Table 3.
The I-HOPE Program’s Multidisciplinary Care Profile
| Timepoint (Place) | Intervention | Staff |
|---|---|---|
| Admission (to a ward or an operating room) | Survey conducted prior to the operation | Physician assistant/Orthopedist |
| 3–5 days following surgery (inpatient department) | Evaluation of the patient’s home care requirements. Pain scale evaluation. |
Nurse case manager |
| Exercise instruction (ankle pumping, quadriceps, gluteal clamping, straight leg lifting, and hip adduction/abduction) at the bedside. Training at the bedside (turning over in bed, sitting, sit to stand, standing posture, and balance training). Using a Walker (10–20 meters). Remind patients who have had hemiarthroplasty not to flex the hip more than 90 degrees, adduct, or externally rotate. Patient education to improve home safety and avoid falling again. |
Physical therapist | |
| Make loans for assistive equipment and teach people how to utilize them. Conduct a home environment survey and provide recommendations for changes. |
Occupational therapist | |
| Educate patients on proper diet and calcium and vitamin D sources. | Nutritionist | |
| If clinically necessary, physical treatment for the chest and breathing exercises. | Respiratory therapist | |
| 7 days after surgery (outpatient department) | Physical activity, balance, and gait analysis. Improve training for fragile individuals (CFS>5). Stress the significance of fall prevention. |
Physical therapist Gerontologist |
| ADL and IADL evaluation. | Nurse case manager | |
| Determine the extent of wound healing and mobility range. DXA scans are used to evaluate bone mineral density. Begin pharmacologic treatment if osteoporosis is indicated. |
Orthopedist/Endocrinologist | |
| 1 month after surgery (individual patient’s home) | Make the house a safer place to live to reduce the chance of falls. Instruct the patients to engage in fall prevention activities. Functional scores are used to evaluate physical activity, balance, and gait (EMS and POMA). Adjust the active rehabilitation strategy and ensure adherence. |
Physical therapist Gerontologist |
| GDS, ADL, and IADL evaluation. Counsel and educate patients on drug usage and therapy adherence. |
Nurse case manager Gerontologist |
|
| Provide dietary evaluation and counseling | Nutritionist | |
| 6 months after surgery (outpatient department) | Physical activity, balance, and gait analysis (EMS and POMA). Instruct the patients to maintain their fall prevention measures. |
Physical therapist Gerontologist |
| GDS, ADL, and IADL evaluation. | Nurse case manager | |
| Confirm current therapy adherence and reaction. | Orthopedist/Endocrinologist |
Abbreviations: ADL, activities of daily living; CFS, Clinical Frailty Scale; DXA, dual-energy X-ray absorptiometry; EMS, Elderly Mobility Scale; GDS, Geriatric Depression Scale; IADL, instrumental activities of daily living; i-HOPE, the Integrated Hip Fracture and Osteoporosis Rehabilitation Program of the Elderly; POMA, Tinetti Performance Oriented Mobility Assessment.