Impact of a new post-operative care model in a rural hospital after total hip replacement and total knee replacement.

PROBLEM: The predicted global trend of increasing total hip replacement and total knee replacement numbers leads to a direct and growing impact on health care services. Models of care including 'fast-track' mobilisation after total hip replacement and total knee replacement have been reported to reduce length of stay. This has not been verified in rural settings. SETTING: Armidale Rural Referral Hospital. KEY MEASURES FOR IMPROVEMENT: The new post-operative care included early discharge planning with or without Day 0 mobilisation with aims to decrease hospital length of stay without affecting complication rates, compared to the conventional model of care. STRATEGIES FOR CHANGE: Consistent communication and planning for early discharge occurred before and throughout admission and Day 0 mobilisation. EFFECTS OF CHANGE: There was a statistically significantly less median length of stay following implementation of the new post-operative care model (3.24 vs 2.29 days [P < .01]). There was no statistically significant difference in complications or readmissions following the change. Those who were allocated to mobilise on Day 0 had a lesser median length of stay than those who did not (2.40 vs 2.27 days, P = .03). LESSONS LEARNT: Our results indicate that the new post-operative care model is safe and feasible for total knee replacement or total hip replacement patients in a rural setting and might reduce length of stay without compromising clinical outcomes.

An observational study of the impact of professional walking aid prescription on gait parameters for individuals with suspected balance impairments.

Background: The primary management strategy for gait impairment is the adoption of a walking aid. However, there are no established criteria upon which to base a decision regarding the need for a walking aid. It appears clinicians prescribe aids based on preference, clinical experience and intuition rather than standardised objective rationale. This may contribute to the inconsistent gait response to walking aids reported in the published literature. Understanding gait changes resulting from gait aid usage may have significant impact on clinical practice by improving confidence of prescribing clinicians and compliance of walking aid usage by patients, maximising the benefits of use, and reducing any risks associated with non-use or inappropriate use, of the walking aid. Research question: Do professionally prescribed walking aids improve gait parameters? Methods: This is a secondary data analysis of a cross-sectional study where participants, identified by healthcare staff requiring a mobility assessment due to potential balance impairment of any cause, walked a 20-m straight walking course under three different walking conditions (no aid, walking stick and 4-wheeled walker). Fifty-eight participants were recruited. Commonly reported spatial and temporal gait parameters were assessed using a validated gait analysis device. Changes in gait parameters across the three conditions were compared, noting the individual's professionally prescribed aid and interpreting changes in parameters towards outcomes of the 'no aid required group'. Results and significance: Gait cycle, cadence, stance, swing and stride length during unaided walking were significantly changed when a walking stick was prescribed (p < 0.05). Stance, swing, double support, stride length, speed, max toe clearance and minimum toe clearance were significantly changed when a 4-wheel walker was prescribed (p < 0.05). Professional walking aid prescription improves some gait parameters. A greater number and magnitude of gait parameter improvements were seen in people requiring a 4-wheel walker than people requiring a walking stick.

A Qualitative Exploration of Refugee Experiences of Access to a Dedicated Multi-Disciplinary Refugee Health Team in an Australian Context: Implication for Future Care.

AIMS: Refugees experience physical and mental health issues that need attention following settlement in a new community. However, access to and utilisation of healthcare services is challenging. We aimed to explore the experience of refugee access to a dedicated multi-disciplinary refugee health team. METHODS: An interpretative qualitative study. 17 qualitative interviews were conducted with Ezidi refugees who attended a newly established multi-disciplinary refugee health program in a regional town in NSW, Australia. Data were analysed using an inductive thematic approach. RESULTS: Participants (n = 17) identified as Ezidi and were from Iraq. Parents were between 23 and 57 years of age and had 1-12 children per family. Most had been in Australia between 2 and 5 years. Four key themes were identified: (1) Identifying the extent of health needs following a long wait to migrate; (2) Health support across the life span: the benefit of access to a multi-disciplinary team; (3) Gaps in cultural competence - impacted by understanding and interpreter access; and (4) Ongoing health and lifestyle concerns - influenced by understanding and education. CONCLUSIONS: We identified the benefit of access to allied health for prompt diagnosis, treatment and management of conditions including congenital and developmental conditions, mental health and chronic diseases. Access to a dedicated team ensured early intervention for a broad range of health and social issues including early referral to services, close coordination and help to complete supporting paperwork and applications. Ongoing investments are needed to maintain this comprehensive and coordinated approach to care that is underpinned by a family centric approach.

Ten-Second Tandem Stance Test: A Potential Tool to Assist Walking Aid Prescription and Falls Risk in Balance Impaired Individuals.

Objective: To assess the utility of a 10-second tandem stance test in predicting gait impairment and the need for a mobility aid. Design: Cross-sectional study. Setting: Public hospital ambulatory and hospitalized care. Participants: Participants were drawn from referrals to the physiotherapy service and patients identified by health care staff as needing mobility assessment. Eighty-seven people were referred to the study. Sixty-one individuals (N=61) consented to participate; mean age was 76±9.8 years and 61% were female. All participants were community dwelling. Intervention: The 10-second tandem stance test and gait parameters were measured while walking with no walking aid, a walking stick, and a 4-wheeled walker were assessed. Main Outcome Measures: Associations between the 10-second tandem stance test performance with prescribed walking aids (primary outcome variable), gait parameters (gait cycle time, cadence, stance phase, swing phase, double support, stride length, speed, peak angle velocity, maximal heel clearance), falls history, falls risk (Falls Risk for Older People in the Community [FROP-Com]), and walking aid use. Results: Inability to maintain tandem stance for 10 seconds significantly increased the odds of requiring a prescribed walking aid (odds ratio [OR], 5.19; P=.01). Tandem stance test time was positively correlated with stride length, gait speed, peak angle velocity, and maximal heel clearance during the gait cycle. Correlation between tandem stance time and number of falls was weak but significant (ρ=-0.31, P=.01), and FROP-Com score for falls risk was negative and moderate for nonpreferred foot behind (ρ=-0.58, P<.01). The 10-second tandem stance with nonpreferred foot behind was associated with falling in previous 12 months (P=.04). Walking aid use history in subgroups with the individuals who cannot maintain the tandem stance with nonpreferred foot behind for 10 seconds was associated with falling in previous 12 months (OR, 55.00; 95% CI, 2.44-1238.46; P=.01). Conclusions: The 10-second tandem stance test was associated with professionally prescribed walking aids, gait parameters with prescribed walking aids, falls, and walking aid use history, indicating the test may be useful to guide the prescription of walking aids.