1. The Health Roundtable Hip Hop A group exercise class for community dwelling adults following a fractured neck of femur (NOF). Tracey Drabsch Orange Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1 1-1b_HRT1215-Session2_DRABSCH_ORANGE_NSW

2. The Health Roundtable KEY PROBLEM  Neck of femur fractures are extremely debilitating  Few clients returning to their pre-fracture level of mobility and function  Fractures = 89% of admissions (50% hip) (peel et al 2002)  NOF fracture: 1.6/1000 men or 3.6/1000 women  Second fracture: 15/1000 men or 22/1000 women (Schroder et al 1993)  One-year survival rate: 55.9% to 78.3% (Kyo et al 1993) (Katelaris et al 1996)  50% of patients are unable to walk across a small room independently and 90% are dependent in climbing stairs (Magaziner et al 2000)  Costs to health service are high (Brainsky et al 1997) 2

3. The Health Roundtable AIM OF THIS INNOVATION  To review an exercise class local for community dwelling clients following a fractured NOF (neck of femur)  Improve the clients function post-op  Address the clients pre-morbid falls risk factors  We need solutions to prevent and treat the increasing number of hip fractures. 3

4. The Health Roundtable BASELINE DATA  Initial assessment  6mwt  Step test  Single leg balance  STS: lowest possible chair height without using hands  Step length  Gait analysis  10m walk test  Physio diagnosed the client ’ s main impairments and also addressed the client ’ s perceived main problems. 4

5. The Health Roundtable KEY CHANGES IMPLEMENTED  6 one hour prescriptive exercise sessions with Physiotherapist available to evaluate and progress program during participation  Home exercise program  2 physiotherapists with up to 8 participants Exercise included: Task-specific training High Level Balance exercises Strengthening exercises Endurance Exercises Stretching Referrals to OT and Dietetics as needed 5

6. The Health Roundtable OUTCOMES  Analysed data of 7 subjects of mean age 82.1 years.  pre post p value  ____________________________________________________________ 6 minute walk test (m) 166.86 293.71 0.03   Step length (m)  affected leg 0.38 0.47 0.004*  non-affected leg 0.35 0.47 0.005*   Chair height (m)  (no hands) 0.50 0.47 0.01  Step test  affected leg 0 8.28 0.002*  non-affected leg 3.42 9.0 0.009*   Single leg stance (sec)  affected leg 0.94 3.8 0.02  non-affected leg 1.38 6.59 0 6

7. The Health Roundtable LESSONS LEARNT  Prescriptive Exercise for # NOF showed statistically significant increase in step length and step test outcomes.  Single leg stance not the best outcome measure to detect change  In hindsight would use Short Physical Performance Battery to evaluate change as quick and easy  Low cost to run i.e. 1 physiotherapist for 4 patients 1 hour/week.  Achievable Home Exercise is part of the program  Falls prevention evidence recommends high level balance e.g. Otago, Tai Chi but difficult for frail elderly to access however prescriptive exercise with PT seems to be best option for frail aged in community (home/group) 7