Routine physiotherapy outcome measures use for acute internal medicine: an implementation study

Le résumé fourni par la source

To measure the implementability of the Clinical Frailty Scale (CFS), de Morton Mobility Index (DEMMI) and modified Iowa Level of Assistance Scale (mILOA) for internal medicine patients requiring physiotherapy. Implementation study (March 2023-December 2024). Behavior change strategies were delivered. Evaluation included fidelity and sustainability (80% outcome measure completion), acceptability (acceptability survey, score range 0–40), and feasibility via limited efficacy of clinical utility (association between frailty and length of stay, mobility and discharge destination via Spearman’s rho). Of 3,375 eligible patients, 23% had all outcome measures completed and 63% (n = 2,122) had CFS scores (80% fidelity was not achieved). Mobility measure completion were higher at admission than discharge (DEMMI admission 53%, discharge 28%; mILOA admission 55%, discharge 32%). Acceptability surveys (n = 22) indicated that the CFS (mean = 30.1, SD 3.2), mILOA (mean = 28.5, SD 3.5) and DEMMI (mean = 27.8, SD 3.2) were all acceptable; the CFS was significantly more acceptable than the DEMMI (p = 0.003), but not the mILOA (p = 0.097). Weak correlations were found between frailty and hospital outcomes. After implementation strategies (including education and goalsetting) outcome measure completion improved. While physiotherapists found the measures were acceptable, weak associations were found between frailty hospital outcomes, indicating questionable utility. Outcome measures can predict patient outcomes and guide rehabilitation interventions, however, they are often rarely performed.After the introduction of strategies informed by the Theoretical Domains Framework, there were higher completion of the Clinical Frailty Scale (CFS), modified Iowa Level of Assistance (mILOA) and de Morton Mobility Index (DEMMI) in physiotherapists working in acute internal medicine.The CFS was more acceptable to physiotherapists than the mILOA and DEMMIFrailty alone may not be sufficient to predict patient outcomes such as length of hospital stay, changes in mobility levels and discharge destination. Outcome measures can predict patient outcomes and guide rehabilitation interventions, however, they are often rarely performed. After the introduction of strategies informed by the Theoretical Domains Framework, there were higher completion of the Clinical Frailty Scale (CFS), modified Iowa Level of Assistance (mILOA) and de Morton Mobility Index (DEMMI) in physiotherapists working in acute internal medicine. The CFS was more acceptable to physiotherapists than the mILOA and DEMMI Frailty alone may not be sufficient to predict patient outcomes such as length of hospital stay, changes in mobility levels and discharge destination.

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