Frequency, duration, and type of physiotherapy in the week after hip fracture surgery - analysis of implications for discharge home, readmission, survival, and recovery of mobility

Purpose: To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery. Methods: A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence. Results: Overall, 73% were female and 40% had high frailty risk. Patients who received ≥2 hours of physiotherapy (versus less) had 3% (95% Confidence Interval: 0–6%), 4% (2–6%), and 6% (1–11%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 3% (0–6%) lower adjusted probability of readmission. Recipients of exercise (versus mobilisation alone) had 6% (1–12%), 3% (0–7%), and 11% (3–18%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 6% (2–10%) lower adjusted probability of readmission. Recipients of 6–7 days physiotherapy (versus 0–2 days) had 8% (5–11%) higher adjusted probability of survival. For patients with dementia, improved probability of survival, discharge home, readmission and indoor mobility recovery were observed with greater physiotherapy access. Conclusion: Greater access to physiotherapy was associated with a higher probability of positive outcomes. For every 100 patients, greater access could equate to an additional eight patients surviving to 30-days and six avoiding 30-day readmission. The findings suggest a potential benefit in terms of home discharge and outdoor mobility recovery. Contribution of the Paper: • To substantiate a case for additional physiotherapy, evidence for an association with improved outcomes is needed. • Analysis of 5383 patients suggests greater access to physiotherapy was associated with higher probability of positive outcomes. • For every 100 patients, this could equate to six more patients avoiding 30-day readmission and eight more patients surviving to 30-days. • The association between access to physiotherapy and survival persisted irrespective of dementia diagnosis. • For other outcomes, associations varied by the presence/absence of dementia and should be explored by future cohort studies.