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PRE-ADMISSION FUNCTIONAL TESTING TO PREDICT LENGTH OF STAY AFTER HIP ARTHROPLASTY IN A DIAGNOSTIC & TREATMENT CENTRE SETTING

Nuffield Orthopaedic Centre NHS Trust, Physiotherapy Research Unit, Windmill Road, Oxford OX3 7LD

The DTC approach to patient management aims to decrease waiting list times and length of stay (LOS). To implement a reduction in the LOS it is imperative that suitable patients are selected. Factors such as co-morbidity and social support are important but other factors may also influence LOS.

To investigate if pre-operative measures of function were predictive of length of stay for patients treated in a Diagnostic & Treatment Centre for elective hip arthroplasty. The first 75 patients treated by the DTC were assessed pre-operatively recording timed measures of function for sit-to-stand, and stair climbing as well as ratings of pain and the WOMAC questionnaire. These measures were compared with the LOS for patients and their functional outcome at 6 weeks after discharge.

Linear regression was used to examine the influence of the measures on LOS. T-tests were used to compare the outcome at 6 weeks for pain and function between patients discharged within 5 days versus > 5 days.

The mean age was 65 years (39 – 80 years SD 8.4); 33 male and 42 female. Mean LOS was 6 days (4–14 SD 1.8), 52 % reached the DTC target of discharge on the 5th day. Regression analysis showed sit-to- stand was the best predictor of LOS (R2 = 46.7%) followed by WOMAC pain and climbing stairs. There were no significant differences in the pain or function scores at 6 weeks for patients discharged at 5 days or later.

Conclusion: There was a linear relationship between pre-operative sit-to-stand and LOS. The timed measures were simple to perform and patients could be tested in their own homes. Early discharge did not result in poorer self-reported outcome at 6 weeks. The routine measurement of sit-to-stand may be useful to clinicians as a prognostic indicator for treatment allocation and planning.

The abstracts were prepared by Mr Tim Briggs. (Editoral Secretary 2003/4) Correspondence should be addressed to him at Lane Farm, Chapel Lane, Totternhoe, Dunstable, Bedfordshire LU6 2BZ, United Kingdom