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Prospectively testing the Stanmore Length of Stay tool to predict length of stay following primary total hip or knee arthroplasty
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The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS1–eS42
OA023 European – level analysis of invasive physiotherapy scope of practice and regulation S. Souto-Camba 1,2,∗ , A. Gómez-Conesa 3 , L. González- Doniz 1,2 , R. Fernández-Cervantes 1,2 , A. Souto-Gestal 1,2 1 University
of A Coru˜na, Physiotherapy, A Coru˜na, Spain 2 Psycosocial Intervention and Functional Rehabilitation Research Group, Physiotherapy, A Coru˜na, Spain 3 University of Murcia, Physiotherapy, Murcia, Spain Relevance: Invasive Physiotherapy (IP) includes techniques that entail the use of a needle to the application of physical agents. There are different methods and techniques under this scope, such as the dry needling and EPI® (electrolysis percutaneous intratisular) or more traditional ones as Acupuncture. More and more physiotherapist (PTs) all around the world are using IP in the treatment of musculoskeletal disorders but the regulation for their practice and the specific nature of the techniques included under the scope of IP in each country remains unknown. Purpose: To map the use of IP in the member organizations (MOs) of the European Region of the World Confederation for Physical Therapy (ER-WCPT). Approach/evaluation: A descriptive study was conducted. In May 2014, all MOs engaged in the ER-WCPT General Meeting (GM) were invited to complete an “ad hoc” questionnaire. Data were analyzed using descriptive statistics package. Outcomes: 36 MOs attended the GM. 33 answered the questionnaire (response rate 91.66%). Two questionnaires were withdrawn due to inconsistency in the answers. The use of IP by PTs was reported in 54.8% of MOs. The existence of regulation in the country for the use of invasive techniques was reported by the same percentage. National competent authorities for health were the entities responsible for IP regulation most frequently (14 countries (82.4%)), followed by the MO (2 countries (11.8%)) and the competent authority for PT (1 country (5.9%)). The most frequent invasive techniques used were dry needling (48%) and acupuncture (38.7%), following by aspiration (32.3%) and injection (16.1%). Three responders reported using EPI® . Other techniques reported by the countries where urogenital exploration and Dry Needling for Hypertonia and Spasticity. Discussion and conclusions: More than half of the ER-WCPT MOs (54.8%) informed that the PTs are using IP in their countries. Although this ratio is consistent with the percentage of countries with regulation for the use of IP
techniques that does not imply that the use of this practices by PTs is regulated. In some countries, the regulation does not allow the IP practice, limiting their use to other health professionals. In others, despite of the fact PTs are using IP, there are not specific regulations for that. Dry needling and acupuncture are the most frequent techniques used by PTs in Europe. However, they are not as extended as it could be presumed (only in PEDro database we can find >3000 records for the keyword acupuncture). A small number of countries have reported the use of EPI® or probes for incontinence. This fact, adding to the lack of regulation, could suggest the need of clarification about what kind of techniques are under the scope of IP. This is a first intent to map the situation of IP in Europe. Future work needs to consider analyze the role of MOs as regulator, the relationship with other health professions, and research if additional educational requirements or accreditation are needed for their use. Impact and implications: The fact that IP techniques are a common practice for EU PTs, involves the development of European Standards to limit the framework and to define the educational requirements. Funding acknowledgement: Authors would like to acknowledge the ER-WCPT Executive Committee for their advice and permission to conduct the survey during the General Meeting. Also, to the MOs delegates who participate. The study was unfunded. http://dx.doi.org/10.1016/j.physio.2016.10.026 OA024 Prospectively testing the Stanmore Length of Stay tool to predict length of stay following primary total hip or knee arthroplasty A. Gilbert 1,∗ , A. Coltman 2 , A. Power 3 , R. Moss 1 , J. Miles 4 , R. Carrington 4 , A. Jaggi 1 1 Royal
National Orthopaedic Hospital, Therapies Department, Stanmore, United Kingdom 2 Royal National Orthopaedic Hospital, Information Department, Stanmore, United Kingdom 3 Royal National Orthopaedic Hospital, Arthroplasty Practitioner Department, Stanmore, United Kingdom 4 Royal National Orthopaedic Hospital, Joint Reconstruction Unit, Stanmore, United Kingdom Relevance: Strategies to improve efficiency in the NHS are high on the current political agenda. The increasing complexity of patients undergoing primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) at a tertiary referral centre is thought to have led to an increased Length of
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS1–eS42
Stay (LOS). Previous research has looked at complicated predictive models for TKA LOS and we therefore developed a simple model, using preoperative Oxford scores and the patients age, to predict LOS in both a TKA and THA cohort – the Stanmore Length of Stay (S-LOS) tool. To our knowledge there are no prospective studies measuring the effectiveness of such a model. Purpose: The purpose of this study was to prospectively assess the accuracy of the S-LOS tool in predicting LOS stay following a TKA or THA. Methods/analysis: Demographic data (age and preoperative Oxford Scores) were collected for patients undergoing a TKA or THA at a tertiary referral centre between the 4th April 2015 and 12th February 2016. Demographic and LOS data was obtained on 380 patients (239 TKA, 141 THA). Data was used to predict the S-LOS predicted LOS and compared to the current prediction model (TKA = 5 days, THA = 4 days) for accuracy. All data was analysed using SPSS v23. All data met parametric assumptions. The independent t-test was used to assess the differences between S-LOS to actual LOS, and current predicted LOS to actual LOS. Results: S-LOS score had a lower difference from actual LOS (total difference = 188 days, mean difference per patient = 0.49 days, SD = 4.02) than the current prediction model (total difference = 516 days, mean difference per patient = 1.36 days, SD = 3.61). The mean difference (0.87 days) between the two groups was statistically significant (t = 3.195 (779.094); p = 0.001). The standardised effect size (d) was 0.23 (small effect). The 95% confidence interval showed that the population mean difference is likely to fall between 0.34 days and 1.41 days. From a cost perspective, based on a rate of £243 per day, this equates to a mean value £80,336 [95% CI £31,396–£130,199]. Discussion and conclusions: The S-LOS tool was statistically more accurate in predicting actual LOS compared to the current LOS model used at a tertiary referral centre. Further prospective studies are required to assess whether more accurate LOS predictions using the S-LOS tool facilitate earlier discharge from hospital. Impact and implications: Increased hospital stay and surgical cancellations due to lack of bed spaces cost time and money for the NHS. Each extended hospital stay costs the NHS in excess of £240 per day. Accurate prediction of LOS may facilitate LOS planning, promote timely discharge, and improve patient experience and the cost effectiveness of services. Furthermore, tool such as this could be utilised to identify these at risk patients and to guide the utilisation of other services, such as prehabilitation, to optimise post-operative length of stay. The S-LOS tool has been prospectively tested, and is accurate at predicting LOS for patients undergoing TKA or THA. Funding acknowledgement: No funding was sought for this work. http://dx.doi.org/10.1016/j.physio.2016.10.027
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OA025 Physiotherapy for children with type 1 diabetes mellitus (T1DM) in Malta: effects of exercise and perceptions towards exercise D. Carabott Pawley ∗ , A. Damato, J. Torpiano, J. Xerri de Caro University of Malta, Msida, Malta Relevance: This study explored the input of physiotherapy within the management of children suffering from T1DM in Malta offering an opportunity to consider how physiotherapy can impact on, and enhance, the population’s health and well-being. Purpose: The purpose of this study was to investigate changes in blood glucose levels in children with T1DM throughout a programme that consisted of structured exercises; seeking to understand the perceptions of these children and their parents towards exercise in the management of T1DM. Methods/analysis: Data was collected in two phases. First, information leading to the perceptions and health beliefs linked to juvenile T1DM was sought via a questionnaire from the current population (n = 73) and included children and their parents. Second, a quasi-experimental design was adopted to observe 7 children (aged 6 to 10) engaging in regular exercise, at moderate intensity levels, for 30 minutes daily over a period of 6 weeks. 3 other children were followed up as a control group. Blood glucose readings were recorded 4 × daily, over a period of 12 weeks including 6 weeks prior to the exercise intervention. Results: 49% (n = 36) responded to the survey. 89% (n = 31) of children reported that they did exercise, however below the dose recommended by the WHO. 83% (n = 30) of parents reported to understand that exercise was effective in controlling the blood glucose levels in their children but did not consider exercise as being one of the main strategies for control. A reported concern was the fear of hypoglycaemia and/or injuries during exercise. Children between 5 and 8 years generally participated in individually supervised exercise whilst older children participated in team events. Children appeared to be more aware of the psychological benefits resulting from exercise than their parents and were less concerned about the possible negative effects. The parents appeared not to understand the role of physiotherapy in the management of T1DM. The blood glucose levels stabilised at 7.05 ± 0.25 mmol/l for the exercise group compared to the control group (8.63 ± 1.03 mmol/l) after lunch (p < 0.011) and before dinner (p < 0.006). This was the time when the children performed the exercise. HbA1C levels were stable in the experimental group but increased by 0.6% in the control group.
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS1–eS42
OA023 European – level analysis of invasive physiotherapy scope of practice and regulation S. Souto-Camba 1,2,∗ , A. Gómez-Conesa 3 , L. González- Doniz 1,2 , R. Fernández-Cervantes 1,2 , A. Souto-Gestal 1,2 1 University
of A Coru˜na, Physiotherapy, A Coru˜na, Spain 2 Psycosocial Intervention and Functional Rehabilitation Research Group, Physiotherapy, A Coru˜na, Spain 3 University of Murcia, Physiotherapy, Murcia, Spain Relevance: Invasive Physiotherapy (IP) includes techniques that entail the use of a needle to the application of physical agents. There are different methods and techniques under this scope, such as the dry needling and EPI® (electrolysis percutaneous intratisular) or more traditional ones as Acupuncture. More and more physiotherapist (PTs) all around the world are using IP in the treatment of musculoskeletal disorders but the regulation for their practice and the specific nature of the techniques included under the scope of IP in each country remains unknown. Purpose: To map the use of IP in the member organizations (MOs) of the European Region of the World Confederation for Physical Therapy (ER-WCPT). Approach/evaluation: A descriptive study was conducted. In May 2014, all MOs engaged in the ER-WCPT General Meeting (GM) were invited to complete an “ad hoc” questionnaire. Data were analyzed using descriptive statistics package. Outcomes: 36 MOs attended the GM. 33 answered the questionnaire (response rate 91.66%). Two questionnaires were withdrawn due to inconsistency in the answers. The use of IP by PTs was reported in 54.8% of MOs. The existence of regulation in the country for the use of invasive techniques was reported by the same percentage. National competent authorities for health were the entities responsible for IP regulation most frequently (14 countries (82.4%)), followed by the MO (2 countries (11.8%)) and the competent authority for PT (1 country (5.9%)). The most frequent invasive techniques used were dry needling (48%) and acupuncture (38.7%), following by aspiration (32.3%) and injection (16.1%). Three responders reported using EPI® . Other techniques reported by the countries where urogenital exploration and Dry Needling for Hypertonia and Spasticity. Discussion and conclusions: More than half of the ER-WCPT MOs (54.8%) informed that the PTs are using IP in their countries. Although this ratio is consistent with the percentage of countries with regulation for the use of IP
techniques that does not imply that the use of this practices by PTs is regulated. In some countries, the regulation does not allow the IP practice, limiting their use to other health professionals. In others, despite of the fact PTs are using IP, there are not specific regulations for that. Dry needling and acupuncture are the most frequent techniques used by PTs in Europe. However, they are not as extended as it could be presumed (only in PEDro database we can find >3000 records for the keyword acupuncture). A small number of countries have reported the use of EPI® or probes for incontinence. This fact, adding to the lack of regulation, could suggest the need of clarification about what kind of techniques are under the scope of IP. This is a first intent to map the situation of IP in Europe. Future work needs to consider analyze the role of MOs as regulator, the relationship with other health professions, and research if additional educational requirements or accreditation are needed for their use. Impact and implications: The fact that IP techniques are a common practice for EU PTs, involves the development of European Standards to limit the framework and to define the educational requirements. Funding acknowledgement: Authors would like to acknowledge the ER-WCPT Executive Committee for their advice and permission to conduct the survey during the General Meeting. Also, to the MOs delegates who participate. The study was unfunded. http://dx.doi.org/10.1016/j.physio.2016.10.026 OA024 Prospectively testing the Stanmore Length of Stay tool to predict length of stay following primary total hip or knee arthroplasty A. Gilbert 1,∗ , A. Coltman 2 , A. Power 3 , R. Moss 1 , J. Miles 4 , R. Carrington 4 , A. Jaggi 1 1 Royal
National Orthopaedic Hospital, Therapies Department, Stanmore, United Kingdom 2 Royal National Orthopaedic Hospital, Information Department, Stanmore, United Kingdom 3 Royal National Orthopaedic Hospital, Arthroplasty Practitioner Department, Stanmore, United Kingdom 4 Royal National Orthopaedic Hospital, Joint Reconstruction Unit, Stanmore, United Kingdom Relevance: Strategies to improve efficiency in the NHS are high on the current political agenda. The increasing complexity of patients undergoing primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) at a tertiary referral centre is thought to have led to an increased Length of
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS1–eS42
Stay (LOS). Previous research has looked at complicated predictive models for TKA LOS and we therefore developed a simple model, using preoperative Oxford scores and the patients age, to predict LOS in both a TKA and THA cohort – the Stanmore Length of Stay (S-LOS) tool. To our knowledge there are no prospective studies measuring the effectiveness of such a model. Purpose: The purpose of this study was to prospectively assess the accuracy of the S-LOS tool in predicting LOS stay following a TKA or THA. Methods/analysis: Demographic data (age and preoperative Oxford Scores) were collected for patients undergoing a TKA or THA at a tertiary referral centre between the 4th April 2015 and 12th February 2016. Demographic and LOS data was obtained on 380 patients (239 TKA, 141 THA). Data was used to predict the S-LOS predicted LOS and compared to the current prediction model (TKA = 5 days, THA = 4 days) for accuracy. All data was analysed using SPSS v23. All data met parametric assumptions. The independent t-test was used to assess the differences between S-LOS to actual LOS, and current predicted LOS to actual LOS. Results: S-LOS score had a lower difference from actual LOS (total difference = 188 days, mean difference per patient = 0.49 days, SD = 4.02) than the current prediction model (total difference = 516 days, mean difference per patient = 1.36 days, SD = 3.61). The mean difference (0.87 days) between the two groups was statistically significant (t = 3.195 (779.094); p = 0.001). The standardised effect size (d) was 0.23 (small effect). The 95% confidence interval showed that the population mean difference is likely to fall between 0.34 days and 1.41 days. From a cost perspective, based on a rate of £243 per day, this equates to a mean value £80,336 [95% CI £31,396–£130,199]. Discussion and conclusions: The S-LOS tool was statistically more accurate in predicting actual LOS compared to the current LOS model used at a tertiary referral centre. Further prospective studies are required to assess whether more accurate LOS predictions using the S-LOS tool facilitate earlier discharge from hospital. Impact and implications: Increased hospital stay and surgical cancellations due to lack of bed spaces cost time and money for the NHS. Each extended hospital stay costs the NHS in excess of £240 per day. Accurate prediction of LOS may facilitate LOS planning, promote timely discharge, and improve patient experience and the cost effectiveness of services. Furthermore, tool such as this could be utilised to identify these at risk patients and to guide the utilisation of other services, such as prehabilitation, to optimise post-operative length of stay. The S-LOS tool has been prospectively tested, and is accurate at predicting LOS for patients undergoing TKA or THA. Funding acknowledgement: No funding was sought for this work. http://dx.doi.org/10.1016/j.physio.2016.10.027
eS19
OA025 Physiotherapy for children with type 1 diabetes mellitus (T1DM) in Malta: effects of exercise and perceptions towards exercise D. Carabott Pawley ∗ , A. Damato, J. Torpiano, J. Xerri de Caro University of Malta, Msida, Malta Relevance: This study explored the input of physiotherapy within the management of children suffering from T1DM in Malta offering an opportunity to consider how physiotherapy can impact on, and enhance, the population’s health and well-being. Purpose: The purpose of this study was to investigate changes in blood glucose levels in children with T1DM throughout a programme that consisted of structured exercises; seeking to understand the perceptions of these children and their parents towards exercise in the management of T1DM. Methods/analysis: Data was collected in two phases. First, information leading to the perceptions and health beliefs linked to juvenile T1DM was sought via a questionnaire from the current population (n = 73) and included children and their parents. Second, a quasi-experimental design was adopted to observe 7 children (aged 6 to 10) engaging in regular exercise, at moderate intensity levels, for 30 minutes daily over a period of 6 weeks. 3 other children were followed up as a control group. Blood glucose readings were recorded 4 × daily, over a period of 12 weeks including 6 weeks prior to the exercise intervention. Results: 49% (n = 36) responded to the survey. 89% (n = 31) of children reported that they did exercise, however below the dose recommended by the WHO. 83% (n = 30) of parents reported to understand that exercise was effective in controlling the blood glucose levels in their children but did not consider exercise as being one of the main strategies for control. A reported concern was the fear of hypoglycaemia and/or injuries during exercise. Children between 5 and 8 years generally participated in individually supervised exercise whilst older children participated in team events. Children appeared to be more aware of the psychological benefits resulting from exercise than their parents and were less concerned about the possible negative effects. The parents appeared not to understand the role of physiotherapy in the management of T1DM. The blood glucose levels stabilised at 7.05 ± 0.25 mmol/l for the exercise group compared to the control group (8.63 ± 1.03 mmol/l) after lunch (p < 0.011) and before dinner (p < 0.006). This was the time when the children performed the exercise. HbA1C levels were stable in the experimental group but increased by 0.6% in the control group.