Twice-daily allied health therapy improves function and is associated with discharge directly home in acutely hospitalised older adults: a mixed methods feasibility study.
Aruska D’Souza1, Jacqueline Kay1, Alana Jacob1, Marlena Klaic1, Celia Marston1, Rose Goonan1, Hannah Crowley1, Catherine Granger11The Royal Melbourne Hospital, Parkville, Victoria, Australia
Abstract
Aim
To determine the feasibility (fidelity, practicality, satisfaction and limited efficacy) of twice-daily physiotherapy, occupational therapy and allied health assistant therapy on the Acute Care of the Elderly (ACE) ward compared to patients in General Medicine (GM) and Geriatric Rehabilitation (GR) wards who received standard care.
Method
Prospective study of older adults on three inpatient wards. Allied health on the ACE ward aimed to deliver at least twice daily physiotherapy, occupational therapy or allied health assistant therapy. Primary outcome was the number of allied health sessions/weekday (fidelity, practicality). Secondary outcomes were discharge destination, patient and clinician satisfaction, and changes in patient function (Modified Iowa Level of Assistance, Short Performance Physical Battery, Katz Activities of Daily Living and Lawton Instrumental Activities of Daily Living; limited efficacy).
Results
Over a 5-month period, 430 eligible older adults were admitted to the three wards. At least twice-daily therapy was provided on 72% (n=757) of ACE therapy sessions. More patients were discharged home from ACE (74%) than GR (57%, p=0.002) or GM (50%, p<0.001). Patients on ACE had significant improvements in functional measures (p<0.001); moderate/large effect sizes were observed (compared to mostly small/moderate effect sizes on GM and GR wards (p<0.05)). Higher satisfaction was recorded from ACE staff than GM, but there were no differences to GR staff. There was no difference in patient satisfaction.
Discussion
Delivery of twice-daily therapy was feasible and associated with improved patient outcomes; further research is required to determine if twice-daily therapy will yield similar outcomes in GR and GM.
Biography
Dr D’Souza is an early-career researcher and physiotherapist with over 11 years of clinical experience in acute care. She was awarded her PhD in 2023 (Predicting Discharge Destination in Acute General Medicine). Dr D’Souza has published four papers and obtained over $160,000 in competitive grant funding. She currently works as the Allied Health Knowledge and Research Translation lead at the Royal Melbourne Hospital and leads multi-disciplinary projects across allied health that investigate a broad range of important clinical areas including Outcome Measurement in acute, COVID-19, Trauma, LGBTQIA+ Patient Liaison Service, General Medicine and Staff Digital Health capability.