and avoidable bias as, depending on the purpose of the study, erroneous inferences may be drawn.

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