Abstract

Research Article

Physiotherapy Can Help Recover Functional Status in Community-dwelling Seniors Assessed in Emergency Departments for Minor Injuries

Laurence Fruteau de Lacos, Andréanne Blanchette, Kadija Perreault, Raoul Daoust, Jacques Lee, Jeffrey J Perry, Marcel Émond, Eddy Lang and Nathalie Veillette and Marie-Josée Sirois*

Published: 01 August, 2023 | Volume 7 - Issue 2 | Pages: 022-028

Background: Around 75% of seniors seeking treatment for injuries in Emergency Departments (ED) are discharged home with minor injuries that put them at risk of functional decline in the following months. 
Objectives: To 1) describe seniors’ characteristics using or not physiotherapy services following ED visits for minor injuries and 2) examine their functional status according to physiotherapy use. 
Methods: Secondary data analyses of the Canadian Emergency Team Initiative cohort study. Participants were 65 years and older, discharged home after consulting EDs for minor injuries and assessed three times: ED, 3- and 6-months. Physiotherapy use was recorded as yes/no. Functional status was measured using the Older American Resources Scale (OARS). Multivariate linear regressions were used to examine change in OARS scores over time, accounting for confounders. 
Results: Among the 2169 participants, 565 (26%) received physiotherapy, and 1604 (74%) did not. Physiotherapy users were more likely females (71% vs. 64%), more educated, and less cognitively impaired. The overall change in OARS at 6 months was -0.31/28 points (95% CI: -0.55; -0.28) with no difference across groups after adjustment. Subgroup analyses among frail seniors showed that physiotherapy users maintained their function while non-users lost clinically significant function (-0.02 vs. -1.26/28 points, p = 0.03). Among the severely injured (Injury Severity Scale ≥ 5), physiotherapy users’ results were higher by almost 1/28 points (p = 0.03) compared to non-users. 
Conclusion: These results suggest that among seniors discharged home after consulting the ED for minor injuries, the frail and severely injured may benefit from being systematically referred to physiotherapy services. 

Read Full Article HTML DOI: 10.29328/journal.jnpr.1001052 Cite this Article Read Full Article PDF

Keywords:

Emergency department; Seniors; Injuries; Physiotherapy

References

  1. Billette JM, Janz T. Injuries in Canada: Insights from the Canadian Community Health Survey. (Catalogue no. 82-624-X). Statistics Canada. 2015. https://www150.statcan.gc.ca/n1/pub/82-624-x/2011001/article/11506eng.htm
  2. Canadian Institute for Health Information (2017) Emergency departments visit in Canada, Access data and reports: Quick Stats. Available at: https://www.cihi.ca/en/quick-stats
  3. Sirois MJ, Émond M, Ouellet MC, Perry J, Daoust R, Morin J, Dionne C, Camden S, Moore L, Allain-Boulé N. Cumulative incidence of functional decline after minor injuries in previously independent older Canadian individuals in the emergency department. J Am Geriatr Soc. 2013 Oct;61(10):1661-8. doi: 10.1111/jgs.12482. PMID: 24117285.
  4. Jefferis BJ, Iliffe S, Kendrick D, Kerse N, Trost S, Lennon LT, Ash S, Sartini C, Morris RW, Wannamethee SG, Whincup PH. How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men? BMC Geriatr. 2014 Oct 27;14:114. doi: 10.1186/1471-2318-14-114. PMID: 25348492; PMCID: PMC4223846.
  5. Nachreiner NM, Findorff MJ, Wyman JF, McCarthy TC. Circumstances and consequences of falls in community-dwelling older women. J Womens Health (Larchmt). 2007 Dec;16(10):1437-46. doi: 10.1089/jwh.2006.0245. PMID: 18062759.
  6. American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, Society for Academic Emergency Medicine, & Geriatric Emergency Department Guidelines Task Force (2014) Geriatric emergency department guidelines. Annals of Emergency Medicine 63(5): e7–e25. https://doi.org/10.1016/j.annemergmed.2014.02.008
  7. Hastings SN, Heflin MT. A systematic review of interventions to improve outcomes for elders discharged from the emergency department. Acad Emerg Med. 2005 Oct;12(10):978-86. doi: 10.1197/j.aem.2005.05.032. PMID: 16204142.
  8. Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23(9):771-787. doi: 10.1007/s12603-019-1273-z. PMID: 31641726; PMCID: PMC6800406.
  9. Carpenter CR, Heard K, Wilber S, Ginde AA, Stiffler K, Gerson LW, Wenger NS, Miller DK; Society for Academic Emergency Medicine (SAEM) Geriatric Task Force. Research priorities for high-quality geriatric emergency care: medication management, screening, and prevention and functional assessment. Acad Emerg Med. 2011 Jun;18(6):644-54. doi: 10.1111/j.1553-2712.2011.01092.x. PMID: 21676064; PMCID: PMC3117251.
  10. Tirrell G, Sri-on J, Lipsitz LA, Camargo CA Jr, Kabrhel C, Liu SW. Evaluation of older adult patients with falls in the emergency department: discordance with national guidelines. Acad Emerg Med. 2015 Apr;22(4):461-7. doi: 10.1111/acem.12634. Epub 2015 Mar 13. PMID: 25773899; PMCID: PMC6778963.
  11. McEwan H, Baker R, Armstrong N, Banerjee J. A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an emergency department. Int J Emerg Med. 2018 Jul 18;11(1):33. doi: 10.1186/s12245-018-0192-9. PMID: 30022394; PMCID: PMC6051952.
  12. Miller E, Wightman E, Rumbolt K, McConnell S, Berg K, Devereaux M, Campbell F. Management of fall-related injuries in the elderly: a retrospective chart review of patients presenting to the emergency department of a community-based teaching hospital. Physiother Can. 2009 Winter;61(1):26-37. doi: 10.3138/physio.61.1.26. Epub 2009 Feb 13. PMID: 20145749; PMCID: PMC2788319.
  13. Canadian Physiotherapy Association (2012) Description of Physiotherapy in Canada.
  14. Richards S, Cristian A. The role of the physical therapist in the care of the older adult. Clin Geriatr Med. 2006 May;22(2):269-79; viii. doi: 10.1016/j.cger.2005.12.003. PMID: 16627078.
  15. Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Van Ness PH. A prehabilitation program for the prevention of functional decline: effect on higher-level physical function. Arch Phys Med Rehabil. 2004 Jul;85(7):1043-9. doi: 10.1016/j.apmr.2003.10.021. PMID: 15241748.
  16. Halvarsson A, Oddsson L, Olsson E, Farén E, Pettersson A, Ståhle A. Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial. Clin Rehabil. 2011 Nov;25(11):1021-31. doi: 10.1177/0269215511411937. Epub 2011 Aug 17. Erratum in: Clin Rehabil. 2012 Nov;26(11):1055. Oddsson, Lars [added]. PMID: 21849377.
  17. Desmeules F, Roy JS, MacDermid JC, Champagne F, Hinse O, Woodhouse LJ. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord. 2012 Jun 21;13:107. doi: 10.1186/1471-2474-13-107. PMID: 22716771; PMCID: PMC3599404.
  18. Taylor NF, Norman E, Roddy L, Tang C, Pagram A, Hearn K. Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial. Physiotherapy. 2011 Jun;97(2):107-14. doi: 10.1016/j.physio.2010.08.011. Epub 2010 Dec 16. PMID: 21497244.
  19. Sirois MJ, Carmichael PH, Daoust R, Eagles D, Griffith L, Lang E, Lee J, Perry JJ, Veillette N, Émond M; Canadian Emergency Team Initiative on Mobility in Aging. Functional Decline After Nonhospitalized Injuries in Older Patients: Results From the Canadian Emergency Team Initiative Cohort in Elders. Ann Emerg Med. 2022 Aug;80(2):154-164. doi: 10.1016/j.annemergmed.2022.01.041. Epub 2022 Mar 16. PMID: 35305850.
  20. Fillenbaum G. Multidimensional functional assessment of older adults: The Duke Older Americans Ressources and Services procedures. Lawrence Erlbaum Associates. 1988.
  21. Bissett M, Cusick A, Lannin NA. Functional assessments utilized in emergency departments: a systematic review. Age Ageing. 2013. https://doi.org/10.1093/ageing/afs187
  22. Provencher V, Sirois MJ, Ouellet MC, Camden S, Neveu X, Allain-Boulé N, Emond M; Canadian Emergency Team Initiative on Mobility in Aging. Decline in activities of daily living after a visit to a Canadian emergency department for minor injuries in independent older adults: are frail older adults with cognitive impairment at greater risk? J Am Geriatr Soc. 2015 May;63(5):860-8. doi: 10.1111/jgs.13389. PMID: 25989564.
  23. Audet N, Lemieux M, Cardin J. Social and health survey 1998 - Technical and methodological notebook: Definitions and composition of the indices. Montreal, Statistical Institute of Quebec. 2001; 215 p.
  24. Daoust R, Beaulieu P, Manzini C, Chauny JM, Lavigne G. Estimation of pain intensity in emergency medicine: a validation study. Pain. 2008 Sep 15;138(3):565-570. doi: 10.1016/j.pain.2008.02.007. Epub 2008 Mar 24. PMID: 18359566.
  25. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Gann DS, Gennarelli T, MacKenzie E, Schwaitzberg S. Progress in characterizing anatomic injury. J Trauma. 1990 Oct;30(10):1200-7. doi: 10.1097/00005373-199010000-00003. PMID: 2213928.
  26. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The Injury Severity Score revisited. J Trauma. 1988 Jan;28(1):69-77. doi: 10.1097/00005373-198801000-00010. PMID: 3123707.
  27. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x. Erratum in: J Am Geriatr Soc. 2019 Sep;67(9):1991. PMID: 15817019.
  28. de Jager CA, Budge MM, Clarke R. Utility of TICS-M for the assessment of cognitive function in older adults. Int J Geriatr Psychiatry. 2003; 18(4): 318-324. https://doi.org/10.1002/gps.830
  29. Rossetti HC, Lacritz LH, Cullum CM, Weiner MF. Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology. 2011 Sep 27;77(13):1272-5. doi: 10.1212/WNL.0b013e318230208a. Epub 2011 Sep 14. PMID: 21917776.
  30. Knopman DS, Roberts RO, Geda YE, Pankratz VS, Christianson TJ, Petersen RC, Rocca WA. Validation of the telephone interview for cognitive status-modified in subjects with normal cognition, mild cognitive impairment, or dementia. Neuroepidemiology. 2010;34(1):34-42. doi: 10.1159/000255464. Epub 2009 Nov 5. PMID: 19893327; PMCID: PMC2857622.
  31. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991 Feb;39(2):142-8. doi: 10.1111/j.1532-5415.1991.tb01616.x. PMID: 1991946..
  32. Kempen GI, Yardley L, van Haastregt JC, Zijlstra GA, Beyer N, Hauer K, Todd C. The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing. 2008 Jan;37(1):45-50. doi: 10.1093/ageing/afm157. Epub 2007 Nov 20. PMID: 18032400.
  33. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95. doi: 10.1503/cmaj.050051. PMID: 16129869; PMCID: PMC1188185.
  34. Lefmann SA, Sheppard LA. Perceptions of emergency department staff of the role of physiotherapists in the system: a qualitative investigation. Physiotherapy. 2014 Mar;100(1):86-91. doi: 10.1016/j.physio.2013.08.004. Epub 2013 Sep 27. PMID: 24268943.
  35. Deslauriers S, Raymond MH, Laliberté M, Lavoie A, Desmeules F, Feldman DE, Perreault K. Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies. Disabil Rehabil. 2017 Dec;39(26):2648-2656. doi: 10.1080/09638288.2016.1238967. Epub 2016 Oct 19. PMID: 27758150.
  36. Salter AE, Khan KM, Donaldson MG, Davis JC, Buchanan J, Abu-Laban RB, Cook WL, Lord SR, McKay HA. Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study. Osteoporos Int. 2006;17(5):672-83. doi: 10.1007/s00198-005-0032-7. Epub 2006 Feb 21. PMID: 16491323.
  37. Moss JE, Flower CL, Houghton LM, Moss DL, Nielsen DA, Taylor DM. A multidisciplinary Care Coordination Team improves emergency department discharge planning practice. Med J Aust. 2002 Oct 21;177(8):435-9. doi: 10.5694/j.1326-5377.2002.tb04884.x. PMID: 12381253..
  38. Wilson CM, Arena SK, Adcock K, Colling D. A Home-Based Older Person Upstreaming Prevention Physical Therapy (HOP-UP-PT) Program Utilizing Community Partnership Referrals. Home Healthc Now. 2019 Mar/Apr;37(2):88-96. doi: 10.1097/NHH.0000000000000716. PMID: 30829786.
  39. Hartley PJ, Keevil VL, Alushi L, Charles RL, Conroy EB, Costello PM, Dixon B, Dolinska-Grzybek AM, Vajda D, Romero-Ortuno R. Earlier Physical Therapy Input Is Associated With a Reduced Length of Hospital Stay and Reduced Care Needs on Discharge in Frail Older Inpatients: An Observational Study. J Geriatr Phys Ther. 2019 Apr/Jun;42(2):E7-E14. doi: 10.1519/JPT.0000000000000134. PMID: 28628498.
  40. Sirois MJ, Griffith L, Perry J, Daoust R, Veillette N, Lee J, Pelletier M, Wilding L, Émond M. Measuring Frailty Can Help Emergency Departments Identify Independent Seniors at Risk of Functional Decline After Minor Injuries. J Gerontol A Biol Sci Med Sci. 2017 Jan;72(1):68-74. doi: 10.1093/gerona/glv152. Epub 2015 Sep 22. PMID: 26400735; PMCID: PMC5155653.

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