Mobility Outcomes At 2 Small Hospitals in the Mid North Coast of NSW

1. Mobility Outcomes At 2 Small Hospitals in the Mid North Coast of NSW Stephen Downs Jodie Marquez Pauline Chiarelli

2. Research Questions • Change in balance • Relationship between diagnosis and change in balance • Accuracy of physiotherapist’s estimates of change • Relationship between balance and discharge destination

3. Mid North Coast NSW

5. Exclusions: • <16 years old • Orthopedically unable to FWB on both legs • Medically unfit to test balance testing • Unable to understand balance testing instructions • Unable to provide informed consent • Expected to have a very short length of stay. Ethics: Approved by the North Coast Area Health Service and the University of Newcastle Human Research Ethics Committees

6. Recorded • Baseline and Discharge Balance Score • Physiotherapist’s Estimate of Change • Clinically Significant conditions • Discharge Destination • Number of Physio interventions

7. Clinically Significant Conditions • Condition affects mobility Or • Condition was reason for admission Carer availability also noted

8. Berg Balance Scale (BBS) • 14 parts each 0-4 (possible total 56 higher score is better) • Reliable • Berg, et al 1989; Liaw et al (2008) • Minimal detectable change (95%) 4.6-6.3 • Donoghue et al (2009) • Predicts Falls • Hall et al (2001)

9. 173 Potential participants 42 didn’t meet criteria 131 Met Criteria 30 Declined 101 Enrolled 12 Lost 89 Completed Study

10. 42 Patients did not meet the inclusion criteria: • 2 were acutely unwell • 2 were end stage palliative care • 15 were not fully weight bearing • 9 were too confused to follow instructions • 14 were expected to be discharged after such a short time that the baseline and discharge measures could not be reasonably expected to change

11. 173 Potential participants 42 didn’t meet criteria 131 Met Criteria 30 Declined 101 Enrolled 12 Lost 89 Completed Study

12. 12 were lost from the study • 1 became acutely unwell and was transferred to an acute care hospital • 1 was too acutely unwell on the day of discharge to allow BBS testing • 7 were lost to follow up • 1 had too short a length of stay • 3 withdrew

13. Age distribution of participants (mean = 80.95)

14. Conditions • 13 Stroke • 9 Joint Replacement • 9 # Proximal Femur • 6 Palliative Care • 1 # Pelvis • 40 Fall • 33 Dementia • 33 Cardiac/Resp/ Vascular • 24 Infection • 20 Musculoskeletal • 20 Delirium • 19 Other Neurological • 13 Depression None of these conditions predicted how much the BBS would change or accuracy of physiotherapist’s estimate

16. Mean Change in BBS The change was significant at p<0.001 but the 2 hospitals did not have significantly different changes in BBS (p=0.45)

17. Describing physiotherapy intervention (average intervention rate 3.65 per week)

18. Accuracy of initial physiotherapist prediction of discharge BBS (n=83)

19. Probability of discharge to nursing home compared to Baseline BBS • Observed • —— Predicted • ……. 95% confidence limit

20. Probability of discharge to nursing home compared to Final BBS • Observed • —— Predicted • ……. 95% confidence limit

21. Days Under Care / Change in BBS

22. What Does This Study Add? • Relationship between BBS and D/C destination • Number of physio interventions • How BBS changes • Prevalence of various conditions • Physios provide useful estimates of change

23. Limitations • Generalisability • No follow up • Causality not shown • Not enough power to predict changes from diagnosis

24. So What? • We have an ageing population • BBS-Nursing home connection • Variable change – wait before placing • Physio predictions of change useful