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P287: Multidisciplinary transmural clinical pathway for patients with a hip fracture: safe and cost-effective
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Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234
rehabilitation program was considered if the Modified Heinemann Index (MHI) [100·(Barthel discharge − Barthel admission)/ (Barthel previous − Barthel admission)] was higher 35%. Results: In univariate analysis, high effectiveness of rehabilitation program was related to better functional status (Lawton, Barthel admission) and endocrinopathy as admission diagnoses; worse results were obtained in older patients, impaired cognitive situation, dementia, dysphagia, malnutrition and respiratory diagnoses at admission. In multivariate analysis, absence of respiratory diagnoses at admission, [OR = 1.89 (1.32– 2.71) (p < 0.001)]; Barthel admission >11 [OR = 2.63 (1.67–4.15) (p < 0.001)]; >25 [OR = 5.36 (3.48–8.23) (p < 0.01)] were associated to higher effectiveness of rehabilitation program. Conclusions: Absence of respiratory diagnoses and better functional capacity at admission were associated to better functional recovery in geriatric rehabilitation in-patients. P287 Multidisciplinary transmural clinical pathway for patients with a hip fracture: safe and cost-effective J.O. Daal, L.M.A. de Vries, J.P. Hering, J. Steens Westfriesgasthuis Hoorn, Hoorn, The Netherlands Introduction: The incidence of hip fractures is expected to increase during the next few years resulting in a high demand for structured clinical protocols in cooperation with transmural care. The aim of this study was to evaluate the effect of implementing a multidisciplinary transmural clinical pathway for patients with a hip fracture at Westfriesgasthuis in Hoorn. Methods: A prospective cohort of patients with a hip fracture treated between august 2009 and august 2010 according to the clinical pathway “Hip fracture rehabilitation program” were compared to patients treated between august 2008 and august 2009 according to standard care. Data were collected regarding length of in-hospital stay, time to surgery, medium/intensive care stay, discharge location, costs and mortality rates during 1 year postoperative. Results: In total, 375 patients were included: 184 patients were treated according to standard care and 191 patients according to the clinical pathway. The mean length of in-hospital stay decreased significantly after implementing the clinical pathway from 10.5 to 8.0 days (p < 0.05). The percentage of patients operated within 24 hours of intake was comparable (85.3% vs 86.4%; p = 0.76). Inhospital and one-year mortality showed a trend with decreasing rates (4.9% vs 2.1% and 17.9% vs 14.7%). This clinical pathway showed a cost reduction of 102,000 Euros per year. In conclusion, this multidisciplinary transmural clinical pathway resulted in standardized care, cost reduction and improved logistics resulting in a decreased length of in-hospital and mortality rates. P288 Effects of robot-assisted therapy on lower limb in geriatric patients with subacute stroke J.H. Kim1 , H.I. Park1 , C.H. Jang1 , Y.H. Lim2 1 Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, South Korea; 2 National health branch Haseomyeon, Buan, South Korea Introduction: To investigate the effect of robot-assisted therapy on motor and functional recovery of lower limb in subacute stroke geriatric patients. Method: Subacute stroke patients between 65 and 80 years were recruited. Eighteen subacute stroke patients were randomly divided into 2 groups. Robot-assisted therapy was performed using Lokomat® (Hocoma AG, Zurich, Switzerland) for thirty minutes per day and five times every week during four weeks while control group received conventional leg training with same duration and frequency as robotic group. Outcome measures were used MMT,
Motricity index (MI), FAC, BBS, Korean-Modified Barthel Index (K-MBI), Korean mini mental state examination (K-MMSE). All recruited patients underwent these evaluations before and after four weeks robot-assisted therapy. Results: Robot-assisted therapy on lower limb after subacute stroke showed improvement on motor strength, gait function, and activities of daily living. Change values in terms of K-MMSE (from the baseline to the follow-up after four weeks robot-assisted therapy) and Motricity index difference (between pre and post) exhibited a statsitically significant difference. But the majority of change values in terms of MMT, MI, BBS, K-MBI, FAC exhibited a no statistically significant difference compared with conventional group. Conclusion: In geriatric patients with lower limb deficits after subacute stroke, Robot-assisted leg training was considered to facilitate motor and functional recovery of lower limb. But robotassisted leg training did not significantly improve gait and function at 4 weeks compared with conventional leg training group. Further research is required about the comparison of conventional rehabilitation therapy group.
P289 Preventive intervention in disabled institutionalized elderly: comparison between two inspiratory muscle training M.A. Tortosa, M.A. Cebria` I Iranzo University of Valencia, Valencia, Spain Introduction: Those oldest old with comorbidity, physical disability and institutionalized, present a respiratory muscle (RM) strength decline. Since RM training has been shown to be an effective method to improve RM functioning, the Threshold Inspiratory Muscle Trainer (IMT) device could be an efficient method to introduce in nursing-homes preventive routines. The aim of this study was to compare the effects of two IMT programs in this frail elderly. We hypothesized the training protocol with higher frequency of sessions, the higher improvement in RM function. Methods: Forty-five institutionalized frail elderly physically disabled, were randomly allocated to one of the two training groups: 6-weeks group (6TG), and 8-weeks group (8TG). Both supervised training programs were performed by means of theThreshold IMT device and consisted of 7 cycles of 2-minute work and 1-minute rest. The 6TG trained 5 days/week and the 8TG trained 3 days/week. Maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax) were assessed in three time points: pre-training, intermediate and post-training. Results: Baseline characteristics of both groups did not show significant differences. The statistical analyses did not reveal significant improvements in PImax and PEmax between groups for any measured time points. However, both groups showed a
Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234
rehabilitation program was considered if the Modified Heinemann Index (MHI) [100·(Barthel discharge − Barthel admission)/ (Barthel previous − Barthel admission)] was higher 35%. Results: In univariate analysis, high effectiveness of rehabilitation program was related to better functional status (Lawton, Barthel admission) and endocrinopathy as admission diagnoses; worse results were obtained in older patients, impaired cognitive situation, dementia, dysphagia, malnutrition and respiratory diagnoses at admission. In multivariate analysis, absence of respiratory diagnoses at admission, [OR = 1.89 (1.32– 2.71) (p < 0.001)]; Barthel admission >11 [OR = 2.63 (1.67–4.15) (p < 0.001)]; >25 [OR = 5.36 (3.48–8.23) (p < 0.01)] were associated to higher effectiveness of rehabilitation program. Conclusions: Absence of respiratory diagnoses and better functional capacity at admission were associated to better functional recovery in geriatric rehabilitation in-patients. P287 Multidisciplinary transmural clinical pathway for patients with a hip fracture: safe and cost-effective J.O. Daal, L.M.A. de Vries, J.P. Hering, J. Steens Westfriesgasthuis Hoorn, Hoorn, The Netherlands Introduction: The incidence of hip fractures is expected to increase during the next few years resulting in a high demand for structured clinical protocols in cooperation with transmural care. The aim of this study was to evaluate the effect of implementing a multidisciplinary transmural clinical pathway for patients with a hip fracture at Westfriesgasthuis in Hoorn. Methods: A prospective cohort of patients with a hip fracture treated between august 2009 and august 2010 according to the clinical pathway “Hip fracture rehabilitation program” were compared to patients treated between august 2008 and august 2009 according to standard care. Data were collected regarding length of in-hospital stay, time to surgery, medium/intensive care stay, discharge location, costs and mortality rates during 1 year postoperative. Results: In total, 375 patients were included: 184 patients were treated according to standard care and 191 patients according to the clinical pathway. The mean length of in-hospital stay decreased significantly after implementing the clinical pathway from 10.5 to 8.0 days (p < 0.05). The percentage of patients operated within 24 hours of intake was comparable (85.3% vs 86.4%; p = 0.76). Inhospital and one-year mortality showed a trend with decreasing rates (4.9% vs 2.1% and 17.9% vs 14.7%). This clinical pathway showed a cost reduction of 102,000 Euros per year. In conclusion, this multidisciplinary transmural clinical pathway resulted in standardized care, cost reduction and improved logistics resulting in a decreased length of in-hospital and mortality rates. P288 Effects of robot-assisted therapy on lower limb in geriatric patients with subacute stroke J.H. Kim1 , H.I. Park1 , C.H. Jang1 , Y.H. Lim2 1 Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, South Korea; 2 National health branch Haseomyeon, Buan, South Korea Introduction: To investigate the effect of robot-assisted therapy on motor and functional recovery of lower limb in subacute stroke geriatric patients. Method: Subacute stroke patients between 65 and 80 years were recruited. Eighteen subacute stroke patients were randomly divided into 2 groups. Robot-assisted therapy was performed using Lokomat® (Hocoma AG, Zurich, Switzerland) for thirty minutes per day and five times every week during four weeks while control group received conventional leg training with same duration and frequency as robotic group. Outcome measures were used MMT,
Motricity index (MI), FAC, BBS, Korean-Modified Barthel Index (K-MBI), Korean mini mental state examination (K-MMSE). All recruited patients underwent these evaluations before and after four weeks robot-assisted therapy. Results: Robot-assisted therapy on lower limb after subacute stroke showed improvement on motor strength, gait function, and activities of daily living. Change values in terms of K-MMSE (from the baseline to the follow-up after four weeks robot-assisted therapy) and Motricity index difference (between pre and post) exhibited a statsitically significant difference. But the majority of change values in terms of MMT, MI, BBS, K-MBI, FAC exhibited a no statistically significant difference compared with conventional group. Conclusion: In geriatric patients with lower limb deficits after subacute stroke, Robot-assisted leg training was considered to facilitate motor and functional recovery of lower limb. But robotassisted leg training did not significantly improve gait and function at 4 weeks compared with conventional leg training group. Further research is required about the comparison of conventional rehabilitation therapy group.
P289 Preventive intervention in disabled institutionalized elderly: comparison between two inspiratory muscle training M.A. Tortosa, M.A. Cebria` I Iranzo University of Valencia, Valencia, Spain Introduction: Those oldest old with comorbidity, physical disability and institutionalized, present a respiratory muscle (RM) strength decline. Since RM training has been shown to be an effective method to improve RM functioning, the Threshold Inspiratory Muscle Trainer (IMT) device could be an efficient method to introduce in nursing-homes preventive routines. The aim of this study was to compare the effects of two IMT programs in this frail elderly. We hypothesized the training protocol with higher frequency of sessions, the higher improvement in RM function. Methods: Forty-five institutionalized frail elderly physically disabled, were randomly allocated to one of the two training groups: 6-weeks group (6TG), and 8-weeks group (8TG). Both supervised training programs were performed by means of theThreshold IMT device and consisted of 7 cycles of 2-minute work and 1-minute rest. The 6TG trained 5 days/week and the 8TG trained 3 days/week. Maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax) were assessed in three time points: pre-training, intermediate and post-training. Results: Baseline characteristics of both groups did not show significant differences. The statistical analyses did not reveal significant improvements in PImax and PEmax between groups for any measured time points. However, both groups showed a