Proceedings of the 10th Fragility Fracture Network Congress held 20-22nd October 2022, Melbourne Australia P01: Driving up the Standard of Care: The Irish Hip Fracture Database 8 Years On

Abstract

Geriatric Orthopaedic Surgery & Rehabilitation Volume 14: 1–61 © The Author(s) 2023 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/21514593231164064 journals.sagepub.com/home/gos Proceedings of the 10th Fragility Fracture Network Congress held 20-22nd October 2022, Melbourne Australia P01: Driving up the Standard of Care: The Irish Hip Fracture Database 8 Years On Louise Brent, Emer Ahern, and Conor Hurson Cork University Hospital, St. Vincent’s University Hospital The IHFD is a clinically led, web based audit of hip fracture case-mix, care and outcomes. The National Office of Clinical Audit (NOCA) provides operational support and governance for the IHFD. All 16 eligible hospitals in the Republic of Ireland are now entering data. It is clinically supported by the Irish Gerontological Society (IGS) and the Irish Institute of Trauma and Orthopaedics (IITOS). The IHFD has been recording data since 2012 and has captured over 29,000 cases to date. In 2017 the IHFD published the Irish Hip Fracture Standards (IHFS), in 2018 these standards formed the basis of a Best Practice Tariff (BPT) i.e a payment of €1000 per case that meets the IHFS. In 2021 a new standard for early mobilization was added. Data is collected through the Hospital In-Patient Enquiry (HIPE) portal in collaboration with the Healthcare Pricing Office (HPO). The amount of data captured has improved consistently year on year with 99% coverage achieved in 2020. There has been an improvement in all IHFS between 2017-2020 with a minor disimprovement in 2020 due to COVID. The focus of the audit going forwardwill be support the hospitals to recover from the impact of the COVID pandemic, to increase the number of patients care meeting the BPT, to support the hospitals to adopt a culture of quality improvement using the IHFD data and to develop a longer term outcome dataset. Several high quality research publications were published in 2021. (2021 data will be ready in Sept 2022). P02: Handgrip Strength and Modified Functional Ambulation Classification Cut-off Points to Identify Post-operative Walker in Fragility Hip Fracture Ivan Long YinAu, Shirley Ka Wai Lee, Tim King Him Chui, Kwok Leung Tiu, Kin Bong Lee, and Andy Chi Ming Chan Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong, Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong The objectives of this study were to investigate the relationship between pre-operative physiotherapy outcomes and early post-operative functional outcomes, (ii) to estimate the cutoff point of pre-operative handgrip strength (HGS) and premorbid Modified Functional Ambulation Classification (MFAC) to identify post-operative walker in fragility hip fracture (FHF) patients. Patients who admitted to a local acute hospital in 2020 and entered the Fragility Hip Fracture Clinical Pathway were reviewed. Pre-operative HGS, MFAC-premorbid, MFAC at discharge (MFAC-DC) and Elderly Mobility Scale (EMS) at discharge (EMS-DC) were retrieved. Correlations among pre-operative HGS, MFAC-premorbid, MFAC-DC and EMS-DC were evaluated by Spearman’s rank correlation coefficient. Receiver operating characteristic analysis was used to estimate pre-operative HGS and MFAC-premorbid cut-off points for the prediction of post-operative walker (i.e. MFAC ≥III or EMS ≥6). Four hundred and thirty-two patients (mean age=84.7 ± 7.3 years old) (144 males, 288 females) were reviewed. Significant positive correlations were found between HGS and MFAC-DC (r = 0.379, p < 0.001), and between HGS and EMS-DC (r = 0.314, p < 0.001). Significant positive correlations were demonstrated between MFAC-premorbid and MFAC-DC (r = 0.403, p < 0.001), and betweenMFACpremorbid and EMS-DC (r = 0.428, p < 0.001). Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). For predicting post-operative walker of MFAC ≥III, HGS cut-off points in male and female patients were 17.1 kilogram-force (sensitivity 65.7%; specificity 56.0%) (AUC=0.647, p = 0.009) and 12.4 kilogram-force (sensitivity 71.6%; specificity 55.1%) (AUC=0.650, p < 0.001) respectively. MFAC-premorbid cut-off point in male patients was Category VII (sensitivity 77.1%, specificity 56.9%) (AUC=0.716, p < 0.001). Pre-operative physiotherapy outcomes, including HGS and premorbid MFAC, can help to determine the early post-operative functional outcomes and facilitate the discharge planning in FHF patients. P03: Boosting Inpatient Exercise After Hip Fracture Using an AlternativeWorkforce: A Mixed Methods Implementation Evaluation (BOOST Study) Marie March, Sarah Dennis, Sarah Caruana, Chris Mahony, Jim Elliott, Stephanie Polley, Bijoy Thomas, Charlie Lin, and Alison Harmer Western Sydney Local Health District and University of Sydney, University of Sydney and South Western Sydney Local Health District, Western Sydney Local Health District, Northern Sydney Local Health District, University of Sydney and Northern Sydney Local Health District, Western Sydney Local Health District and Northern Sydney Local Health District, University of Sydney Aims: Our objective was to evaluate the safety, fidelity, acceptability, and effectiveness of implementing thricedaily exercise by an alternative workforce for patients in the acute setting after hip fracture. Methods: We conducted a pre-post mixed methods implementation evaluation. We included ambulant, community dwelling participants who were prescribed at least 50% weightbearing after operative fixation for hip fracture. The Consolidated Framework for Implementation Research (CFIR) was used as a determinant framework to guide implementation planning. Our intervention combined once-daily mobility training implemented by a physiotherapist, with added twice-daily sit-to-stand exercise implemented by the alternative workforce. Our primary outcome was effectiveness, measured by acute hospital hospital length of stay. Primary outcome data was analysed using T-tests, with a reference cohort from registry data. Results: 25 participants were recruited from 26 eligible patients at two hospitals over 10 weeks. Our reference cohort and BOOST cohort were similar at baseline. Acute hospital length of stay was 3 days less in the BOOST cohort compared to the reference cohort (mean 8.2 vs 11.5, mean difference -3.27, 95%CI -5.39 to -1.16, P = 0.003). No safety concerns were identified related to the BOOST intervention. We had 72% fidelity to planned occasions of service across both sites. The intervention was acceptable to patients and carers, staff and the orthogeriatric team, with the main barrier to implementation identified as patient cognition. Conclusion: Thrice-daily exercise intervention is safe, effective, acceptable and feasible for patients in the acute stage after hip fracture when implemented by a supervised alternative workforce. P04: Bone Structure Using Peripheral Quantitative Computed Tomography (pQCT)-Based Finite Element Modelling in Young Adults Born Extremely Preterm or Extremely LowBirthweight (EP/ELBW) In 1991 and 1992 Thang Dao, Dale Robinson, Lex Doyle, Peter Lee, Joy Olsen, Ashwini Kale, Jeanie Cheong, and John Wark Melbourne Medical School, The University of Melbourne, Melbourne, Australia, Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia; Newborn Research, Royal Women’s Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia, Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Bone and Mineral Medicine, Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Australia, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia; Newborn Research, Royal Women’s Hospital, Melbourne, Australia Aims: The long-term bone health of young adults born extremely preterm (EP; <28 weeks’ gestation) or extremely low birth weight (ELBW; <1000g birth weight) in the post-surfactant era (since early 1990s) is unclear. This study investigated their bone structure and estimated bone strength using pQCT-based finite element modelling (pQCT-FEM). Methods: VICS is a longitudinal cohort study of EP/ELBW survivors and controls born in Victoria, Australia, during 1991-92. At age 25 years, participants underwent pQCT at 4% and 66% of the tibia length which was analysed using pQCT-FEM, and groups compared using linear regression, adjusting for height and weight. Parameters measured included compressive stiffness (kcomp), shear stiffness (kshear), torsional stiffness (ktorsion), and bending stiffness (kbend). 2 Geriatric Orthopaedic Surgery & Rehabilitation 14(0)