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. 2023 Oct;14(5):999-1010.
doi: 10.1007/s41999-023-00808-8. Epub 2023 Jun 17.

The role of depression in the association between physiotherapy frequency and duration and outcomes after hip fracture surgery: secondary analysis of the physiotherapy hip fracture sprint audit

Rhian Milton-Cole  1 , Matthew D L O'Connell  2 , Katie Jane Sheehan  2 , Salma Ayis  2
Affiliations

The role of depression in the association between physiotherapy frequency and duration and outcomes after hip fracture surgery: secondary analysis of the physiotherapy hip fracture sprint audit

Rhian Milton-Cole et al. Eur Geriatr Med. 2023 Oct.

Abstract

Purpose: It is not known whether the association between the frequency and duration of physiotherapy and patient outcomes varies for those with and without depression. This study aims to evaluate whether the associations between the frequency and duration of physiotherapy after hip fracture surgery and discharge home, surviving at 30 days post-admission, and being readmitted 30 days post discharge vary by depression diagnosis.

Methods: Data were from 5005 adults aged 60 and over included in the UK Physiotherapy Hip Fracture Sprint Audit who had undergone surgery for a nonpathological first hip fracture. Logistic regression models were used to estimate the unadjusted and adjusted odds ratios and their 95% confidence intervals for the associations between physiotherapy frequency and duration and outcomes.

Results: Physiotherapy frequency and duration were comparable between patients with and without depression (42.1% and 44.6%). The average adjusted odds for a 30-min increase in physiotherapy duration for those with and without depression for discharge home were 1.05 (95% CI 0.85-1.29) vs 1.16 (95% CI 1.05-1.28, interaction p = 0.36), for 30-day survival were 1.26 (95% CI 1.06-1.50) vs 1.11 (95% CI 1.05-1.17, interaction p = 0.45) and for readmission were 0.89 (95% CI 0.81-0.98) vs 0.97 (95% CI 0.93-1.00, interaction p = 0.09). None of the interaction tests reached formal significance, but the readmission models were close (p = 0.09).

Conclusion: Results suggest physiotherapy duration may be negatively associated with readmission in those with depression but not those without depression, while no clear difference in the other outcomes was noted.

Keywords: Depression; Hip fracture; Older adults; Rehabilitation.

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Conflict of interest statement

KS received funding from the NIHR Research for Patient Benefit, Chartered Society of Physiotherapy Charitable Trust and UKRI Future Leaders Fellowship for hip fracture health services research. RMC’s PhD studentship is funded as a host contribution to KS UKRI Future Leaders Fellowship. SA is funded by the NIHR Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust, King’s College London. MOC received funding from the NIHR Programme Grants for Applied Research.

Figures

Fig. 1
Fig. 1
Diagram of the sample selection process, each statistical model and the adjusted models results
Fig. 2
Fig. 2
Difference in the adjusted predicted probability and their 95% CI, for those with and without a diagnosis of depression, of discharge home, survival at 30-days and avoiding readmission at 30-days by frequency and duration of physiotherapy. *Calculated using the interaction logistic regression models to show the adjusted predicted Probability for those with depression minus probability of those without depression
See this image and copyright information in PMC

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