[Show abstract][Hide abstract] ABSTRACT: Bed rest with elevation of the affected limb is commonly prescribed postoperatively following ankle fracture fixation although there is no evidence that this is necessary.
The aim of this prospective, randomised study was to investigate the effects of early mobilisation following surgical fixation of an ankle fracture on wound healing and length of stay (LOS).
A total of 104 patients underwent primary internal fixation of an ankle fracture at The Alfred hospital, Melbourne between July 2008 and January 2010.
The strategy included either early mobilisation group (first day post surgery) or control group (bed rest with elevation until day 2 post surgery).
Data collected included demographic, injury type and surgical procedure. Outcome data included inpatient LOS, wound condition at 10-14 days, opioid use and re-admission rate.
Groups were comparable at baseline. Wound breakdown rate was 2.9% (3 patients in the control group). Median LOS of the early mobilisation group was 55 h compared with 71 h in the control group (p<0.0001). Opioid use for the control group was an average of 90 mg morphine equivalent in the first 24 h post surgery compared with 67 mg morphine equivalent for the early mobilisation group (p=0.32).
This study indicates that early mobilisation following surgical fixation of an ankle fracture results in a shorter hospital stay without evidence of an increased risk of re-admission or wound complication.
[Show abstract][Hide abstract] ABSTRACT: Background: A short stay elective centre was opened in 2007 at The Alfred in Melbourne, Australia. The objective was to safely discharge patients home on the third post-operative day. This prospective observational study reports the outcomes for hip and knee replacement patients during the first year of operation. Methods: Forty-seven patients (28 women and 19 men; mean age 65 years) were eligible for the study. Data was collected at preadmission, discharge and 6 months. Results: Thirty-four of 47 patients (72.3%) achieved discharge home within 3 days. Mean length of stay for the whole group was 4.55 days (95% CI 3.78–5.33 days). Patients who had medical complications were significantly more likely to stay longer than 3 days (p < 0.001). Patients with more pre-operative co-morbidity were more likely to suffer a post-operative medical complication resulting in a stay longer than 3 days (p = 0.09). Six month re-admission rates were 6% for those with a 3 day discharge and 15% for others. Conclusions: Preliminary findings suggest that a 3-day length of stay is possible for a defined group of patients, and can be achieved without increase in complication or re-admission rates. Failure to achieve Day 3 discharge is primarily related to medical complications.
International Journal of Orthopaedic and Trauma Nursing 02/2011; 15(1):29-34. DOI:10.1016/j.ijotn.2010.07.001
[Show abstract][Hide abstract] ABSTRACT: Regular physical activity is recommended for patients with human immunodeficiency virus (HIV) to help manage their disease. However, to date, little is known about levels of uptake of this advice. This study describes daily physical activity in HIV antibody-positive patients attending a public hospital infectious diseases clinic, compares them with those of patients attending the clinic for general infectious diseases and investigates compliance with the recommendations of the Centres for Disease Control and Prevention and American College of Sports Medicine physical activity guidelines. During April 2006, 261 patients completed the International Physical Activity Questionnaire short form. One hundred and ninety-one reported being HIV antibody-positive. Results showed that 1:4 HIV antibody-positive and 1:3 HIV antibody-negative respondents failed to meet the recommended guidelines. These findings are of concern, given the evidence-based benefits of regular physical activity. Further work is needed to identify barriers to participation and interventions that can improve uptake.
International Journal of STD & AIDS 09/2008; 19(8):514-8. DOI:10.1258/ijsa.2007.007237 · 1.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: What is the effect of a six-month, supervised, aerobic and resistance exercise program on self-efficacy in men living with human immunodeficiency virus (HIV)?
Randomised, controlled trial. Participants: 40 (5 dropouts) men living with HIV, aged 18 years or older.
The experimental group participated in a twice-weekly supervised aerobic and resistance exercise program for six months and the control group participated in a twice-weekly unsupervised walking program and attended a monthly group forum.
The primary outcome measure was self-efficacy using the General Self-Efficacy Scale. Secondary outcome measures were cardiovascular fitness using the Kasch Pulse Recovery test, and health-related quality of life using the Medical Outcomes Study HIV Health Survey. Measures were taken by an assessor blinded to group allocation.
By six months, the experimental group had improved their self-efficacy by 6.8 points (95% CI 3.9 to 9.7, p < 0.001) and improved their cardiovascular fitness by reducing their heart rate by 20.2 bpm (95% CI -25.8 to -14.6, p < 0.001) more than the control group. Health-related quality of life improved in only two out of the eleven dimensions: the experimental group improved their overall health by 20.8 points (95% CI 2.0 to 39.7, p = 0.03) and their cognitive function by 14 points (95% CI 0.7 to 27.3, p = 0.04) more than the control group.
The findings of this study add to the known benefits of exercise for the HIV-infected population.
The Australian journal of physiotherapy 11/2006; 52(3):185-90. DOI:10.1016/S0004-9514(06)70027-7 · 3.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Level 3 evidence-based guidelines recommend first walk after hip fracture surgery within 48 h. Early mobilization is resource and effort intensive and needs rigorous investigation to justify implementation. This study uses a prospective randomized method to investigate the effect of early ambulation (EA) after hip fracture surgery on patient and hospital outcomes.
Sixty patients (41 women and 19 men; mean age 79.4 years) admitted between March 2004 through December 2004 to The Alfred Hospital, Melbourne, for surgical management of a hip fracture were studied. Randomization was either EA (first walk postoperative day 1 or 2) or delayed ambulation (DA) (first walk postoperative day 3 or 4). Functional levels on day 7 post-surgery, acute hospital length of stay and destination at discharge were compared.
At 1 week post-surgery, patients in the EA group walked further than those in the DA group (P = 0.03) and required less assistance to transfer (P = 0.009) and negotiate a step (P = 0.23). Patients in the EA group were more likely to be discharged directly home from the acute care than those in the DA group (26.3 compared with 2.4%) and less likely to need high-level care (36.8 compared with 56%). A failed early ambulation subgroup had significantly more postoperative cardiovascular instability and worse results for all outcome measures.
EA after hip fracture surgery accelerates functional recovery and is associated with more discharges directly home and less to high-level care.
ANZ Journal of Surgery 08/2006; 76(7):607-11. DOI:10.1111/j.1445-2197.2006.03786.x · 1.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine whether targeted postoperative care, based on preoperative risk assessment, can increase the number of patients who are discharged home directly from acute care after elective hip or knee arthroplasty.
Quasiexperimental with historical control.
A public university teaching hospital.
One hundred patients who had an elective hip or knee arthroplasty.
Between January and July 2001, 50 patients had their risk of discharge to extended inpatient rehabilitation assessed preoperatively with a newly developed Risk Assessment and Prediction Tool (RAPT). Postoperative management was targeted on the basis of the identified level of risk. Results were compared with those of a similar group of 50 patients treated between January and July 2000.
Discharge destination, length of stay (LOS), and readmission rates.
The percentage of patients discharged directly home increased significantly, from 34% during 2000 to 64% in 2001 (P=.002), with no increase in readmission rates in the 12 months postdischarge. In addition, the mean acute hospital LOS decreased by 1.1 days to 7.5 days in 2001 (P=.02).
Use of the RAPT and targeted postoperative care resulted in more patients being discharged directly home after hip or knee arthroplasty while hospital LOS further decreased.
Archives of Physical Medicine and Rehabilitation 10/2004; 85(9):1424-7. DOI:10.1016/j.apmr.2003.12.028 · 2.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Oldmeadow LB, McBurney H, Robertson VJ, Kimmel L, Elliott B. Targeted postoperative care improves discharge outcome after hip or knee arthroplasty. Arch Phys Med Rehabil 2004;85:1424–7.
[Show abstract][Hide abstract] ABSTRACT: This study developed and validated an easily administered method of predicting a patient's risk of needing extended inpatient rehabilitation after hip or knee arthroplasty. Seven factors generated by experts and from the literature were shown to be statistically significantly related to discharge destination (P</=.001). Factor weightings derived from a logistic regression equation and tested on the first 520 cases were used to devise a scoring method. This method was validated using a further 130 cases and the Risk Assessment and Predictor Tool (RAPT) was formulated. The RAPT identified 3 levels of risk of needing extended inpatient rehabilitation after hip or knee arthroplasty, with an accuracy rate of 89% for those most at risk.
The Journal of Arthroplasty 09/2003; 18(6):775-9. DOI:10.1016/S0883-5403(03)00151-7 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patient outcomes at discharge from acute care after knee arthroplasty were investigated in a prospective observational outcome study at three Melbourne public acute care hospitals during a five-month period from November 1999 to March 2000. The participants were 105 consecutive patients (35 at each hospital), with a mean age of 71 years. Outcome measures were length of stay, destination (home or rehabilitation), knee range of movement, and functional mobility at discharge from the acute care facility. During the study period, mean hospital length of stay across the three hospitals was 6.5 days, more than 30% less than the Victorian average for the preceding year. In that time, 56% of patients had achieved functional independence sufficient for discharge directly home, however only 36% were actually discharged home. The reasons identified for discharge to rehabilitation despite the achievement of sufficient functional independence included pressure on clinicians to decrease length of stay and the need to make decisions regarding discharge early in the post-operative recovery when the eventual patient outcome may still be unclear. Unnecessary discharges to rehabilitation increase the overall length of stay in the health care system and costs per patient. This finding suggests a method of risk screening is required to assist clinical decision making with regard to discharge.
The Australian journal of physiotherapy 02/2002; 48(2):117-21. DOI:10.1016/S0004-9514(14)60205-1 · 3.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The impact of shorter hospital lengths of stay on patient outcomes at discharge from acute care after knee arthroplasty was investigated in a prospective observational outcome study at three Melbourne public hospitals during a 5-month period from October 1999 to March 2000. The participants were 105 consecutive patients (35 at each hospital), with a mean age of 71 years. Outcome measures were length of stay, destination (home or rehabilitation) and functional mobility at discharge from the acute care facility. During the study period mean hospital length of stay across the three hospitals was 6.5 days, more than 30% less than the Victorian average for the preceding year. This was associated with high rates of discharge to rehabilitation facilities (mean 64%), with rates varying between the three hospitals (97%, 57% and 40%). However, in each hospital, one-third of this group had already achieved a level of independent functional mobility adequate for discharge home, highlighting an apparent influence of non-clinical factors on discharge decisions, including pressure to decrease length of stay, hospital policy and availability of a rehabilitation bed. Ways of achieving discharge directly home for a greater number of patients following knee arthroplasty and of determining optimal length of stay are discussed.
Journal of Quality in Clinical Practice 10/2001; 21(3):56-60. DOI:10.1046/j.1440-1762.2001.00411.x