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Martin J1, Barker K2,3
1Oxford University Hospitals NHS Foundation Trust, Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom, 2Oxford University Hospitals NHS Foundation Trust, Physiotherapy Research Unit, Oxford, United Kingdom, 3University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
Background: Length of stay following hip and knee replacement is reducing with the widespread adoption of enhanced recovery protocols. Optimal patient flow in these protocols reduces waiting times and exposure to hospital risks and allows efficient use of resources. Predicting when patients will be ready for discharge will further optimise patient care. Current predictors are based on pre-operative factors such as age and BMI. There is less evidence for post-operative functional measures to predict length of stay.
The Hierarchical Assessment of Balance and Mobility (HABAM) is a graphic and rapid assessment of balance, transfers and mobility scored from 0-65, with higher scores representing higher function. The HABAM is noted as a useful measure in detecting deterioration and recovery of physical function, and has previously been used to identify patients at risk of delayed discharge in other populations such as pneumonia and fracture neck of femur.
Purpose: The aim of this project was to assess the use of the HABAM as a predictor of length of stay following hip and knee replacement.
Methods: Observational Study. A focus group of experienced orthopaedic physiotherapists were asked to consider typical patients undergoing total hip or knee replacement, and identify a HABAM score which signified an acceptable level of function for discharge. The HABAM was collected for three consecutive months, between October and December 2017. HABAM scores were collected for all patients undergoing primary total hip and total knee replacement (n=191) at each post-operative physiotherapy session. Patients followed the hospital's enhanced recovery programme and were judged safe for discharge home when they were independently mobile (with or without walking aid), could manage stairs if required, and were safe performing personal care.
Results: Mean (SD) HABAM score on the first post-operative day was 35.8 (14.6) which increased to 51.4 (3.8) at discharge. A HABAM score of less than 31 on the first post-operative day predicted longer than mean length of stay (4 days) with sensitivity and specificity of 79% and 83%. Using the HABAM, a consensus by physiotherapists for acceptable physical function at discharge was a mean score of 50.4 (0.7). ROC analyses showed that a HABAM score of 50 was the optimal cut-off point at which patients were discharged.
Conclusion(s): The HABAM offers a quick and practical way to quantify and objectively track patients' physical function following hip and knee replacement, and a score of less than 31 on the first post-operative day can help identify patients at risk of an increased length of stay. The HABAM also provides clinicians with a functional and objective 'discharge score' of 50, which corresponds to existing discharge criteria and can be used to quantify readiness for discharge.
Implications: The HABAM is a graphic and rapid measurement of mobility, taking on average 72 seconds to complete. It provides important information which can aid decision making on readiness for discharge. The predictive capability may also help the prioritisation of therapy caseloads, scheduling of admissions and reduce avoidable discharge delay.
Keywords: Arthroplasty, mobility limitation, rehabilitation
Funding acknowledgements: The authors received no financial support for the research, authorship, or publication of this project.
The Hierarchical Assessment of Balance and Mobility (HABAM) is a graphic and rapid assessment of balance, transfers and mobility scored from 0-65, with higher scores representing higher function. The HABAM is noted as a useful measure in detecting deterioration and recovery of physical function, and has previously been used to identify patients at risk of delayed discharge in other populations such as pneumonia and fracture neck of femur.
Purpose: The aim of this project was to assess the use of the HABAM as a predictor of length of stay following hip and knee replacement.
Methods: Observational Study. A focus group of experienced orthopaedic physiotherapists were asked to consider typical patients undergoing total hip or knee replacement, and identify a HABAM score which signified an acceptable level of function for discharge. The HABAM was collected for three consecutive months, between October and December 2017. HABAM scores were collected for all patients undergoing primary total hip and total knee replacement (n=191) at each post-operative physiotherapy session. Patients followed the hospital's enhanced recovery programme and were judged safe for discharge home when they were independently mobile (with or without walking aid), could manage stairs if required, and were safe performing personal care.
Results: Mean (SD) HABAM score on the first post-operative day was 35.8 (14.6) which increased to 51.4 (3.8) at discharge. A HABAM score of less than 31 on the first post-operative day predicted longer than mean length of stay (4 days) with sensitivity and specificity of 79% and 83%. Using the HABAM, a consensus by physiotherapists for acceptable physical function at discharge was a mean score of 50.4 (0.7). ROC analyses showed that a HABAM score of 50 was the optimal cut-off point at which patients were discharged.
Conclusion(s): The HABAM offers a quick and practical way to quantify and objectively track patients' physical function following hip and knee replacement, and a score of less than 31 on the first post-operative day can help identify patients at risk of an increased length of stay. The HABAM also provides clinicians with a functional and objective 'discharge score' of 50, which corresponds to existing discharge criteria and can be used to quantify readiness for discharge.
Implications: The HABAM is a graphic and rapid measurement of mobility, taking on average 72 seconds to complete. It provides important information which can aid decision making on readiness for discharge. The predictive capability may also help the prioritisation of therapy caseloads, scheduling of admissions and reduce avoidable discharge delay.
Keywords: Arthroplasty, mobility limitation, rehabilitation
Funding acknowledgements: The authors received no financial support for the research, authorship, or publication of this project.
Topic: Orthopaedics; Older people; Musculoskeletal: lower limb
Ethics approval required: No
Institution: Oxford University Hospitals FT Audit committee
Ethics committee: Trauma & Orthopaedics Directorate Audit committee
Reason not required: Reviewed by committee and deemed audit not research - approved as audit.
All authors, affiliations and abstracts have been published as submitted.
