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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). 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. 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. 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. To 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: It is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear. Methods: A systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness. Results: Fourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures. Conclusion: Evidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the psychometric properties of the Modified Iowa Level of Assistance scale in hospitalized older adults in subacute care. Design: A cohort, measurement-focused study. Participants and setting: Fifty-eight older adults, aged 65 years and older, were recruited from a subacute rehabilitation hospital. Methods: Inter-rater reliability was established by having two physiotherapists independently assess each participant within 24-h of each other. Construct validity was established using “known-groups” validity, while concurrent validity was also examined by correlating modified Iowa Level of Assistance scores with the Elderly Mobility Scale. Responsiveness was assessed by examining the difference in modified Iowa Level of Assistance scores from admission to discharge. Results: The mean age of participants was 82.8 years (SD 7.5; range 68-97). The modified Iowa Level of Assistance scale was found to be reliable, valid, and responsive in this sample of hospitalized older adults. It had excellent inter-rater reliability (intraclass correlation coefficient [2,1] 0.96; 95% confidence intervals (CI) 0.93, 0.98) and no systematic differences across the range of scores. The scale displayed a mean difference between two known groups of 11.4 points and correlated significantly and negatively with the Elderly Mobility Scale (Spearman’s rho − 0.90). The modified Iowa Level of Assistance score also changed significantly over the course of the hospital admission with an effect size of 1.2. Conclusions: The modified Iowa Level of Assistance scale is a valid measure with excellent inter-rater reliability in hospitalized older adults. It is responsive to functional change during hospital admission and may be useful for routine outcome assessment for hospitalized older adults in subacute care. Implications for Rehabilitation: The mILOA scale is a valid, reliable, and responsive outcome measure that can be used to quantify the gait and mobility impairments in hospitalized older adults in subacute care. For optimal reliability and responsiveness, consistent administration of the mILOA scale will be required particularly for higher level mobility tasks such as negotiating a step. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria.Methods: A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes.Results: There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12.Conclusion: Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity. [ABSTRACT FROM AUTHOR]

Background: Level 3 evidence-based guidelines recommend first walk after hip fracture surgery within 48 h. Early mobilization is resource and effort intensive and needs rigorous investigation to justify implementation. This study uses a prospective randomized method to investigate the effect of early ambulation (EA) after hip fracture surgery on patient and hospital outcomes. Methods: Sixty patients (41 women and 19 men; mean age 79.4 years) admitted between March 2004 through December 2004 to The Alfred Hospital, Melbourne, for surgical management of a hip fracture were studied. Randomization was either EA (first walk postoperative day 1 or 2) or delayed ambulation (DA) (first walk postoperative day 3 or 4). Functional levels on day 7 post-surgery, acute hospital length of stay and destination at discharge were compared. Results: At 1 week post-surgery, patients in the EA group walked further than those in the DA group ( P = 0.03) and required less assistance to transfer ( P = 0.009) and negotiate a step ( P = 0.23). Patients in the EA group were more likely to be discharged directly home from the acute care than those in the DA group (26.3 compared with 2.4%) and less likely to need high-level care (36.8 compared with 56%). A failed early ambulation subgroup had significantly more postoperative cardiovascular instability and worse results for all outcome measures. Conclusion: EA after hip fracture surgery accelerates functional recovery and is associated with more discharges directly home and less to high-level care. [ABSTRACT FROM AUTHOR]

Care pathways incorporating Hospital in the Home (HITH) programs are available for people following low-trauma (osteoporotic) hip fracture (LTHF) as a strategy to reduce total length of stay (LOS), but there is no published evidence supporting the development of key components of such programs for this specific population. As a precursor to program implementation, a multidisciplinary team devised criteria for HITH eligibility and considerations for readiness for HITH transfer. This study aimed to describe the rates and timing of suitability for HITH when these criteria and considerations were applied prospectively to adults admitted with LTHF who underwent surgical fixation. Prospective, 5-month audit of patients admitted to a single facility following LTHF. Criteria for HITH inclusion/exclusion and 3 time-based safety considerations for readiness for HITH transfer (time [post-operative day, POD] to first complication, time to medical stability, time to mobilization threshold) were applied to patient-level data routinely available in the medical record. Eligibility: Of 114 patients screened, 61 (54%) were initially eligible with 41 (36%) remaining eligible over the episode-of-care. Transfer considerations: 75% of those who experienced a complication did so by POD4; 75% achieved medical stability by POD5; 75% achieved the mobility criterion by POD7; and, 75% of patients met all criteria by POD7. Using data-informed criteria and considerations, we estimate that one-third of LTHF patients will be eligible for HITH with most ready for transfer within a week post-surgery. A HITH program using safety-focused criteria may help reduce LOS for patients with LTHF. [ABSTRACT FROM AUTHOR]