Experience of a falls and injuries risk assessment clinic.

AIM: To describe the first 2 years of operation of a specialist Falls Clinic providing assessment of falls risk and individual preventive interventions in a public hospital setting. METHOD: Drawing from the available falls prevention evidence, a multidisciplinary Falls Clinic involving specialist medical assessment, physiotherapy assessment and treatment was established. RESULTS: Over 2 years, 386 patients were seen in the clinic with the majority referred by a GP. The most frequent intervention for patients was referral to a Falls Education Program run by allied health staff at the hospital. Patients attending balance and exercise classes through this program showed significant improvement in physiotherapy test scores, reducing their risk of falls. The detection and treatment of osteoporosis was another important outcome for older persons attending the clinic. CONCLUSIONS: The Falls Clinic provides access to evidence-based strategies for patients. Waiting lists for the clinic have increased dramatically since its inception. Ideally many of the interventions should be available in the primary care setting to increase access for those in the community at risk of falls.

Physiotherapy rehabilitation for individuals with lower limb amputation: a 15-year clinical series.

BACKGROUND AND PURPOSE: Individuals with amputations are a core group in Australian rehabilitation units that have a long index length of stay. The Repatriation General Hospital (RGH) offers general rehabilitation services to the population of Southern Adelaide (a population of 350,000) and includes an on-site prosthetic manufacturing facility. Using a physiotherapy database at the RGH, we sought to answer the following questions: What are the demographic and clinical characteristics of patients admitted for lower limb prosthetic rehabilitation over 15 years? What are the times to rehabilitation outcomes? How have these changed over 15 years with changes in service delivery? METHODS: This paper is a retrospective observational study using a physiotherapy clinical database (1996-2010) of 531 consecutive individuals with lower limb amputation at one South Australian hospital (RGH). There were two changes in service delivery: 1) a multidisciplinary interim prosthetic programme (IPP) introduced in 1998 and 2) removable rigid dressings (RRDs) introduced in 2000. Outcome measures were patient demographics, clinical characteristics and time to rehabilitation outcome markers. RESULTS: Mean age was 68 years (standard deviation [SD]: 15), with 69% male, 80% dysvascular and 68% transtibial. The overall median inpatient rehabilitation length of stay (RLOS) was 39 days (interquartile range [IQR]: 26-57). Individuals with amputation entering rehabilitation each year had a higher number of co-morbidities (ß: 0.08; 95% confidence interval: 0.05-0.11). Introduction of the IPP was associated with a significant reduction in time to initial prosthetic casting, independent walking and inpatient RLOS. Introduction of RRDs was associated with a significant reduction in time to wound healing, initial prosthetic casting and independent walking. CONCLUSIONS: Individuals with amputation were typically elderly dysvascular men with transtibial amputations. Introduction of the IPP and RRDs successfully reduced time to rehabilitation outcomes including independent walking, an outcome that is rarely reported but is of significance to patients and physiotherapists.