Boosting inpatient exercise after hip fracture using an alternative workforce: a mixed
methods implementation evaluation (BOOST study).
Marie March1, Sarah Dennis2,3, Sarah Caruana1, Christopher Mahony4, Jim Elliott2,4, Stephanie Polley1,4, Bijoy Thomas1, Charlie Lin4, Alison Harmer2 1Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia2Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia3South Western Sydney Local Health District, Liverpool , NSW, Australia4Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
Abstract
Aims
Our objective was to evaluate the safety, fidelity, acceptability, and effectiveness of implementing thrice-daily exercise by an alternative workforce for patients in the acute setting after hip fracture.
Methods
We conducted a pre-post mixed methods implementation evaluation. We included ambulant, community dwelling participants who were prescribed at least 50% weight-bearing after operative fixation for hip fracture. The Consolidated Framework for Implementation Research (CFIR) was used
as a determinant framework to guide implementation planning. Our intervention combined once-daily mobility training implemented by a physiotherapist, with added twice- daily sit-to-stand exercise implemented by the alternative workforce. Our primary outcome was effectiveness, measured by acute hospital hospital length of stay. Primary outcome data was analysed using T -tests, with a reference cohort from registry data.
Results
25 participants were recruited from 26 eligible patients at two hospitals over 10 weeks . Our reference cohort and BOOST cohort were similar at baseline. Acute hospital length of stay was 3 days less in the BOOST cohort compared to the reference cohort (mean 8.2 vs 11.5, mean difference -3.27, 95%CI -5.39 to -1.16, p=0.003 ). No safety concerns were identified related to the BOOST intervention. We had 72% fidelity to planned occasions of service across both sites. The intervention was acceptable to patients and carers, staff and the orthogeriatric team, with the main barrier to implementation identified as patient cognition.
Conclusion
Thrice-daily exercise intervention is safe, effective, acceptable and feasible for patients in the acute stage after hip fracture when implemented by a supervised alternative workforce.
Biography
Marie is Senior Clinical and Research Physiotherapist at Blacktown Mt Druitt Hospitals and a Clinical Lecturer at the University of Sydney. She has extensive clinical experience in orthopaedics and musculoskeletal care and is currently in a transdisciplinary clinical role in the emergency department. Marie’s research interests include optimising complex patients undergoing arthroplasty, implementing high value models of care, and psychologically-informed physiotherapy practice. Her PhD has recently been accepted at the University of Sydney exploring psychological health and recovery from knee arthroplasty. She has ~$150000 of grant funding and siz publications.