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The Allied Health Clinical Research Office

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Weekend Allied Health Services

6 vs 5 day per week rehabilitation services

Many inpatients receive little or no rehabilitation on weekends. This project led by Professor Nick Taylor, aimed to determine the effect of providing additional Saturday rehabilitation during inpatient rehabilitation on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation. This trial randomly allocated 996 rehabilitation inpatients to receive additional allied health services from Monday to Saturday or usual-care rehabilitation services from Monday to Friday. Patients in the weekend therapy group were discharged about 2 days earlier at a higher level of function, with benefits sustained for 6 months after discharge. The service was cost effective with benefits to the patient and savings to the health service. The evidence from this trial has been used to inform the Standards for the provision of Inpatient Adult Rehabilitation Medicine Services in Public and Private Hospitals published by the Royal Australia College of Surgeons, which now recommend that “The provision of therapy on weekends is strongly recommended as it has been shown to increase functional independence, physical activity, quality of life and in some cases, reduce length of stay”.


6 day vs 5 day services in Geriatric Evaluation and Management

Geriatric Evaluation and Management (GEM) provides inpatient care for people with complex conditions associated with ageing, cognitive dysfunction, chronic illness and disability. There is evidence from systematic reviews that GEM reduces the risk of functional decline at discharge and reduces the risk of discharge to residential care at 1 year. Providing additional Saturday allied health services for inpatient rehabilitation can help patients get better quicker, with cost savings for the health service. However, it was not known if providing an additional day of allied health services per week in GEM can also reduce length of stay and improve health outcomes. We aimed to assess if providing additional Saturday allied health services on a GEM ward reduced length of stay and improved health outcomes. A controlled before-and-after trial alongside a health economic analysis was completed on two GEM wards in a public health network in Australia. Participants included all patients discharged from the two wards during the 6-month pre-intervention (N=331) and intervention (N=462) periods. Saturday allied health services (physiotherapy, occupational therapy, social work and an on-call service for other allied health professions) were provided on the intervention ward in addition to usual Monday to Friday staffing. There were no Saturday allied health services on the comparison ward. Providing additional allied health services on a Saturday to a GEM ward did not reduce length of stay or total cost, but may have reduced readmissions in the 30 days following discharge. Observations in the comparison ward which may have been influenced by a change in medical leadership suggest that reductions in length of stay should be considered in the context of whether these changes were achieved at the expense of discharging patients with a lower level of functional independence which may be associated with higher rates of readmission.

Publications
  1. Taylor NF, Lawler K, Brusco NK, Peiris CL, Harding KE, Scroggie GD, Boyd JN, Wilton AM, Coker F, Ferraro JG, Shields N. Saturday allied health services for geriatric evaluation and management: A controlled before‐and‐after trial. Australasian journal on ageing. 2019 May 9.
  2. Taylor N. A 7 day physiotherapy service. Journal of Physiotherapy (Editorial). 2014;60:179-80. www.journalofphysiotherapy.com/article/S1836-9553(14)00111-8/pdf
  3. Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. (in press). Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis Archives of Physical Medicine and Rehabilitation (accepted 5 March 2018. http://www.archives-pmr.org/article/S0003-9993(11)00247-4/abstract
  4. English C, Shields N, Brusco NK, Taylor N, Watts JJ, Peiris C, Bernhardt J, Crotty M, Esterman A, Segal L, Hillier S. 2016. Additional weekend therapy may reduce length of rehabilitation stay after stroke: An individual patient data meta-analysis. Journal of Physiotherapy 62(3):124-129. http://www.journalofphysiotherapy.com/article/S1836-9553(16)30018-2/abstract
  5. Brusco NK, Watts JJ, Shields N, Taylor NF. 2015. Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial. BMC Health Services Research 15:165, impact factor 1.66. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-0822-3
  6. Brusco NK, Watts JJ, Shields N, Taylor NF. 2014. Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up. BMC Medicine 12:89. https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-12-89
  7. Brusco NK, Taylor NF, Watts JJ, Shields N. 2014. Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings. Archives of Physical Medicine and Rehabilitation 95:94-116. http://www.archives-pmr.org/article/S0003-9993(13)00278-5/abstract
  8. Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. 2013. Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial. BMC Medicine 11:198, impact factor 6.679.  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-198
  9. Shaw K, Taylor NF, Brusco N. 2013. Physiotherapy services provided outside of business hours in Australian hospitals: A national survey. Physiotherapy Research International 18:115-123. https://onlinelibrary.wiley.com/doi/full/10.1002/pri.1537
  10. Peiris CL, Taylor NF, Shields N. 2012. Additional Saturday allied health services increase habitual physical activity among patients receiving inpatient rehabilitation for lower limb orthopedic conditions: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 93: 1365-1370. http://www.archives-pmr.org/article/S0003-9993(12)00176-1/abstract
  11. Taylor NF, Brusco NK, Watts JW, Shields N, Peiris C, Sullivan N, Kennedy G, Teo CK, Farley A, Lockwood K, Radia-George C. 2010. A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes. BMC Health Services Research 10(1): 308. https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-10-308