Boosting inpatient exercise after hip fracture using an alternative workforce: a mixed methods implementation...

Area of Science:

• Geriatric Rehabilitation
• Orthopedic Surgery
• Health Services Research

Background:

• Hip fractures significantly impact individuals and healthcare systems, necessitating improved patient outcomes.
• Enhanced physiotherapy provision shows promise but faces workforce challenges in implementation.
• Current physiotherapy models struggle to meet the needs of the growing hip fracture population.

Purpose of the Study:

• To evaluate the safety, feasibility, acceptability, effectiveness, and cost of thrice-daily physiotherapy for acute hip fracture patients.
• To assess the implementation of an alternative workforce model for increased physiotherapy delivery.
• To compare outcomes against usual care and a reference cohort.

Main Methods:

• A mixed-methods approach was employed in two public hospitals, utilizing the Consolidated Framework for Implementation Research (CFIR).
• The intervention involved twice-daily exercises by an alternative workforce (physiotherapy students, allied health assistants) complementing usual physiotherapy.
• Hospital length of stay was compared to a historical reference cohort.

Main Results:

• Acute care hospital length of stay reduced from 11 days (reference) to 8 days (BOOST cohort), a statistically significant decrease.
• Intervention fidelity was 72%, demonstrating feasibility, with 96% uptake and no reported safety concerns.
• The intervention was acceptable to patients, carers, and healthcare providers and found to be cost-effective.

Conclusions:

• Higher daily physiotherapy frequency, delivered by an alternative workforce, is safe, feasible, and effective for acute hip fracture patients.
• This model addresses physiotherapy workforce challenges and improves patient outcomes in the acute care setting.
• Implementation of enhanced physiotherapy is a viable and beneficial strategy for hip fracture management.