Abstract
BackgroundThe association between the functional decline occurring with bedrest and hospitalization in older persons is well-known. A long wait in the emergency department (ED), where patients can be bedridden, is a risk factor for the development of an immobilization syndrome (IS). IS is one of the unwanted consequences of inactivity, which causes pathological changes in most organs and systems. Early mobility interventions, such as physical therapy (PT) delivered in the ED, may prevent its development. To our knowledge, no prior studies have reported on this topic. The goal of this study was to (i) assess the feasibility and (ii) explore the potential clinical value of adding PT services to the ED, in collaboration with nursing staff, to prevent IS.MethodsFor 12 weeks, PT services were delivered in the ED to older persons (>65 years old) presenting with ≥1 clinical signs associated with the development of IS. Patients were screened by ED nurses and then seen by the physiotherapist. In order to assess feasibility, access to patients, percentage of patients who met eligibility criteria, acceptability of the intervention, and barriers/facilitators to the implementation were measured. To describe the clinical benefits of early PT services, we counted the number of new IS cases among patients after their admission to the ward.ResultsAfter 12 weeks, the ED nurses screened 187 potential patients and 20 received PT services in the ED (before their admission to the ward). Accessibility was not an issue and we observed good acceptability from the milieu. We did not find majors problems or insurmountable obstacles to implementation of the intervention. Clinical outcomes showed that nine patients received PT treatments in the ED and on the ward (after their admission). For the 11 other patients, no PT interventions were done in the ED following the assessment. Follow-up of these 11 patients showed that two of them developed IS during their hospital stay. As for the nine patients who began PT treatments in the ED, none of them developed IS.ConclusionBased on the results of this feasibility study, it would be likely and potentially beneficial to implement PT services in the ED, which could have a positive impact on preventing the development of IS in older persons presenting risk factors. While only a small proportion of patients (11 %) received PT services, better screening tools/methods should be developed.
Highlights
The association between the functional decline occurring with bedrest and hospitalization in older persons is well-known
Feasibility outcomes Access to participants Over the 12 weeks of implementation, a total of 2527 patients aged 65 and over accessed the emergency department (ED). All of these patients went through triage, but less than 10 % were transferred to the evaluation unit and met the inclusion criteria - the ED evaluation unit nurses identified a total of 187 potential patients
Implementation facilitators The physical therapy (PT) staff reported that they had easy access to potential patients in the ED, and found it relatively easy to follow-up after patients were transferred to the floor
Summary
The association between the functional decline occurring with bedrest and hospitalization in older persons is well-known. One study has shown that for an older person who already has mobility deficits or limitations, a 24 h bedrest is long enough to induce a sufficient degree of deconditioning that can prevent patients from being able to walk safely on their own [1, 6]. This prolonged and avoidable bedrest increases the risk of developing IS. In acute care settings, such as ED, it is feasible for the nursing staff to rapidly evaluate these activities of daily living, which have been associated with a functional decline in hospitalized elderly patients [9, 10]
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