Evaluation of Missed Physiotherapy Appointment and Its Influence on Cost, Efficiency and Patient Outcomes

Evaluation of Missed Physiotherapy Appointment and Its Influence on Cost, Efficiency and Patient Outcomes Fatoye F1, Gebrye T2, Fatoye C3, Mbada C4, Afolabi O5, Fasuyi F5 1Manchester Metropolitan University, Manchester, LIN, UK, 2Manchester Metropolitan University, Manchester, UK, 3Manchester Metropolitan University, Manchester, LAN, UK, 4Obafemi Awolowo University, Ile-Ife,, Nigeria, 5University of Medical Sciences, Ondo, Nigeria OBJECTIVES: Missed appointments (MAs) contribute to the rising costs of physiotherapy and are a significant challenge to healthcare administration, organisational workflow and health outcomes for patients. This study assessed prevalence and pattern of missed physiotherapy appointments, wait time, and its impact on cost, efficiency and patient outcome in Nigeria. METHODS: A retrospective study was conducted at the Outpatient Physiotherapy Clinic of Obafemi Awolowo University, Ile-Ife, Nigeria. A total of 3243 physiotherapy appointments booked between 2009 and 2018 were assessed. Data were collected on socio-demographic and patient outcomes related to Mas. MAs was defined as any appointment where a patient did not show up at all, or attend to follow up appointment or notify staff of a cancellation. The total revenue loss due to MAs was calculated as a product of the total of MAs and per treatment cost. Descriptive of mean, standard deviation and frequency and inferential statistics of t-test were used to analyse the data. RESULTS: MAs constituted 1701 (52.5%) of all appointments and the average wait time for first appointment was 9.6 ± 23.2 days. The proportion of MAs was higher among females (50.2%), middle-aged adults (34-55 years) (31.7%), patients who were not resident close to the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from orthopaedic surgeons (32.8%). There were significant associations (p < 0.05) between MAs and age, sex, location of patient’s residence and the source of referral. Considering the per treatment schedule cost of 1000 naira, a 52.5% MAs rate resulted in a lower efficiency of 76.6% with an efficiency ratio of 0.23. CONCLUSIONS: MAs for physiotherapy treatment poses a significant challenge on costs, efficiency and patients’ outcome. Thus, an innovative reminder system may help reduce patients’ non-attendance of physiotherapy and its consequences

Cross-cultural adaptation and psychometric evaluation of the Yoruba version of Oswestry disability index.

INTRODUCTION:Low-Back Pain (LBP) is a common public health problem that is often worsened by maladaptive beliefs and disability. Thus, necessitating the need for availability of outcome measures to assess these sequelae among patients with chronic LBP. This study aimed to cross-culturally adapt and determine the psychometric properties of the Yoruba version of the ODI (ODI-Y). METHODS:The ODI-Y was cross-culturally adapted following the process involving forward translation, synthesis, backward translation, expert review, and pilot testing. Internal consistency and test-retest reliability of the ODI-Y were determined using the Cronbach's alpha and intra-class correlation. Other psychometric properties explored included the factor structure, convergent validity, standard error of measurement and the minimal detectable change. RESULTS:One hundred and thirty-six patients with chronic LBP took part in the validation of the ODI-Y; 86 of these individuals took part in the test-retest reliability (within 1-week interval) of the translated instrument. The mean age of the respondents was 50.5±10.6years. The ODI-Y showed a high internal consistency, with a Cronbach's alpha (α) of 0.81. Test-retest of the Yoruba version of the ODI within 1-week interval yielded an Intra-Class Correlation coefficient of 0.89. The ODI-Y yielded a three-factor structure which accounted for 61.56% of the variance. Correlation of ODI-Y with the visual analogue scale was moderate (r = 0.30; p = 0.001). The standard error of measurement and minimal detectable change of the ODI-Y were 2.0 and 5.5. CONCLUSIONS:The ODI was adapted into the Yoruba language and proved to have good psychometric properties that replicated the results of other obtainable versions. We recommend it for use among Yoruba speaking patients with LBP

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Occupational engagement pattern among the elderly in sub-Saharan Africa: A scoping review protocol

This scoping review protocol will guide the study to provide a systematic map of the body of knowledge on the occupational engagement pattern of the elderly in sub-Saharan Africa. The proposed review will equally identify any existing gap in the literature on the subject due to the perceived paucity of research by occupational scientists and therapists on the elderly in SSA

Missed physiotherapy appointment and its influence on cost, efficiency and patients’ outcomes

Background: Missed appointments (MAs) is a significant challenge to efficient running of physiotherapy departments and it has cost implications. In this study, wait time and the pattern and impact of MAs on cost, efficiency, and patient outcome was assessed among Nigerian patients receiving physiotherapy. Method: In this retrospective study a total of 3243 physiotherapy appointments booked between 2009 and 2019 at an Outpatient Physiotherapy Clinic in Nigeria. were conducted. Data were gleaned on socio-demographic and patient outcomes related to MAs. The total revenue loss due to MAs was calculated as a product of the total of MAs and per treatment cost. Results: MAs constituted 1701 (52.5%) of all appointments and the average wait time for the first appointment was 9.6 ± 23.2 days. The proportion of MAs was higher among females (50.2%), patients who were not residents within the same location as the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from an orthopaedic surgeon (32.8%). Females, those who live far within the city, and those with neurological/medical conditions were 1.68, 1.24, and 1.52 times more likely to have MAs compared with males (OR = 1.68, CI = 1.44 – 1.96, p = < 0.001), and those who live outside the city (OR = 1.24, CI = 1.05 – 1.46, P = 0.01), and have orthopaedic conditions (OR = 1.52, CI = 1.20 – 1.93, p = <0.001), respectively. Using per treatment schedule cost of N1000 (an equivalent of $2.31), a 52.5% MAs rate resulted in lower efficiency of 76.6% with an efficiency ratio of 0.23. Further, a 52.5% MAs rate could potentially impact patient recovery by 3402 days if MAs slow a patient recovery process by 2 days. Conclusions: MAs for physiotherapy treatment pose a significant challenge in terms of costs, efficiency, and patient outcomes. Thus, an innovative reminder system may help reduce patients’ non-attendance to physiotherapy and its consequences

Prevalence and correlates of bullying in physiotherapy education in Nigeria

Background: Bullying is an unexpressed part and parcel of medical education but it is largely unexplored in physiotherapy. This study assessed the prevalence and socio-demographic correlates of bullying in physiotherapy education in Nigeria. Methods: Two hundred and nineteen clinical physiotherapy students from three purposively selected Federal Universities in Nigeria participated in this study. Following a cross-sectional design, the Students Perception of Professor Bullying Questionnaire (SPPBQ) was used to obtain information on bullying. The SPPBQ includes a working definition of lecturer bullying followed by other sections inquiring about lecturers bullying experiences. Data was collected on socio-demographic characteristics, bullying experiences and availability of adequate policy and support on bullying. Descriptive and inferential statistics were used analyze data. Alpha level was set at p < 0.05. Results: Lifetime and point prevalence of bullying in physiotherapy education were 98.6 and 99.1%. 94.5% of the respondents had witnessed physiotherapy students bullying and there was a 100% rate of 'no attempt' to stop a physiotherapy lecturer from bullying. 38.4 and 44.7% of the respondents believed there was adequate school policy and support available on bullying. There was no significant association between bullying and each of age (í2 = 0.117, p = 0.943), gender (í2 = 0.001, p = 0.974), level of study (í2 = 0.000, p = 0.995) and any specific university (í2 = 1.343, p = 0.511). Conclusion: There is high lifetime and point prevalence of bullying in physiotherapy education in Nigeria, which are largely unchallenged or redressed. Being a clinical physiotherapy student ordinarily predisposes to bullying without necessary contributions of intrinsic and extrinsic factors

Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study.

Background Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. Methods We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5\u201315 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. Findings 15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34\ub75%) underwent appendicectomy. The normal appendicectomy rate was 15\ub79% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0\ub784 (95% CI 0\ub782\u20130\ub786). Applying score cutoffs of 3 points or lower for children aged 5\u201310 years and girls aged 11\u201315 years, and 2 points or lower for boys aged 11\u201315 years, the failure rate was 3\ub73% (95% CI 2\ub70\u20135\ub72; 18 of 539 patients), specificity was 44\ub73% (95% CI 41\ub74\u201347\ub72; 521 of 1176), and positive predictive value was 41\ub74% (38\ub75\u201344\ub74; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72\ub76%, 67\ub74\u201377\ub74) was similar to that of ultrasound scan (75\ub70%, 65\ub73\u201383\ub71). Interpretation The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. Funding None