Background
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evaluate, after appropriate case-mix adjustment, the associations of rehabilitation (including physiotherapy) interventions with post-operative hip fracture mobility
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evaluate the associations of rehabilitation interventions with postoperative discharge destination and return to the same setting as pre-fracture.
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To assess the data quality of relevant NHFD variables
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To assess the appropriateness of current NHFD variables to audit rehabilitation interventions and to make recommendations for improvement
Methods
Data source
Exposure variables
Predictor variables
Outcome variables
Statistical analysis
Results
Mobility
Variables | Mobility model | |
---|---|---|
Frequency | Percentage % | |
Age group | ||
60–69 | 1681 | 7.3 |
70–79 | 4384 | 19.0 |
80–89 | 10,471 | 45.5 |
> 90 | 6504 | 28.2 |
Total | 23,040 | 100.0 |
Sex | ||
Male | 6228 | 27.0 |
Female | 16,812 | 73.0 |
Total | 23,040 | 100.0 |
Pre Fracture Mobility | ||
Freely mobile without aids | 7939 | 34.5 |
Mobile outdoors with one aid | 4646 | 20.2 |
Mobile outdoors with two aids or frame | 2619 | 11.4 |
Some indoor mobility but never goes out | 7132 | 31.0 |
No functional mobility | 391 | 1.7 |
Missing | 313 | 1.4 |
Total | 23,040 | 100.0 |
Mobility at 30 days | ||
Freely mobile without aids | 452 | 2.0 |
Mobile outdoors with one aid | 1746 | 7.6 |
Mobile outdoors with two aids or frame | 3759 | 16.3 |
Some indoor mobility but never goes out | 14,032 | 60.9 |
No functional mobility | 3051 | 13.2 |
Missing | 0 | 0.0 |
Total | 23,040 | 100.0 |
Physiotherapy assessment | ||
No | 399 | 1.7 |
Yes | 22,546 | 97.9 |
Missing | 95 | 0.4 |
Total | 23,040 | 100.0 |
Mobilised on day of or day following surgery | ||
No | 3332 | 14.5 |
Yes-physiotherapy | 13,210 | 57.3 |
Yes-Other | 661 | 2.9 |
Missing | 5837 | 25.3 |
Total | 23,040 | 100.0 |
Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|
ORs (95% CIs) | P value | ORs (95% CIs) | P value | |
Age 60–69 | 1 | 1 | ||
70–79 | 1.067 (1.036–1.099) | < 0.001 | 1.139 (0.936–1.388) | 0.196 |
80–89 | 0.857 (0.842–0.872) | < 0.001 | 1.628 (1.310–2.024) | < 0.001 |
> 90 | 1.513 (1.876–2.778) | < 0.001 | 2.269 (1.865–2.760) | < 0.001 |
Sex Male | 1 | 1 | ||
Female | 1.018 (1.470–1.558) | 0.54 | 0.931 (0.877–0.989) | 0.02 |
Mobilised day of/after surgery No | 1 | |||
Yes-PT | 0.438 (0.415–0.463) | < 0.001 | 0.541 (0.511 0.573) | < 0.001 |
Yes-Other | 0.354 (0.304–0.413) | < 0.001 | 0.472 (0.403–0.553) | < 0.001 |
ASA grade Normal healthy individual | 1 | 1 | ||
Mild systemic disease that does not limit activity | 2.627 (2.241–3.080) | < 0.001 | 1.601 (1.359–1.885) | < 0.001 |
Severe systemic disease that limits activity but is not incapacitating | 6.987 (5.970–8.178) | < 0.001 | 2.453 (2.081–2.892) | < 0.001 |
Incapacitating systemic disease which is constantly life-threatening | 12.096 (10.184–14.368) | < 0.001 | 3.078 (2.567–3.690) | < 0.001 |
Moribund - not expected to survive 24 h with or without surgery | 36.562 (20.941–63.834) | < 0.001 | 7.057 (3.824–13.025) | < 0.001 |
Unknown | 8.536 (6.734–10.820) | < 0.001 | 2.35 (1.828–3.021) | < 0.001 |
AMTS Score Poor cognitive function 0 | 1.263 (1.055–1.511) | 0.084 | 1.179 (0.979–1.420) | 0.084 |
1 | 1 | 1 | ||
2 | 0.906 (0.723–1.136) | 0.339 | 0.896 (0.710–1.132) | 0.339 |
3 | 0.858 (0.683–1.077) | 0.53 | 0.931 (0.736–1.178) | 0.53 |
4 | 0.737 (0.589–0.923) | 0.038 | 0.789 (0.626–0.995) | 0.038 |
5 | 0.747 (0.600–0.929) | 0.188 | 0.861 (0.687–1.079) | 0.188 |
6 | 0.647 (0.522–0.802) | 0.033 | 0.787 (0.631–0.982) | 0.033 |
7 | 0.474 (0.388–0.580) | < 0.001 | 0.626 (0.509–0.771) | < 0.001 |
8 | 0.378 (0.313–0.456) | < 0.001 | 0.571 (0.470–0.693) | < 0.001 |
9 | 0.262 (0.219–0.314) | < 0.001 | 0.465 (0.386–0.560) | < 0.001 |
Good cognitive function 10 | 0.163 (0.137–0.193) | < 0.001 | 0.373 (0.312–0.446) | < 0.001 |
Not done | 0.328 (0.266–0.405) | < 0.001 | 0.473 (0.382–0.587) | < 0.001 |
PT assessment No | 1 | 1 | ||
Yes | 1.191 (0.996–1.424) | 0.055 | 1.267 (1.056–1.520) | 0.008 |
Pre Fracture Mobility Freely mobile no aids | 1 | 1 | ||
Mobile outdoors one aid | 2.043 (1.901–2.197) | < 0.001 | 1.621 (1.503–1.749) | < 0.001 |
Mobile outdoors two aids or frame | 2.813 (2.568–3.082) | < 0.001 | 1.956 (1.778–2.150) | < 0.001 |
Some indoor mobility never goes out | 7.872 (7.315–8.472) | < 0.001 | 3.729 (3.442–4.039) | < 0.001 |
No functional mobility | 53.419 (42.656 66.899) | < 0.001 | 27.849 (21.388–34.512) | < 0.001 |
Unknown | 10.046 (7.929–12.727) | < 0.001 | 3.892 (3.051–4.964) | < 0.001 |
Delay (hours) to operation < 24 | 1 | 1 | ||
24–48 | 0.304 (0.237–0.389) | < 0.001 | 0.999 (0.999–1.002) | 0.95 |
48–70 | 0.336 (0.269–0.419) | < 0.001 | 0.999 (0.999–1.002) | 0.95 |
> 70 | 0.338 (0.272–0.419) | < 0.001 | 1 |