Does additional weekend and holiday physiotherapy benefit geriatric patients with hip fracture? - A case-historical control study.

Objective: To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training.

Methods: A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals.

Results: With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II ( $p=0.015$ ) and significant higher MBI scores ( $\text{mean}\pm \text{standard}$ deviation, median; Study group: $47.4\pm 19.6$ points, 51 points; Control group: $43.0\pm 20.0$ points, 43 points; $p=0.042$ ) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: $8.2\pm 5.5$ points, 7 points; Control group: $8.4\pm 6.1$ points, 6 points; $p=0.998$ ) and MBI scores (Study group: $63.0\pm 23.4$ points, 68 points; Control group: $61.2\pm 26.1$ points, 64 points; $p=0.743$ ) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: $7.7\pm 3.9$ days, 7 days; Control group: $7.4\pm 5.0$ days, 6 days; $p=0.192$ ). The average LOS in rehabilitation hospital (Study group: $20.0\pm 5.5$ days, 20 days; Control group: $24.3\pm 9.9$ days, 23 days; $p<0.001$ ) and total in-patient LOS (Study group: $26.7\pm 6.4$ days, 26 days; Control group: $30.7\pm 11.2$ days, 28 days; $p<0.001$ ) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, $p<0.001$ ).

Conclusion: Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.