Physiotherapy Services Research Articles

Evaluation of the quality of physiotherapy service in university of Gondar comprehensive specialized hospital, northwest Ethiopia: A mixed method evaluation.

Currently, the number of people with physical disability and impairment is increasing significantly in Ethiopia, especially in the northern part. In that regard, the Ethiopian government has been providing physical rehabilitation services to recover patients. However, due to the widespread problem of healthcare service and the increase in patients seeking physiotherapy service, the quality of the service might be compromised, and the evidence is limited. Thus, this study aimed to evaluate the quality of physiotherapy services at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. A single case study with concurrent mixed method research design was conducted from June 02- August 10, 2022. The evaluation used patient-centeredness, timeliness, compliance and availability dimensions with 27 indicators. A total of 415 systematically selected patients who came for physiotherapy service for exit interviews, 9 service providers and managers for key-informant interviews, and 8 patients for in-depth interviews participated in the study. Approximately 176 patient medical charts were reviewed, and direct observation of 14 patient-provider interactions was performed. Binary logistic regression analysis was computed to identify factors associated with patient-centeredness. In the final model, variables with a p value < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistical significance. Thematic analysis for the qualitative data using OPEN CODE version 4.03 was performed. Finally, the dimensions and overall quality of physiotherapy service were judged using predetermined criteria. The overall quality of the physiotherapy service was found to be fair or intermediate (66.5%), computed from the availability of resources 63.4%, compliance of service providers 68.6%, timelines 64.2%, and patient centeredness 73.1%. Qualitative findings also revealed that insufficient staffing and heavy workload, lack of resources, inconvenient facilities, relocation of resources in the academic division of physiotherapy department, lack of training and continuous professional development opportunities, lack management attention and institutional support and nonexistence of multidisciplinary approaches leads to significant gaps in quality service delivery. Attending primary school (AOR = 3.22, 95% CI: 1.56, 6.61), secondary (AOR = 4.24, 1.91, 9.41), and higher education (AOR = 4.79, 1.94, 11.84) and being a private employee (AOR = 0.34, 95% CI: 0.16, 0.76) were significantly associated with patient centeredness. The overall quality of physiotherapy service was deemed intermediate and needs further improvement. The required resources, such as clinical assessment tools, therapeutic exercise equipment, electrotherapy modalities and infrastructure, were not adequate. Educational level and occupation were significantly associated with patient centeredness.

Rehabilitation Teams Across the Disaster: A Field Report

Background and Objectives: The article highlights the crucial role of rehabilitation teams in managing disasters. While the importance of rehabilitation in the post-disaster phase is well-recognized, the article underscores the need for greater emphasis on pre-disaster planning and mitigation efforts. Case Presentation: A case study on the 2017 Kermanshah earthquake illustrates the challenges and successes of physiotherapy in disaster relief. The Iranian Physiotherapy Association (IPA) swiftly established a temporary clinic staffed by volunteers. Physiotherapy addressed a range of injuries, including soft tissue and neurological problems. Challenges in delivering physiotherapy services during emergencies include resource constraints, accessibility issues, and infrastructure damage. Conclusion: The article concludes that improvements in these areas can significantly enhance physiotherapy services during crises, leading to better recovery outcomes for survivors. Increased collaboration of rehabilitation teams and implementing research, may improve disaster preparedness and response.

Patterns of referral to interprofessional services among frail older adults presenting to emergency departments in Canada.

Geriatric Emergency Department (ED) Guidelines recommend optimizing transitions of care for older patients with complex needs. In this study, we investigated referral patterns to interprofessional services, including occupational therapy, physiotherapy, dietician, social work, home care, and specialized geriatric services, among older adults presenting to the ED with high-risk characteristics. We recruited community-dwelling older adults presenting to 10 EDs across Ontario, Quebec, and Newfoundland, Canada, from April 2017 to July 2018. To observe processes of care in the ED, we deployed a two-stage high-risk case-finding and focused comprehensive assessment process based on the interRAI ED-Screener and ED Contact Assessment to identify and characterize older adults at high risk. We analyzed the secondary data using descriptive statistics and logistic regression. We screened 5265 individuals with the ED Screener, further assessed 1479 with the ED Contact Assessment, and analyzed data from a subset of 1055 community-dwelling older adults assessed with the ED Contact Assessment. Participants in our study sample had a mean age of 83 years, 58% were female, and many had a complex burden of cognitive and functional impairment and social needs. Over half of this high-needs sample were referred to general home care services (62.7%), occupational therapy (59.3%), and physiotherapy services (55.2%), while 16% were referred to specialized geriatric services. We also found a significant positive association between interprofessional referrals and the Assessment Urgency Algorithm and Institutional Risk Scale. The most important determinants of referral to interprofessional services were hospital province, functional, clinical, and social burden and support measures. The referral patterns identified suggest that patient needs and risk intensity did not always guide referral patterns in the Canadian EDs investigated. We suggest that EDs critically examine the appropriateness of their documentation and referral systems for supporting person-centered care provision.

Experience-based co-design to develop innovative telehealth physiotherapy interventions and resources for children and young people with asthma and dysfunctional breathing

Introduction Healthcare requires new technologies to deliver hybrid services. Before embedding health-delivery transformations including physiotherapy in asthma clinics, it is essential to give young people and their carers a voice to facilitate co-designing of services. Objective To co-design hybrid telehealth physiotherapy services and online resources for, and in partnership with, young people with asthma and dysfunctional breathing, and their families. Methods Experience based co-design study undertaken at a specialist paediatric difficult asthma clinic, including online service user focus groups and electronic questionnaires for service providers. Eight children aged between 11 and 17 years and their families and 11 members of the multi-disciplinary team (MDT) managing children with difficult asthma were recruited purposively. Results A series of seven online videos were created, topics included: how to support a breathless child, education on how we breathe, breathing patterns, symptom differentiation, breathlessness, rescue breathing techniques, and exercise. Each video has downloadable resources. Five children and four parents wrote blogs to share their experiences. A live online 12-week physiotherapy program was developed on a web-based platform www.beamfeelgood.com called Asthma Kids. Conclusion Co-design enabled partnership working to develop hybrid telehealth physiotherapy services and prototype interventions to support home practice for children with asthma and dysfunctional breathing.

Physiotherapy management of acute perineal trauma: a patient satisfaction survey

Pelvic floor muscle (PFM) training is recommended in the immediate postpartum period because it can restore PFM function and prevent pelvic floor dysfunction. There are no national physiotherapy guidelines on how to deliver this intervention in the acute period. There is also no consensus on the need for outpatient follow-up to treat pelvic floor dysfunction that arises from perineal trauma, or as a preventative strategy in the long term. The aim of this study was to evaluate a current service provided for women with acute perineal trauma. The authors assessed patient satisfaction and compliance with physiotherapy advice, and identified preferences for future service development. One hundred and thirty patients completed satisfaction questionnaires after receiving inpatient physiotherapy treatment. Thirty consented to completing a retrospective telephone consultation about their care at 6–8 weeks postpartum. The questionnaire found high levels of satisfaction, and recorded a National Health Service Friends and Family Test score of 93. In the telephone consultation, 87% of the women reported that they were complying with ongoing PFM training. Eighty-five per cent of women who completed the questionnaire suggested that outpatient physiotherapy follow-up would be useful. Fifty per cent stated that options inclusive of outpatient follow-up would be useful for onward service development. Because of the high levels of satisfaction recorded and high compliance with the information provided in the acute postpartum period, it was concluded that the service should continue as it is. It is hoped that this service evaluation can be utilized as a benchmark for other acute and outpatient pelvic health physiotherapy services.

Key Factors Driving Physiotherapy Use in Patients with Nonspecific Low Back Pain: Retrospective Clinical Data Analysis

Background/objectives: Understanding the factors that influence physiotherapy (PT) service use among patients with nonspecific lower back pain (LBP) is necessary to optimize treatment strategies, healthcare resource allocation, and the planning of value-based initiatives. We report factors that influence the number of PT visits per episode of care (defined as a referral from a physician) for an LBP population in Saudi Arabia, and compare them with patients experiencing their first and recurrent episodes of LBP. Methods: LBP patients were retrospectively enrolled from a clinical dataset derived from an outpatient PT clinic in Saudi Arabia. The primary outcome variable was the number of PT visits performed per episode of care. Multiple linear regression analysis was performed to examine the relationships between the numbers of PT visits per episode of care and independent variables. Results: The number of PT sessions per week (β 0.34, p &lt; 0.001), compliance with PT sessions (β 0.31, p &lt; 0.001), and pre-pain scores (β 0.29, p &lt; 0.001) explained 41.8% (adjusted R2 0.32) of the variance in the total number of PT visits per episode of care (p &lt; 0.001). Conclusions: Factors that might improve value-based care for LBP patients are reported. The more PT sessions per week, compliance with these sessions, and higher baseline pain scores predict a higher number of PT visits per episode of care among these patients. While reported for a Saudi Arabian population, there is no reason to believe that these findings do not apply internationally.

People at Risk of, or with Cardiovascular Diseases’ Perspectives and Perceptions of Physiotherapist-Led Health Promotion in Cameroon: A Mixed-Methods Study

Cardiovascular diseases (CVDs) and their risk factors are a major cause of illness and death worldwide, especially in low- and middle-income countries like Cameroon. Physiotherapist-led health promotion (PLHP) has proven effective in improving health and reducing CVD risks. Understanding patient perspectives is crucial for designing effective, context-specific PLHP interventions. This study explored patients’ views, experiences, perceived usefulness, acceptability, and preferred methods of PLHP, through a sequential explanatory mixed-methods approach. The quantitative data highlights a significant burden of CVD conditions and risk factors among patients seen in physiotherapy services. Qualitatively, three themes were identified and included: (1) perspectives and experiences of people at risk or with CVDs (pwCVDs) on PLHP; (2) perceived usefulness and acceptability of PLHP; (3) preferred delivery methods of PLHP. Participants reported positive feedback on PLHP and physiotherapy services. Barriers to effective PLHP included high workloads for physiotherapists, limited service access in rural areas, and prohibitive costs. Despite these challenges, participants expressed strong confidence in physiotherapists’ competence, though they also called for improved regulation and ongoing professional development. PLHP components, especially physical treatment and dietary advice, were deemed highly useful and acceptable. Patients suggested various delivery methods, including peer support groups, home visits, and mass media interventions. This study highlights the need to improve the scope of practice, competence of physiotherapists, and accessibility of physiotherapy services in Cameroon for pwCVDs. It is necessary to adopt multidisciplinary approaches to achieve better outcomes for risk factors like diabetes and hypertension in context.

Implementation of Standard Physiotherapy Service Policies In Puskesmas: Literature Review

The growing prevalence of non-communicable diseases (NCDs) such as hypertension, stroke, diabetes, joint disorders, lack of physical activity, injury, and disability has resulted in an increasing need for physiotherapy services within healthcare facilities, especially at community health centers. Despite many unresolved public health issues, the rise of NCDs continues to pose significant challenges. According to the Minister of Health Regulation No. 65 of 2015, physiotherapy services are crucial in primary healthcare as part of promotive and preventive efforts, without neglecting curative and rehabilitative functions. This study aims to highlight the importance of physiotherapy in community health centers in providing both preventive and supportive care to address the public's increasing healthcare demands. The findings emphasize the strategic role of physiotherapists in disease prevention and health promotion at the primary level. The novelty of this research lies in its focus on the integration of physiotherapy into primary care services as a proactive approach to managing NCDs. The contribution of this research is to support healthcare policy and practices that prioritize physiotherapy services to improve public health outcomes, particularly in the prevention and management of NCDs.

Predictors of Patient Experience for 89,205 Physical and Occupational Therapy Patients Seen for Musculoskeletal Disorders: A Retrospective Cohort Study

OBJECTIVE: To identify predictors of patient experience among a cohort of 89,205 individuals who sought physical and occupational therapy services for musculoskeletal disorders. DESIGN: Retrospective cohort. METHODS: Patient experience was measured using a previously validated tool, the Select Medical Patient Reported Experience Measure (SM-PREM©), for physical and occupational therapy outpatient clinics. Linear and logistic regression models measured the association between demographic, clinical, and payment-related variables and SM-PREM© scores at discharge. RESULTS: Multiple variables that were statistically significantly associated with SM-PREM scores across regression analyses (p&lt;0.05); 4 predictors consistently emerged from the regression analyses. The use of paper outcomes capture (OR=1.21, 95%CI 1.17, 1.26), higher cancellation rates (OR=1.00, 95%CI 1.00, 1.01), higher percent out-of-pocket costs (OR=1.00, 95%CI 1.00, 1.01), and failure to meet the outcomes MCID (OR=0.76, 95%CI 0.73, 0.78) were predictors of a less favorable patient experience. CONCLUSION: Outcome capture methods, managing cancellation rates, and addressing financial barriers were important for improving patient experiences. More research is needed to investigate the underlying mechanisms driving these associations, explore interventions to mitigate their negative impacts and consider additional variables that may further explain variations in SM-PREM scores.

Structure and process of Parkinson's disease rehabilitation in the southern sector of Ghana: A cross-sectional survey.

The structure, process and outcome (SPO) framework has been used to establish that improved structures of care influences an enhanced process of stroke care resulting in improved outcome. Although, both stroke and Parkinson's disease (PD) are neurological conditions that require prolonged period of care and rehabilitation, the SPO framework has not yet been used to describe the existing structures and processes of PD care and rehabilitation in Ghana. To describe the current structures and processes of PD rehabilitation across the three healthcare levels (primary, secondary and tertiary) in the southern sector of Ghana. An online cross-sectional descriptive survey design was used via REDCap. Fifty-two therapists, including department heads, physiotherapists, occupational therapists and speech and language therapists from seven healthcare facilities were purposefully sampled and invited to complete the survey on structures and processes of PD rehabilitation. Descriptive statistical analysis was performed with SPSS v29.0. Comparative analysis was performed using Pearson's chi-square and Kruskal-Wallis test (H-test) as appropriate. Statistical significance was set at p < 0.05. Forty-nine (94.2%) responses were received and four incomplete responses were excluded from analysis. Structure of rehabilitation: Most of the participants were physiotherapists (n = 36/45; 80.0%) and tertiary level professionals (n = 31/45; 68.9%). Only physiotherapy service was available across all the healthcare levels. Persons with PD were mostly referred for rehabilitation at Hoehn and Yahr stage III as reported by 55.6% (n = 20/36) of the therapists. Process of rehabilitation: Most therapists treated persons with PD two times weekly (n = 19/33; 57.6%) and on individual basis (n = 29/33; 87.9%). Only 9 (27.2%) and 7 (21.2%) therapists often used clinical guidelines or outcome measures respectively in managing PD and 93.9% of the therapists had no local protocols. The structures and processes needed for PD rehabilitation exist but differ across the healthcare levels and among therapists. Physiotherapy was the most common rehabilitation service available at all levels of healthcare.

POSIÇÕES NÃO-SUPINAS E AUTONOMIA MATERNA NA ASSISTÊNCIA AO PARTO POR EQUIPE DE FISIOTERAPIA EM SAÚDE DA MULHER

Introduction: Childbirth in supine positions centralizes interventions instead of maternal autonomy, physiology and biomechanics of birth which are facilitated by non-supine positions. Objective: To quantitatively describe the prevalence of maternal positioning choice and non-supine positions in childbirth through assistance conducted by a Women's health physiotherapy team. Methods: Quantitative and descriptive cross-sectional study through retrospective secondary data available on the Assistance Database of the Women's health physiotherapy service of a public maternity hospital in Salvador from 2015 to 2019. initiated after approval by the Research Ethics Committee and waiver of the informed consent form. Results: Out of the total patients assisted by a multidisciplinary team with Women’s Health physiotherapists during childbirth from 2015 to 2019, 35.1% delivered in the supine position and 61% in non-supine positions. 65.4% chose the position they give birth in and 34.3% didn’t. Conclusion: Delivery assistance by a multidisciplinary team with a physical therapist promotes deliveries in non-supine positions and maternal autonomy during childbirth.

Consolidation of Publicly Funded Outpatient Musculoskeletal Physiotherapy Services in Winnipeg, Manitoba: Effects on Accessibility and Service Delivery

Consolidation of Publicly Funded Outpatient Musculoskeletal Physiotherapy Services in Winnipeg, Manitoba: Effects on Accessibility and Service Delivery

Racial Disparities in Outpatient Physical Therapy Use After Hip Fracture: A Retrospective Cohort Study

INTRODUCTION: The objective of our study was to examine whether there is a racial disparity among Medicare beneficiaries in the likelihood of using outpatient PT services following a hip fracture. METHODS: Our retrospective descriptive cohort study analyzed administrative claims data for 51,781 Medicare beneficiaries post-hip fracture. We examined the association between race and physical therapy (PT) use within the first 6 months post-fracture using hierarchical logistic regression, adjusting for demographics, medical complexity, and socioeconomic factors. We used Poisson regression to examine the association between race and the number of PT visits. RESULTS: Only 31% of beneficiaries used outpatient PT after hip fracture with significant racial disparities. After controlling for demographics, medical complexity, and socioeconomic factors, Black beneficiaries had 42% lower odds of using PT [aOR = 0.58, 95% CI 0.51-0.66] compared to White beneficiaries. Among PT users, Black beneficiaries received fewer visits than White beneficiaries (RR = 0.85, 95% CI 0.82-0.88) with this disparity persisting after adjustments (RR = 0.88, 95% CI 0.85-0.91). CONCLUSION: Even after adjusting for demographic, medical, and socioeconomic factors, Black beneficiaries were less likely to use outpatient PT following hip fractures. Conditional on an initial PT evaluation, Black beneficiaries received fewer sessions.

Correlation between parental willingness to pay, health-related quality of life, and satisfaction with physiotherapy services in Nigeria: a cross-sectional study

Abstract Background Being a parent of a child with a disability requiring many clinic visits is burdensome. Therefore, understanding the willingness-to-pay (WTP) for physiotherapy for children with disability is important to facilitating access to care and for policy-making. This study aimed to investigate patterns and correlates of parental WTP for physiotherapy. Methods A total of 65 parents of children with disability receiving physiotherapy as outpatients were recruited from selected tertiary hospitals in Nigeria. A WTP questionnaire, SF-12 health survey, and Physiotherapy Satisfaction Questionnaire were used to assess the WTP, health-related quality of life (HRQoL), and satisfaction with physiotherapy respectively. Descriptive statistics of mean, standard deviation, frequency, and percentages were used to summarize the data. Chi-square and regression analysis were also used to test the association and determinants of WTP from each of the socio-demographic factors, satisfaction with physiotherapy, and health-related quality of life, respectively. Results A majority (49.2%) of the respondents were in the 21–35 years age category. There was 30.8% “no WTP” for physiotherapy among parents of children with disability. A significant association was observed between socio-economic status and WTP for all treatment modalities (p &lt; 0.05). The majority of the respondents had above-average levels of physical and mental health domain of SF-12. No significant association was observed between WTP and each satisfaction with physiotherapy and HRQoL (p &gt; 0.05). Conclusion There was a high rate of ‘no WTP’ for physiotherapy among parents of children with disability. Level of satisfaction with physiotherapy and health-related quality of life was not significantly associated with parental WTP for physiotherapy.

Emergency department physiotherapists: consideration of perceived barriers and facilitators to help optimise their role in the Australian emergency department

QuestionsWhat are the current barriers and facilitators to the role of ED physiotherapists? How do ED physiotherapists believe their role may be optimised within the context of the ED?DesignMixed methods study using a cross sectional survey.ParticipantsAustralian physiotherapists currently providing services to patients within an Australian emergency department.InterventionN/A.Outcome measuresThe survey included questions related to the level of integration of ED physiotherapy into emergency department teams and wider health system, and open answer questions to identify the factors which impact and influence ED physiotherapy practice, and the future of ED physiotherapy.Results1 - Organisational culture, 2 - training and credentialling, 3 - governance, legislation and policies, 4 - funding, and 5 - advocacy and research were the five major themes generated from participant comments on existing facilitators and barriers to their role and the role of ED physiotherapists nationally. Six themes were generated from participant comments regarding the strategies to overcome barriers and facilitate an increased contribution by ED physiotherapists in the future: 1 - Training opportunities and specialisation pathways, 2 - Organisational culture, 3 - Governance, legislation and policies, 4 - Funding, 5 - Advocacy, 6 - Medicolegal Risks.ConclusionAustralian emergency department physiotherapists perceive their roles and emergency physiotherapy service provision to be impacted by complex and multi-factorial influences. The overall contribution of ED physiotherapy is susceptible to influence from non-linear interactions of various agents and factors which span all levels of the health system.Trial registrationN/A.

Demographics and scope of Australian emergency department physiotherapists

QuestionsTo provide workforce data on the status of Australian Emergency Department (ED) physiotherapy practice, including physiotherapist demographic data, staffing levels and funding sources. Evaluate the scope of practice currently undertaken by ED physiotherapists and alignment of ED physiotherapy service provision with demand levels.DesignCross sectional survey.ParticipantsAustralian physiotherapists working within an Australian ED.Outcome measuresWorkforce data, scope of practice and alignment of physiotherapy service provision to ED presentations and demand.Results94 Australian ED physiotherapists completed the survey, 76.9% were working as primary contact clinicians. They had a diverse scope of practice, 100% perform mobility assessments, 89.9% provide care for paediatric patients and 10.1% were involved in administration of medications. 86.2% of participants (75/87) reported working within a service model that provided seven-day per week physiotherapy coverage to ED.ConclusionThe sample of ED physiotherapists were found to be experienced and highly trained clinicians with a diverse scope of practice, who are well placed to meet the unpredictable and highly variable patient caseload of Australian EDs.

Extent and Pattern of Physiotherapy Profession: A pilot Study

Question: What is the level of awareness and understanding of the Physiotherapy profession among the general population of Delhi National Capital Region (NCR), India? Objective: To evaluate the general awareness of the physiotherapy profession among the general population of Delhi National Capital Region (NCR). Design: A cross-sectional survey and qualitative analysis of multiple-choice responses. Participants and Methods: In this pilot study total responses 250 and participants were randomly selected from the general public in areas of Delhi NCR were collected using an investigator-administered questionnaire. Data were analysed with MS office and SPSS. Results: In this study there were 250 respondents, out of them 121 (48%) were males and 129 (52%) were females. Out of total participants only 1% were illiterate and 99% were literate. 88% of the respondents were aware of the term ‘physiotherapy’ and 12% had never heard about it. 52% had the knowledge of a physiotherapist’s qualifications and 49% had knowledge of various physiotherapy services. Lack of awareness and knowledge was thought to be the main cause behind why people do not access physical therapy services, followed by the perception that it is all about massage and lastly that it is just for the elderly population, with figures 67%, 22% and 11%, respectively. Conclusion: The study’s participants had moderate level of awareness and positive belief regarding physiotherapy. The findings suggested that there is still a need to increase the awareness of the role of a physiotherapist among the general population so that its maximum potential can be tapped.

Day Centre Functional Physiotherapy Classes for Older People; Client Survey

Abstract Background Our Long-Term Residential Care facility provides physiotherapy services for approximately 117 Day Care clients. As part of our local Quality Improvement Programme, we wished to assess client perception of Day Centre Functional physiotherapy classes to help ascertain their perception regarding exercise intensity of classes, ability to follow guidance in class and ask questions. Emphasis of the class is to promote a learning environment, improve health literacy and functional independence of clients. As Falls Prevention is key re National Programme for older people (NCOP) and National Frailty Education, questions related to falls frequency and fear of falls prevalence. Methods This was a survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (&amp;gt; 65 years), This was a qualitative survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (&amp;gt; 65 years) Results 70% response rate. 100% reported feeling comfortable asking Physio instructor questions &amp; that exercise guidance was clear and understandable. 96% reported being physically able to keep up with class intensity. 80% reported class intensity as moderate, 20% as high, 0% reported class intensity as easy. 84% reported a fear of falling. 17% reported no fall in the previous year. 68% reported 1-3 falls, 15% reported &amp;gt; 3 falls in last year. Class attendances reported: 4% 0-5 classes, 18% 5-10 classes, 78% more than 10 classes. Conclusion Results obtained from the survey have provided worthwhile feedback and supports that Falls prevention measures should address fear of falls. Significant findings on client satisfaction/perception of exercise intensity noted. Next steps will include tailoring physiotherapy classes for this demographic to include fear of falling, optimising exercise intensity, promoting health literacy and best practice for exercise prescription. Also, consideration of further objective testing of balance post physio class programme period to ascertain success of exercise classes.

Enhancing Physiotherapy Services within a Community Specialist Team for Older Adults: An Evaluation Study

Abstract Background An aim of Community Specialist Teams (CSTs) is to provide integrated multidisciplinary services to older people closer to home. Physiotherapy is a key component of this service. This evaluation aims to describe current physiotherapy practices within a specific CST and identify potential areas for improvement. The CST under examination maintains a physiotherapy staffing level of 1.2 Full-Time Equivalents. Methods An evaluation was completed of the physiotherapy input provided to 71 older adults who underwent a Comprehensive Geriatric Assessment (CGA) with the CST between July and December 2023. Data encompassing service user demographics and physiotherapy specific information were anonymised and analysed using Microsoft Excel. Results The median age of clients was 84 years (range 66-95), with 84.5% aged over 75 years. 70% were female. The median Clinical Frailty Scale (CFS) was 5 (range 3-7), with 75% being classified as frail. The reasons for referral were community rehabilitation (43%), admission avoidance (20%), early supported discharge (17%) and other (20%). Median time to CGA was 18 days (range 1-64 days). 64 (94%) patients were referred to physiotherapy and received an average of 4.4 sessions. Time to physiotherapy assessment following CGA ranged from 0-41 days with a median of 6 days. 83% of clients had physiotherapy intervention in their homes, 14% attended community hubs and 3% both. Analysis of delayed discharge revealed a range of 0-99 excess days beyond the estimated discharge date, with a median delay of 6 days. Conclusion This evaluation underscores the prevalent need for physiotherapy input among the service users engaged with this CST. Concerns arise regarding the breach of the of the National Integrated Care Programme for Older Persons (NICPOP) guideline for CGA timing (2 weeks) and target discharge date (6 weeks). The findings of this review will inform future service planning and the development of integrated physiotherapy pathways for older people.

Are There Missed Opportunities For Falls Prevention In Older People With Fractures? Data From TILDA

Abstract Background Fractures can represent a seminal event in later life associated with significantly higher rates of functional impairment, nursing home admission and mortality. The aim of this study therefore was to measure the cumulative incidence of hip and wrist fractures longitudinally in a population-representative sample of community-dwelling older people and examine opportunities to intervene prior to the fracture. Methods Participants aged ≥65 years from the Irish Longitudinal Study on Ageing were included and followed from Wave 1 to Wave 5 (8-year follow-up). Falls and Fractures (Hip and Wrist) and were elicited by self-report at each wave. Participants were also asked how steady they feel when standing / walking. Logistic regression models assessed the relationship between reported falls and unsteadiness, and subsequent fracture. Results 3,072 participants were included (Mean age 73 years, 53% female) and followed for a median of 6.3 years, with over 7% (228/3,072) reporting a fracture. Over one quarter (69/267) of fractures were preceded by an injurious fall requiring medical attention in the prior 24 months, 45% were preceded by a fall of any type (121/267). One third of participants who subsequently had a fracture (89/267), reported that they were unsteady on their feet when interviewed prior to the fracture. One fifth (19/89) of these participants accessed physiotherapy services prior to the fracture. The combination of either a fall or unsteadiness reported during the preceding 24 months significantly increased the likelihood of future fracture (Odds Ratio 2.62 (95% CI 2.05 – 3.35)). Conclusion Most fractures are predictable with almost two thirds heralded by falls or unsteadiness in the preceding 24 months. Falls prevention strategies, which can reduce further falls by 20-40%, targeted at those with unsteadiness and falls would likely prevent an important proportion of future fractures, and have a positive impact on health outcomes in this cohort.