Falls Prevention: a positive effect of the Osteoarthritis Chronic - - PowerPoint PPT Presentation
Falls Prevention: a positive effect of the Osteoarthritis Chronic Care Program (OACCP) Matthew Williams Snr Physiotherapist, Musculoskeletal Coordinator Royal North Shore/Ryde Hospitals Danella Hackett Snr Physiotherapist, Musculoskeletal
Matthew Williams Snr Physiotherapist, Musculoskeletal Coordinator Royal North Shore/Ryde Hospitals Danella Hackett Snr Physiotherapist, Musculoskeletal Coordinator Fairfield Hospital May 2016
1 in 5 people currently suffer from OA, this will increase to 1 in 4 by the year 2050. The risk of disability due to knee OA alone is greater than that due to any other medical condition over the age of 65. (Framingham Study – Guccione et al., 1994) The incoming “silver tsunami” see’s an aging population with unprecedented obesity and sedentary characteristics. Individuals with OA have a 30% greater chance of falling.
better management of musculoskeletal conditions was recognised, especially those individuals awaiting elective joint replacement
established a proposed model of care to cater for this cohort and the OACCP was born.
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ORP OACCP Legend: Green - implemented Orange – underway Red – no activity Site FLC hours Medical support in team Site Coordination with MDT Patient cohort RPAH Full-time Yes - Rheumatology Fairfield Yes Waitlist Concord Rotating registrar All medical team - Endocrine Nepean Yes Waitlist Nepean Full-time ? Don’t know if Gustavo was replaced - Geriatrics Gosford/Wyong Yes Waitlist POW Full-time buy with other endocrine nurse duties Yes - Endocrine RNSH/Ryde Yes Waitlist Wagga 16 hrs/week No – GP model, not working Manly Yes but very limited hours Waitlist RNSH/Ryde Full-time Yes – Endocrine and Rheumatology Hornsby Yes but very limited hours Waitlist Hornsby 4 days/week Yes - Rehabilitation Sutherland Yes – limited hours Waitlist Manly 2-3 days Yes – Rheumatology Bowral Yes but limited hours Waitlist Newcastle Part-time Yes –Rheumatology Newcastle ? Model has moved to community so unsure ? Port Kembla Full-time Yes – Rehabilitation Port Macquarie Yes Waitlist Coffs Harbour 3 days Yes – Rheumatology Coffs Harbour Yes Waitlist Lismore Full-time Yes – Geriatrics Hunters Hill Private ? ? Tweed Heads Full-time Yes – Endocrinology Murrumbidgee PHN Yes Waitlist Grafton 0.6 FTE Yes – unsure specialty Broken Hill Yes Waitlist St Vincent’s No FLC Endocrine – all medical team Coffs Harbour GP leadership with MDT Pre-waitlist Grafton Coordinator but model ???? Waitlist Broken Hill In set-up mode ? RNSH Coordination of GP referred patients Pre-waitlist Liverpool/Fair field In planning mode Rheumatology, orthopaedics, rehabilitation all involved Orange In set up mode – not signed off Waitlist Canberra Full-time No – still working on the model Armidale In set up mode – not signed off ? Western NSW LHD, Southern NSW LHD, Western Sydney LHD Sydney LHD, Western Sydney, Western NSW, Illawarra Shoalhaven LHD, Southern NSW
The OACCP offers a comprehensive, evidence based and integrated model of care that improves the interdisciplinary coordination of treatment for individuals with OA. Objectives:
Client Centred - What does this really mean? – Client Choice, Client Control – First ask then offer – Wait til 8 – Targeted education and individualised goals
Commenced in 2009 and assisted ACI Musculoskeletal network in the development of the OACCP Team – Senior PT Musculoskeletal Coordinator, Level ½ Physio part time and Orthopaedic CNC – We can refer to Occupational Therapy and Social Work within the hospital as these patients are seen as an inpatient by these service providers
Diabetes Osteoporosis Cardiac/Pulmonary Rehabilitation Smoking Cessation programs Psychology Allied Health Get Healthy Service
– Able and Stable program – Falls Clinic – Stepping on – Staying active and on your feet Booklet – Falls network handouts including those in other languages – Walking aids – Occupational therapy review
Patients invited from elective joint replacement list and referrals from orthopods and rheumatologists. Initial Appointment with Msk co-ordinator involving a holistic assessment, OA education, exercise program and referral to services within and outside of program. Attendance at MDT clinic Follow up with Msk coordinator every 3 months for reassessment - ? Escalation for surgery, or removal from WL. Linking up with community based programs and support networks to further assist self management.
Exercise - strengthening, aerobic conditioning, hydrotherapy Weight management,
Joint protection, need for assistive devices, lifestyle/ functional adaptations Assist with coping, self efficacy, catastrophising Monitor and advise pharmacologic interventions with GP or pain clinic Need for insoles, motion control shoes, braces
Approximately 1 in 3 people report having a fall in the preceding 12 months prior to OACCP contact Approximately 1 in 5 patients who have knee OA and 1 in 2 patients who have hip OA are at increased risk of falls
75 Year old Female awaiting R THR PmHx: HTN, Hypercholesterolaemia, Osteoporosis (last BMD 5 years previous), L THR 20 years ago and revised 5 years ago Falls history - 2 falls in last 6 months, last one was a week prior to initial assessment # rib BMI 29.5, TUG 10.7 secs, repeated STS in 10 secs (failed) Patients goal was that she wanted to improve her mood
Pre Final Follow up 3/12 STS test 5 6 4 Tandem Stance 8” 15” 15” TUG 13” 7” 11” Number of falls 2
your Feet booklet
she was found to have osteopenia and had her osteoporosis treatment changed at this time.
Patient still presently awaiting surgery as was deferred secondary to some other surgery she needed to have first. At last contact she really enjoyed the exercise program, was still completing the exercises Mood – had improved to some degree although she still felt some isolation secondary to her difficulty with public transport due to her hip problem
Mr SB Category C – L TKR 63yo male with 4 year history of left knee pain progressively worsening PHx: R knee osteotomy ‘06 R TKR, R THR ’08 PMhx: DM2, bilat ear canal recon ’93 X-ray: Severe medial T/F joint OA
VAS 2/10 Restricted knee ROM, quads inhib, TUG 21.1 sec, 6MWT 322m Gait: Wide BOS, shuffled steps, slow to initiate. History of increasing falls (5 in last 3/12) BMI 35.27 Waist circumference: 123cm Flat affect – mild depression score on DASS Vacant facial expression Referrals: Rheumatologist, Dietician, Orthotist, SW, Hydrotherapy, Falls prevention. ACTION: Contact GP ? Parkinson’s Disease – referred to neurologist – diagnosis confirmed. Placed on levodopa
3 month review: TUG from 21.1 to 11.5sec 6MWT 322m up to 397m Nil reports of falls. Patient had an early call up to surgery due to a cancellation and had a successful knee replacement mobilising independently with a walking stick.
OA is a sleeping giant which is expected to effect 1 in 4 Australians by the year 2050 with a significant proportion of these at high risk of falls. A proactive, multi-disciplinary approach with an emphasis on exercise and ideally positioned in primary care is imperative in tackling this increasing burden.