Tan SM1, Han YJ1, Ong SYTC1, Toh X1, Lim J1
1Changi General Hospital, Rehabilitative Services, Singapore, Singapore
Background: Geriatric rehabilitation is not a core physiotherapy undergraduate module in many places internationally. Hence, many graduates have to pick up such competencies on the job from scratch. Along with the growth of an aging world population, evidence in the area of geriatric rehabilitation has been emerging. This reflects that appropriate and effective care for older adults is paramount. Therefore, there is an urgent need to bridge this practice gap to ensure that our older adults receive the best management plans from us.
Purpose: To evaluate the feasibility of applying evidence-based geriatric rehabilitation principles in group therapy settings within an acute hospital outpatient physiotherapy department.
Methods: Plan-Do-Study-Act (PDSA) cycle provided the systematic methodology in implementing evidence-based geriatric rehabilitation recommendations in our acute hospital outpatient physiotherapy setting. A plan was developed to introduce rehabilitation principles to physiotherapists involved in geriatric outpatient services. The group of staff decided to adopt the following recommendations that could be realistically implemented. ( 1) Use of group therapy, (2)Gait speed and 5 chair stands as outcome measures to track effectiveness of group therapy, (3) Focus on lower limb strengthening exercises for patients who are frail. From June 2016 to November 2017, patients who required more than 15seconds to walk 10metres and had no musculoskeletal acute pains were offered to join a weekly group therapy class. Duration of the classes was about an hour.
Results: Fifty-six patients informed this evaluation. Physiotherapists' compliance to outcome measurements improved over time from 46% to 78% in the last 6 months of the evaluation cycle. About half of the incomplete data was due to patients defaulting for medical reasons or physiotherapists' oversight. Patients attended 1 to 21 group therapy sessions with the majority (n= 35, 62.5%) attending 4-6 sessions. 41% of these patients had improvements in gait speed ranging from 0.08-0.42m/s (mean 0.19m/s = 227% improvement). Additionally, 70% of these patients improved in their chair stands scores in the range of 2.1-36.33seconds (mean 10.4seconds = 30% improvement).Patients also reported improvements such as adopting “regular exercise” and felt “both legs stronger”.
Conclusion(s): Evidence-based geriatric rehabilitation principles can be implemented and sustained successfully within an outpatient setting of an acute hospital. In addition, grouping outpatients with geriatric syndromes according to their functional level resulted in improved physical measures of gait speed and 5 chair stands for majority of patients. Some patients also felt that they benefited from these group sessions because it helped them habitualise exercise or get stronger.
Implications: Group therapy is a feasible option for older adult patients in outpatient settings when they are grouped according to their functional levels. Involving stakeholders to form a common goal and design steps for implementation can facilitate successful and sustained use of best practice geriatric rehabilitation recommendations.
Keywords: Outcome measure, Evidence-based, Older adult
Funding acknowledgements: Not applicable
Purpose: To evaluate the feasibility of applying evidence-based geriatric rehabilitation principles in group therapy settings within an acute hospital outpatient physiotherapy department.
Methods: Plan-Do-Study-Act (PDSA) cycle provided the systematic methodology in implementing evidence-based geriatric rehabilitation recommendations in our acute hospital outpatient physiotherapy setting. A plan was developed to introduce rehabilitation principles to physiotherapists involved in geriatric outpatient services. The group of staff decided to adopt the following recommendations that could be realistically implemented. ( 1) Use of group therapy, (2)Gait speed and 5 chair stands as outcome measures to track effectiveness of group therapy, (3) Focus on lower limb strengthening exercises for patients who are frail. From June 2016 to November 2017, patients who required more than 15seconds to walk 10metres and had no musculoskeletal acute pains were offered to join a weekly group therapy class. Duration of the classes was about an hour.
Results: Fifty-six patients informed this evaluation. Physiotherapists' compliance to outcome measurements improved over time from 46% to 78% in the last 6 months of the evaluation cycle. About half of the incomplete data was due to patients defaulting for medical reasons or physiotherapists' oversight. Patients attended 1 to 21 group therapy sessions with the majority (n= 35, 62.5%) attending 4-6 sessions. 41% of these patients had improvements in gait speed ranging from 0.08-0.42m/s (mean 0.19m/s = 227% improvement). Additionally, 70% of these patients improved in their chair stands scores in the range of 2.1-36.33seconds (mean 10.4seconds = 30% improvement).Patients also reported improvements such as adopting “regular exercise” and felt “both legs stronger”.
Conclusion(s): Evidence-based geriatric rehabilitation principles can be implemented and sustained successfully within an outpatient setting of an acute hospital. In addition, grouping outpatients with geriatric syndromes according to their functional level resulted in improved physical measures of gait speed and 5 chair stands for majority of patients. Some patients also felt that they benefited from these group sessions because it helped them habitualise exercise or get stronger.
Implications: Group therapy is a feasible option for older adult patients in outpatient settings when they are grouped according to their functional levels. Involving stakeholders to form a common goal and design steps for implementation can facilitate successful and sustained use of best practice geriatric rehabilitation recommendations.
Keywords: Outcome measure, Evidence-based, Older adult
Funding acknowledgements: Not applicable
Topic: Older people; Outcome measurement; Older people
Ethics approval required: No
Institution: SingHealth
Ethics committee: Institution Review Board
Reason not required: Project is a Quality Imporvement project looking at therapist compliance with documenting outcome data. No patient/therapist identifyng data was involved. Therefore, ethics application was not required.
All authors, affiliations and abstracts have been published as submitted.
