Αn advanced physiotherapist model in hip fracture care may reduce costs and surgical registrar time without adversely influencing patient outcomes.


Advance physiotherapy roles in elective arthroplasty across global settings have demonstrated benefit in safely reducing time burden on surgical teams and healthcare costs. The utility of similar roles in the care of hip fracture is unclear. This quality initiative, conducted in Australia, aimed to implement and evaluate a new model of care substituting a surgical registrar with an advanced physiotherapist in a post-discharge hip fracture clinic.


During the implementation of this model (October 2020- January 2023), 346 hip fracture patients (median age 75 years) were seen by an advanced physiotherapist. The following key elements were reported:


• Eighty-one patients seen by an advanced physiotherapist required brief informal discussion with the consultant surgeon during physiotherapy management sessions.
• Fifteen patients required a formal consultant review and ongoing management by the surgeon; these were routinely patients with complex pain management or requiring surgical revision. 
• There have been no patient complaints, critical incidents or other unintended consequences following implementation.
• The overall net surgical time realised over the 3 years was 110 hours. While there were no physiotherapy overtime hours, 5347 hours of registrar surgical overtime were incurred during the evaluation period.
• Cost comparative data suggest a very small cost of $A330 across the entirety of the programme, although basic modelling did not account for the reduction in surgical penalty rates for overtime. 
 

The study demonstrated that this model in hip fracture care is cost neutral, may reduce overtime and associated penalty payments, and free up surgical registrar time for full scope surgical tasks, without adversely influencing patient satisfaction or leading to harm.


The authors concluded that: ‘This single site quality initiative provides a passing glance at the potential benefit of an advanced physiotherapy clinic for hip fracture patients. We are looking forward to ongoing research to rigorously evaluate this innovative approach to meeting the foreseen challenge of unmet surgical demand for service in this vulnerable population’.

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The management of Vertebral Fragility Fractures (VFF) is a problem around the globe. Models have been developed to highlight best practice care for individuals who have had a VFF. It is unclear if these models are appropriate and realistic in high, low- and middle-income countries or if new tools would help clinicians manage these complex patients through their acute episode, their recovery or secondary prevention.  

To find out more about what is happening around the globe, through the VFF Special Interest Group, FFN clinical experts have adapted, with permission, the Royal Osteoporosis Society (UK) Model which reflects the best evidence currently available.  

They are now undertaking a survey to identify if this model is appropriate and realistic for providing care in different healthcare sectors (hospitals and primary care) and countries. The survey results will also provide information on tools that could be developed to help healthcare professionals improve their care.

The survey can be completed by any healthcare professional who has seen one or more VFF patients in 2023, through any stage of their acute episode to recovery, return to function, and secondary prevention. 


If you treat VFF patients, please help us to find out about VFF across the globe by accessing the 10-minute survey here.

Please share this with your colleagues who are interested in VFF.

For any questions, please contact Operations@fragilityfracturenetwork.org

The integrated orthogeriatric care model with shared responsibility and decision-making between the orthopaedic surgeon and the geriatrician has a positive effect on quality indicators pre-and post-operatively for hip fracture patients.


Orthogeriatric care improves the hip fracture patient’s opportunity to attain prefracture level of mobility, independency and health, but there is no consensus on which model of orthogeriatric care that is best to achieve patients prefracture function. The aim of this study was to evaluate two different orthogeriatric models for patients with hip fracture. The study was conducted at Oslo University hospital in Norway and included 516 patients >65 with a hip fracture.


An ‘Integrated Care Model’ (ICM) was compared with a ‘Geriatric Consult Service’ (GCS). The differences between the care protocols of these models were that in ICM there was an evening round by the geriatrician on call preoperatively and the ICM group followed the routine in the orthogeriatric unit, where every day the orthogeriatric team (geriatrician, orthopaedic surgeon, hip fracture nurse and physiotherapist) participated at interdisciplinary rounds to the patients. The patients in the GCS group followed the routine in the orthopaedic trauma ward with rounds by the orthopaedic surgeon and nurse. In addition, they were offered a visit by the geriatrician but without the orthogeriatric team.


The results of the study indicated that the ICM with co-management of the patients and shared decision-making and responsibility between the orthopaedic surgeon and the geriatrician, provided equally good or better results on all the quality indicators measured.  The quality indicators regarding postoperative care (removal of urinary catheter 1 postoperative day, mobilisation 1 postoperative day and treatment with antiosteoporotic drugs) has the highest level of improvement at the ICM model, in addition to preoperative nerve block. There was no statistically significant difference between the 2 models in terms of mortality.

Dr Lene Solberg, one of the authors, stated: ‘ICM provides better acute care for the hip fracture patients measured by selected quality indicators. However, more research which embraces a wider spectrum is needed to clearly state that a model of co-management between the orthopaedics and the geriatricians affects important outcome measures, such as mobility, post-discharge dependency and quality of life.’ 

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