Wash and Dress:
Are we providing a full
Monty Service ?
Jeong Su Lee
Senior Occupational Therapist
Guys and St Thomas’ NHS Foundation
Trust
Facts around Hip Fracture
Major cause of mortality, morbidity and loss of home
for older people
•Number of hip fracture incidents are around 70,000 per
year and is rising 2 % every year
•10% of people with hip fractures die due to direct and
non direct impact of hip fracture
•74% of people admitted hospital for hip fractures are
from their own home or sheltered accommodation. On
discharge only 45% return to their own home
•Half of those patients never regain their previous level of
function
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Cost implication
•Estimate cost in NHS UK for hip fracture care :1.4
Billion pounds per year
•It doubles when considering social care costs
Facts around rehabilitation
•NICE guidelines for management of hip fractures 2011 'Rapid restoration of physical and self care are critical to
recover for hip fracture. ' : ADL is a part of essential
rehabilitation programme
•However we at GSTT felt that inpatient rehabilitation
post hip fractures focuses primarily on functional
transfers and mobility, whereas specific goals of
independence in washing and dressing are left to the
post discharge rehabilitation team
•Community rehabilitation services provides wash and
dress training for patients, however, these services are
costly
Aim of service evaluation
We wanted to determine whether increased inpatient
occupational therapy assessment and rehabilitation for
washing and dressing could reduce the requirement for
community rehabilitation of inpatients following hip
fractures post discharge.
Method
•Collection of retrospective (pre-group) and prospective
(post-group) data of 27 patients in each group
•Data was processed in a proforma designed by the
service evaluation leads
•Specific inclusion and exclusion criteria outlined
Participant characteristics for pre and post
groups
•In both groups greater than 70% of participants
were female and greater than 80% resided in
London
•The average age of the pre and post intervention
groups was also similar (79.5 versus 77.2)
•In the post intervention group a somewhat lower
proportion of participants had dynamic hip screw
operation (26%), in comparison to the pre
intervention group (48%)
Results 1
There was a noticeable change in inpatient OT
practice between the pre and post intervention
groups, with significant increases in the proportion
of patients receiving both wash and dress
assessments (p<0.001) and wash and dress
rehabilitation (p=0.001)
For the post intervention group the OT service was modified to allow additional
resources to focus more on wash and dress assessment and rehabilitation
Level of OT input for Wash and Dress:
Retrospective data
Level of OT input for W+D : Prospective
data
Results 2
The change in OT practice had a significant
impact on the level of support needed at discharge
(p=0.001). In the pre intervention group the
proportion of patients independent at discharge was
0.15 compared to 0.59 in the post intervention group
(difference in proportion independent = 0.44; 95%
confidence interval 0.22 to 0.67; p= 0.002)
Discharge Result : Retrospective Data
Discharge Result :
Prospective Data
Results 3
The change in OT practice had no observable
impact on length of stay, which was a median of 13
days in the pre intervention group and median of 11
days in the post intervention group (p=0.15 for
difference in length of stay)
Summary of findings
Increased inpatient OT wash and dress
assessment and rehabilitation significantly impacts
on ADL independence, and can reduce the
dependency on community services
The Finding indicates that there are needs for
audit or a formal research to obtain the concrete
evidence of this practice
Reference
•British Orthopaedic Association Blue Book (2007). The care of patients with
fragility fracture. London. Available:
http://www.nhfd.co.uk/003/hipfracturer.nsf/luMenuDefinitions/FCEF9FCB98A1B
8EB802579C900553996/$file/Blue_Book.pdf?OpenElement
•National Institute for Health and Clinical Excellence (NICE). (2011). The
management of hip fracture in adults. Clinical guideline; no. 124. London (UK):
NICE.
•The National Hip Fracture Database Report 2012. Available:
http://www.nhfd.co.uk/003/hipfractureR.nsf/resourceDisplay?openform
•Yardly, L and Todd. C (2005) Preventing Fall – Don’t mention F-Word. London.
Help the Aged
•Age UK. Later Life in the United Kingdom (2012) Available:
http://www.ageuk.org.uk/Documents/ENGB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true
Acknowledgement
Special thanks to
Elise van der Veen (Senior Occupational
Therapist) and
Jade Cope ( Highly specialist occupational
therapist trauma and elective orthopaedics )