Perceptions of an Interactive Trauma Recovery Information Booklet.

BACKGROUND: Previous research has shown that people with traumatic injuries have unmet information needs with respect to their injuries, management, and recovery. An interactive trauma recovery information booklet was developed and implemented to address these information needs at a major trauma center in Victoria, Australia. OBJECTIVE: The aim of this quality improvement project was to explore patient and clinician perceptions of a recovery information booklet introduced into a trauma ward. METHODS: Semistructured interviews with trauma patients, family members, and health professionals were undertaken and thematically analyzed using a framework approach. In total, 34 patients, 10 family members, and 26 health professionals were interviewed. RESULTS: Overall, the booklet was well accepted by most participants and was perceived to contain useful information. The design, content, pictures, and readability were all positively appraised. Many participants used the booklet to record personalized information and to ask health professionals questions about their injuries and management. CONCLUSION: Our findings highlight the usefulness and acceptability of a low-cost interactive booklet intervention to facilitate the provision of quality of information and patient-health professional interactions on a trauma ward.

Radiological features of pulmonary fat embolism in trauma patients: a case series.

PURPOSE: Fat embolism syndrome (FES) is a rare complication in trauma patients (usually with long bone fractures) in which migrating medullary fat precipitates multiorgan dysfunction, classically presenting with dyspnoea, petechiae and neurocognitive dysfunction. Although this triad of symptoms is rare, it nonetheless aids diagnosis of pulmonary fat embolism (PuFE). Typical imaging features of PuFE are not established, although increasing use of CT pulmonary angiography (CTPA) in this cohort may provide important diagnostic information. We therefore conducted a case series of FES patients with CTPA imaging at a Level 1 Trauma Centre in Melbourne, Australia. METHODS: Medical records and various radiological investigations including CTPA of consecutive patients diagnosed clinically with FES between 2006 and 2018, including demographics, injury and their progress during their admission, were reviewed. RESULTS: Fifteen FES patients with retrievable CTPAs were included (mean age 31.2 years, range 17-69; 12 males [80%]). 93.3% had long bone fractures. CTPA was performed 2.00 ± 1.41 days post-admission. Review of these images showed pulmonary opacity in 14 (93.3%; ground-glass opacities in 9 [64.3%], alveolar opacities in 6 [42.9%]), interlobular septal thickening in 10 (66.7%), and pleural effusions in 7 (46.7%). Filling defects were identified in three (20%) CTPAs, with density measuring - 20HU to + 63HU. Ten patients (66.7%) had neuroimaging performed, with two patients demonstrating imaging findings consistent with cerebral fat emboli. CONCLUSION: CTPA features of PuFE are variable, with ground-glass parenchymal changes and septal thickening most commonly seen. Filling defects were uncommon.

Levels of Physical Activity and Sedentary Behavior During and After Hospitalization: A Systematic Review.

OBJECTIVES: To systematically review and synthesize the evidence on physical activity and sedentary behavior during and after hospitalization. DATA SOURCES: Electronic databases and reference lists of relevant articles were searched from 2000 to April 2020. STUDY SELECTION: Studies which continuously monitored physical activity and/or sedentary behavior in hospitalized adults across 2 settings (ie, without a break in measurement between settings). Monitoring could occur from an acute to a subacute or rehabilitation hospital setting, an acute setting to home, or from a subacute or rehabilitation setting to home. DATE EXTRACTION: Data extraction and methodological quality assessments were independently performed by 2 reviewers using standardized checklists. DATA SYNTHESIS: A total of 15 of the 5579 studies identified were included. The studies were composed of heterogenous patient populations. All studies monitored patients with either an accelerometer and/or pedometer and reported a variety of measures, including steps per day, sedentary time, and activity counts. The majority of studies (12 of 15) showed that patients engaged in 1.3 to 5.9 times more physical activity and up to 67% less daily sedentary behavior at home after discharge from acute or subacute settings. CONCLUSIONS: Patients engaged in more physical activity and less sedentary behavior at home compared to both the acute and subacute hospital settings. This may reflect the natural course of recovery or the effect of setting on activity levels. Enabling early discharge home through the implementation of home-hospitalization models may result in increased patient physical activity and reduced sedentary behavior. Further experimental studies are required investigating the effect of home-based models of care on physical activity and sedentary behavior.

Discharge destination and patient-reported outcomes after inpatient treatment for isolated lower limb fractures.

OBJECTIVES: To examine the association between discharge destination (home or inpatient rehabilitation) for adult patients treated in hospital for isolated lower limb fractures and patient-reported outcomes. DESIGN: Review of prospectively collected Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) data. SETTING, PARTICIPANTS: Adults (18-64 years old) treated for isolated lower limb fractures at four Melbourne trauma hospitals that contribute data to the VOTOR, 1 March 2007 - 31 March 2016. MAIN OUTCOME MEASURES: Return to work and functional recovery (assessed with the extended Glasgow Outcomes Scale, GOS-E); propensity score analysis of association between discharge destination and outcome. RESULTS: Of 7961 eligible patients, 1432 (18%) were discharged to inpatient rehabilitation, and 6775 (85%) were followed up 12 months after their injuries. After propensity score adjustment, the odds of better functional recovery were 56% lower for patients discharged to inpatient rehabilitation than for those discharged directly home (odds ratio, 0.44; 95% CI, 0.37-0.51); for the 5057 people working before their accident, the odds of return to work were reduced by 66% (odds ratio, 0.34; 95% CI, 0.26-0.46). Propensity score analysis improved matching of the discharge destination groups, but imbalances in funding source remained for both outcome analyses, and for also for site and cause of injury in the GOS-E analysis (standardised differences, 10-16%). CONCLUSIONS: Discharge to inpatient rehabilitation after treatment for isolated lower limb fractures was associated with poorer outcomes than discharge home. Factors that remained unbalanced after propensity score analysis could be assessed in controlled trials.

Advanced musculoskeletal physiotherapists are effective and safe in managing patients with acute low back pain presenting to emergency departments.

Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners). Methods A retrospective audit (October 2012-September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED. Results One thousand and eighty-nine patients with low back pain were seen during AMP service hours (360 in the AMP group, 729 in the non-AMP group). Patients seen by the AMP had a significantly shorter ED wait time (median 13 vs 32min; P<0.001) and ED length of stay (median 141 vs 175min; P<0.001). Significantly fewer patients seen by the AMP were admitted (P<0.001), and this difference remained after accounting for the difference in triage code between the groups. Conclusions Improved ED metrics were demonstrated in patients with low back pain when managed by an AMP compared with patients seen by doctors and nurse practitioners. What is known about the topic? There is a growing body of literature regarding the role of AMPs in the Australian healthcare system in providing clinical services for patients with musculoskeletal conditions, including settings such as the ED. AMPs have proven to be safe and cost-effective, achieving high patient satisfaction and improved patient outcomes. However, there is little to no information regarding their effect on ED metrics, such as ED length of stay, wait time and admission rates for patients presenting to the ED with low back pain. What does this paper add? This paper demonstrates improved ED metrics for patients presenting to the ED with low back pain when seen by an AMP compared with patients seen by doctors and nurse practitioners. The specific improved metrics for these patients were decreased admission rates, decreased ED length of stay and decreased wait time. What are the implications for clinicians? This paper provides evidence that the AMPs effectively discharge patients admitted to the ED in a timely manner, without evidence of increased readmissions, compared with their medical and nursing colleagues. Support for the role of the AMP within the ED setting is strengthened by these results.

Clinicians' perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma.

Objective The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. What is known about the topic? Little is known about the drivers for referral to, or acceptance at, in-patient rehabilitation following acute hospital care for traumatic injury in Victoria, Australia, including who makes these decisions of behalf of patients and how these decisions are made. What does this paper add? This paper provides information regarding the perceptions of acute hospital consultant surgeons and allied health, as well as rehabilitation clinicians, in terms of discharge destination decision making from the acute hospital following trauma. The use of case studies further highlights differences between, and within, these specialities with regard to this decision making. This research also highlights the importance of financial considerations as drivers of decision making, and the lack of consistency of the factors thought to be important drivers of discharge between these different clinical groupings. What are the implications for practitioners? This research shows that financial factors are significant drivers of discharge destination decision making for trauma patients. The present study highlights opportunities to engage with stakeholders (acute care, rehabilitation, administration, government and patients) to develop more consistent discharge processes that optimise the use of rehabilitation resources for those patients who could benefit from in-patient rehabilitation.

HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial.

OBJECTIVES: To investigate the effects of intensive acute hospital physiotherapy for patients with isolated hip fractures. DESIGN, SETTING: Single-institution, prospective, randomised trial at a level 1 trauma centre in Melbourne, March 2014 - January 2015. PARTICIPANTS: 92 patients aged 65 years or more with isolated hip fractures. Patients were excluded if the fracture was subtrochanteric or pathological, or if post-operative orders required the patient to be non-weight-bearing on the operated leg. INTERVENTIONS: Randomisation to usual care physiotherapy (daily; control group) or intensive physiotherapy (three times daily; intervention group). MAIN OUTCOME MEASURES: Outcomes were assessed at post-operative Day 5, at discharge, and at 6 months. The primary outcome was the modified Iowa Level of Assistance (mILOA) score, with other outcome measures including Timed Up and Go test performance and hospital length of stay (LOS). RESULTS: After controlling for sex, anaesthetic type and home setting, the between-group difference in Day 5 mILOA score favoured the intervention group (mean difference v control group, -2.7 points; P = 0.04). Hospital LOS was also shorter for the intervention group (median, 24.4 days v 35.0 days; P = 0.01). A Cox proportional hazard model that controlled for potential confounders indicated that the probability of discharge was greater for intervention group patients at all time points following surgery (P < 0.001). Re-admission and complication rates and 6-month outcomes for the two groups were not significantly different. CONCLUSIONS: Intensive acute hospital physiotherapy is safe and reduces hospital LOS after an isolated hip fracture. This has the potential to improve bed flow, given the large numbers of inpatient beds occupied by this patient population. TRIAL REGISTRATION: Clinical Trials Registry #NCT02088437.

Discharge from the acute hospital: trauma patients' perceptions of care.

Objective The involvement of orthopaedic trauma patients in the decision-making regarding discharge destination from the acute hospital and their perceptions of the care following discharge are poorly understood. The aim of the present study was to investigate orthopaedic trauma patient experiences of discharge from the acute hospital and transition back into the community. Methods The present qualitative study performed in-depth interviews, between October 2012 and November 2013, with patients aged 18-64 years with lower limb trauma. Thematic analysis was used to derive important themes. Results Ninety-four patients were interviewed, including 35 discharged to in-patient rehabilitation. Key themes that emerged include variable involvement in decision-making regarding discharge, lack of information and follow-up care on discharge and varying opinions regarding in-patient rehabilitation. Readiness for discharge from in-patient rehabilitation also differed widely among patients, with patients often reporting being ready for discharge before the planned discharge date and feeling frustration at the need to stay in in-patient care. There was also a difference in patients' perception of the factors leading to recovery, with patients discharged to rehabilitation more commonly reporting external factors, such as rehabilitation providers and physiotherapy. Conclusion The insights provided by the participants in the present study will help us improve our discharge practice, especially the need to address the concerns of inadequate information provision regarding discharge and the role of in-patient rehabilitation. What is known about the topic? There is no current literature describing trauma patient involvement in decision-making regarding discharge from the acute hospital and the perception of how this decision (and destination choice; e.g. home or in-patient rehabilitation) affects their outcome. What does this paper add? The present large qualitative study provides information on patients' opinion of discharge from the acute hospital following trauma and how this could be improved from their perception. Patients are especially concerned with the lack of information provided to them on discharge, their lack of involvement and understanding of the choices made with regard to their discharge and describe concerns regarding their follow-up care. There is also a feeling from the patients that they are ready to leave rehabilitation before their actual planned discharge date, a concept that needs further investigation. What are the implications for practitioners? The patient insights gained by the present study will lead to a change in discharge practice, including increased involvement of the patient in the decision-making in terms of discharge from both the acute and rehabilitation hospitals and a raised awareness of the need to provide written information and follow-up telephone calls to patients following discharge. Further research into many aspects of patient discharge from the acute hospital should be considered, including the use of rehabilitation prediction tools to ensure patient involvement in decision-making and a discharge and/or follow-up coordinator to ensure patients are aware of how to access information after discharge.

The influence of hospital and home environments on physical activity and sedentary behaviour: Perceptions of people recovering from fractures.

BACKGROUND: A lack of evidence exists contrasting the factors that influence physical activity and sedentary behaviour in both hospital and home settings before and after discharge from acute hospitalisation for fractures. OBJECTIVE: To describe and compare perceptions of environmental influences on physical activity in hospital and home settings in people recovering from fractures. METHOD: Semi-structured interviews were conducted with patients hospitalised following fractures (hip fracture or multi-trauma), exploring the barriers and enablers to physical activity within hospital and home settings. Interviews were conducted within two weeks of hospital discharge, audio recorded and transcribed prior to thematic analysis via a framework approach. RESULTS: Between December 2022 and May 2023, 12 semi-structured interviews were undertaken with an equal number of participants who sustained an isolated hip fracture or multi-trauma. The median (IQR) age of participants was 60 (52-68) years, with half being male, and the majority sustaining their injuries via transport crashes. Three main themes that influenced physical activity behaviours in hospital and home settings were: having the opportunity, having a reason, and having support and assistance to be active. CONCLUSION: During the period of reduced physical capability following fracture, patients need to be provided with opportunities and motivation to be active, particularly within the hospital setting. Findings from this study will assist clinicians to better support people recovering from fractures via greater engagement in physical activity within hospital and home settings.

Implementation of supplemental physiotherapy following hip fracture surgery: a protocol for the process evaluation of a randomised controlled trial.

BACKGROUND: Patient outcomes following low-trauma hip fracture are suboptimal resulting in increased healthcare costs and poor functional outcomes at 1 year. Providing early and intensive in-hospital physiotherapy could help improve patient outcomes and reduce costs following hip fracture surgery. The HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER) trial will compare usual care physiotherapy to intensive in-hospital physiotherapy for patients following hip fracture surgery. The complex environments in which the intervention is implemented present unique contextual challenges that may impact intervention effectiveness. This study aims to complete a process evaluation to identify barriers and facilitators to implementation and explore the patient, carer and clinician experience of intensive therapy following hip fracture surgery. METHODS AND ANALYSIS: The process evaluation is embedded within a two-arm randomised, controlled, assessor-blinded trial recruiting 620 participants from eight Australian hospitals who have had surgery for a hip fracture sustained via a low-trauma injury. A theory-based mixed method process evaluation will be completed in tandem with the HIPSTER trial. Patient and carer semi-structured interviews will be completed at 6 weeks following hip fracture surgery. The clinician experience will be explored through online surveys completed pre- and post-implementation of intensive therapy and mapped to domains of the Theoretical Domains Framework (TDF). Translation and behaviour change success will be assessed using the Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) framework and a combination of qualitative and quantitative data collection methods. These data will assist with the development of an Implementation Toolkit aiding future translation into practice. DISCUSSION: The embedded process evaluation will help understand the interplay between the implementation context and the intensive therapy intervention following surgery for low-trauma hip fracture. Understanding these mechanisms, if effective, will assist with transferability into other contexts and wider translation into practice. TRIAL REGISTRATION: ACTRN 12622001442796.

HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER): a protocol for a randomised controlled trial.

INTRODUCTION: Hip fractures result in substantial health impacts for patients and costs to health systems. Many patients require prolonged hospital stays and up to 60% do not regain their prefracture level of mobility within 1 year. Physical rehabilitation plays a key role in regaining physical function and independence; however, there are no recommendations regarding the optimal intensity. This study aims to compare the clinical efficacy and cost-effectiveness of early intensive in-hospital physiotherapy compared with usual care in patients who have had surgery following a hip fracture. METHODS AND ANALYSIS: This two-arm randomised, controlled, assessor-blinded trial will recruit 620 participants who have had surgery following a hip fracture from eight hospitals. Participants will be randomised 1:1 to receive usual care (physiotherapy according to usual practice at the site) or intensive physiotherapy in the hospital over the first 7 days following surgery (two additional sessions per day, one delivered by a physiotherapist and the other by an allied health assistant). The primary outcome is the total hospital length of stay, measured from the date of hospital admission to the date of hospital discharge, including both acute and subacute hospital days. Secondary outcomes are functional mobility, health-related quality of life, concerns about falling, discharge destination, proportion of patients remaining in hospital at 30 days, return to preadmission mobility and residence at 120 days and adverse events. Twelve months of follow-up will capture data on healthcare utilisation. A cost-effectiveness evaluation will be undertaken, and a process evaluation will document barriers and facilitators to implementation. ETHICS AND DISSEMINATION: The Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients and carers. TRIAL REGISTRATION NUMBER: ACTRN12622001442796.

Measurement of Mobility and Physical Function in Patients Hospitalized With Hip Fracture: A Systematic Review of Instruments and Their Measurement Properties.

OBJECTIVE: Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting. METHODS: Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. RESULTS: Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed "Up & Go" Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness over time (effect sizes 0.63-2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] >0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%-60% of patients). The TUG, CAS, and BI all had good clinical utility. CONCLUSION: Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting. IMPACT: This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes.

Validity of the activPAL and ActiGraph for measuring sitting time and steps in hospitalised orthopaedic patients with altered weight bearing.

PURPOSE: To determine the criterion validity of the activPAL and ActiGraph for measuring steps and sitting/sedentary time, compared to observation, in people hospitalised following orthopaedic lower limb injury who were weight bearing (WB) (i.e., walking) or non-weight bearing (NWB) (i.e., hopping). MATERIALS AND METHODS: Participants wore an activPAL and ActiGraph on the hip/thigh/unaffected (UA)/affected ankle (AA) while completing bouts of walking and sitting. Lin's concordance correlation coefficient, Bland-Altman methods, and ratio of agreement were used to compare device-measured to observed (videoed) step count, sitting/sedentary time. RESULTS: In 42 participants, the ActiGraph demonstrated excellent concordance with the observed step count when worn on the ankle (LCC 0.91-0.92) compared to the hip (LCC 0.56) in participants that were WB. The ActiGraph AA achieved the highest concordance (LCC 0.71) with observed steps in participants NWB. The activPAL had poor concordance with observed steps, particularly at slow gait speeds, in participants that were WB (LCC 0.38-0.46), however was less influenced by gait speed and had good concordance in NWB participants (LCC 0.52-0.69). The activPAL (LCC 0.79-0.88) and ActiGraph UA (LCC 0.94) showed excellent concordance with observed sitting and sedentary time, respectively. CONCLUSIONS: The ActiGraph worn at the ankle provided the most valid measure of steps in people who are WB and NWB following orthopaedic injury, while the activPAL was best for measuring sitting time.Implications for rehabilitationTo accurately measure both steps and sitting time in people with lower limb orthopaedic injuries, a combination of activity monitors should be used (i.e., ActiGraph for steps, activPAL for sitting time).The ActiGraph device when worn on the ankle demonstrated the strongest agreement with observed step count in people who were weight bearing and non-weight bearing.Caution is needed when using thigh- or hip-worn devices in people who walk slowly.

Outcomes after application of halothoracic orthosis for cervical spine trauma.

BACKGROUND: Cervical spine fractures can be managed operatively or nonoperatively, considering injury type and patient factors. Nonoperative management may include application of a halothoracic orthosis (HTO). The aim of our study was to describe our patients managed with HTO, review their 6-month and 12-month outcomes, and identify associated factors. METHODS: Patients fitted with an HTO at our institution in 2014 were included. Data collected included patient demographics, hospital-related data, and radiological union. Injury detail and 6-month and 12-month patient-reported outcomes (Glasgow Outcomes Scale Extended and return to work [RTW]) were accessed through Victorian Orthopedic Trauma Outcomes Registry. Factors related to these outcomes were included in a mixed-effect regression model for each outcome. RESULTS: Eighty-six patients (median age 46.5 years) of whom 52 (60%) were male individuals were included. Two-thirds (57 patients) were road trauma patients, and 58 patients (67%) experienced an isolated injury. Thirty-seven patients (43%) experienced a C2 fracture and 27 (31%) experienced a facet fracture. Twelve-month follow-up was completed for 78 patients (91%) with 27 (35%) reporting a good recovery, and 65% (31/48) patients returned to work. Factors associated with lower odds of RTW included compensation, a facet joint fracture, and experiencing comorbidities. No factors were significantly associated with functional outcome, although female individuals exhibited a slower recovery trajectory than male individuals. CONCLUSION: Many patients reported poor 12-month outcomes after HTO for traumatic injury. Factors associated with worse outcomes should be considered when deciding on management of patients with cervical spine fractures.

Rocktape provides no benefit over sham taping in people with knee osteoarthritis who are completing an exercise program: a randomised trial.

OBJECTIVES: To investigate if Rocktape combined with exercise is more effective than exercise and sham taping in patients with knee osteoarthritis. DESIGN: Single institution, prospective, participant and assessor blinded, randomised study. SETTING: Outpatient physiotherapy department of a tertiary hospital. PARTICIPANTS: Thirty-six patients with knee osteoarthritis. INTERVENTION: Participants were randomised to either; 1) Rocktape plus exercise or 2) sham taping plus exercise. MAIN OUTCOME MEASURES: A linear mixed-effect model was used to assess differences between groups over time for the primary outcome measure (VAS at rest and movement) as well as the secondary outcome measures. Secondary measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS), 30second sit to stand, 40m walk and stair climb tests. Exercise adherence and analgesia use were recorded via a diary. Outcomes were assessed at baseline, immediately prior to the first tape application and immediately following first taping (both at one week after baseline), then two and five weeks after first tape application. RESULTS: There were no between group differences over time in pain at rest [median Rocktape group 0.035 (IQR -0.1 to 3.0) vs median sham 0 (IQR 0 to 1.6) mean adj diff (0.053, 95% CI -0.17 to 0.27)] or with movement [median tape group 2.45 (IQR -0.5 to 4.8) vs median sham 2.0 (IQR 0.8 to 4.1) mean adj diff 0.072, 95% CI -0.20 to 0.35]. There were no significant differences between groups in any of the KOOS subscales or performance-based tests administered over time. Pain on movement significantly improved over time in both groups, whilst pain at rest only improved at the final time point. CONCLUSION: There was no additional benefit of Rocktape over sham tape in patients with knee osteoarthritis who were completing a home exercise program over five weeks. TRIAL REGISTRATION: Clinical Trials Registry (#NCT02049216).

Reliability, Validity, Clinical Utility, and Responsiveness of Measures for Assessing Mobility and Physical Function in Patients With Traumatic Injury in the Acute Care Hospital Setting: A Prospective Study.

OBJECTIVE: The longer-term impact of injury is increasingly recognized, but the early phases of recovery are less well understood. The best tools to measure early recovery of mobility and physical function following traumatic injury are unclear. The purpose of this study was to assess the clinical utility, validity, reliability, and responsiveness of 4 mobility and physical function measures in patients following traumatic injury. METHODS: In this cohort, measurement-focused study (n = 100), the modified Iowa Level of Assistance Score, Acute Care Index of Function, Activity Measure for Post-Acute Care "6 Clicks" short forms, and Functional Independence Measure were completed during first and last physical therapy sessions. Clinical utility and floor and ceiling effects were documented. Known-groups validity (early vs late in admission and by discharge destination), predictive validity (using 6-month postinjury outcomes data), and responsiveness were established. Interrater reliability was assessed in 30 patients with stable mobility and function. RESULTS: Participants had a median age of 52 years (interquartile range = 33-68 years), and 68% were male. The modified Iowa Level of Assistance Score, Acute Care Index of Function, and "6 Clicks" short forms were quick to administer (an extra median time of 30 seconds-1 minute), but the Functional Independence Measure took much longer (extra median time of 5 minutes). At the last physical therapy session, ceiling effects were present for all measures except the Functional Independence Measure (18%-33% of participants). All had strong known-groups validity (early vs late in admission and by discharge destination). All were responsive (effect sizes >1.0) and had excellent interrater reliability (intraclass correlation coefficients = 0.79-0.94). CONCLUSION: All 4 measures were reliable, valid, and responsive; however, their clinical utility varied, and ceiling effects were common at physical therapy discharge. IMPACT: This study is an important step toward evidence-based measurement in acute trauma physical therapy care. It provides critical information to guide assessment of mobility and physical function in acute trauma physical therapy, which may facilitate benchmarking across different hospitals and trauma centers and further progress the science and practice of physical therapy following traumatic injury.

Outcomes of severe lower limb injury with Mangled Extremity Severity Score ≥ 7.

AIMS: Complex fractures of the femur and tibia with associated severe soft tissue injury are often devastating for the individual. The aim of this study was to describe the two-year patient-reported outcomes of patients in a civilian population who sustained a complex fracture of the femur or tibia with a Mangled Extremity Severity Score (MESS) of ≥ 7, whereby the score ranges from 2 (lowest severity) to 11 (highest severity). METHODS: Patients aged ≥ 16 years with a fractured femur or tibia and a MESS of ≥ 7 were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (January 2007 to December 2018). Cases were grouped into surgical amputation or limb salvage. Descriptive analysis were used to examine return to work rates, three-level EuroQol five-dimension questionnaire (EQ-5D-3L), and Glasgow Outcome Scale-Extended (GOS-E) outcomes at 12 and 24 months post-injury. RESULTS: In all, 111 patients were included: 90 (81%) patients who underwent salvage and 21 (19%) patients with surgical amputation. The mean age of patients was 45.8 years (SD 15.8), 93 (84%) were male, 37 (33%) were involved in motor vehicle collisions, and the mean MESS score was 8.2 (SD 1.4). Two-year outcomes in the cohort were poor: six (7%) patients achieved a GOS-E good recovery, the mean EQ-5D-3L summary score was 0.52 (SD 0.27), and 17 (20%) patients had returned to work. CONCLUSION: A small proportion of patients with severe lower limb injury (MESS ≥ 7) achieved a good level of function 24 months post-injury. Further follow-up is needed to better understand the long-term trajectory of these patients, including delayed amputation, hospital readmissions, and healthcare utilization. Cite this article: Bone Joint J 2021;103-B(4):769-774.

Substituting inpatient rehabilitation beds for home-based multidisciplinary rehabilitation: A qualitative study of patient perceptions.

OBJECTIVE: To understand the patients' perspectives of the pilot Better at Home program in order to inform the development of bed substitution rehabilitation services. METHODS: Prospective qualitative study using semi-structured interviews undertaken 3-6 months following program participation was performed. Interviews were transcribed and themes developed by two independent researchers. RESULTS: Nineteen participants (14 females) were interviewed. Major themes found included high satisfaction with the service and a high regard for the importance of communication both within the team and with the patients. Patients had inconsistent views on the provision of services with some feeling that the program was not specific to their needs, whilst others felt it was focused and flexible. Involvement in decision-making for referral to the service was also not always fully understood. CONCLUSION: This study provides important information that can be utilised in the development of any bed substitution home-based model of care.

Patients from residential aged care with hip fractures-Does discharge destination from acute care affect outcomes?

OBJECTIVE: The aim of this study was to describe the demographics of patients from residential aged care facilities (RACFs) who underwent fixation of hip fracture and to compare 12-month functional and mortality outcomes for those returning to their RACF with those admitted to a subacute facility (SAF) following their acute hospital stay. METHODS: A retrospective review was undertaken of all patients from a RACF with high-level care needs admitted to Alfred Hospital, Melbourne, for fixation of hip fracture in 2014-2015. Data including demographic and hospital event details, length of stay (LOS), discharge destination and 12-month functional outcomes measured by the Glasgow Outcome Scale-Extended (GOS-E), were collected. Factors related to discharge destination and outcomes were analysed. RESULTS: Ninety patients from a RACF were included in this study, with 68 patients (76%) returning to their RACF and 22 (24%) admitted to a SAF after acute hospital stay. Those discharged to a SAF had an average LOS at this facility of 20.79 days (SD 8.02). The SAF group also had a longer acute LOS (7 days IQR 5-10, compared to 6 days IQR 4-7.5) but there was no difference between groups at 12 months in terms of mortality or function, with 50% of all patients deceased at this time point (n = 40) and the remaining 40 patients (50%) reporting a poor functional outcome. CONCLUSIONS: Mobility status during acute and subacute stay, and 12-month functional and mortality outcomes were similar in both groups irrespective of discharge destination, with the influence of cognition and concomitant medical issues currently unknown. Further research is required to evaluate the efficacy of current hip fracture models of care, the factors that influence clinician discharge planning decision-making and to interrogate new models of care that support rehabilitation and complex medical management in RACFs.