title: Length of Stay and Achievement of Functional Milestones in a Rural First Nations Population in Northwestern Ontario during Acute-Care Admission after Total Hip Replacement: A Retrospective Chart Review.
abstract: OBJECTIVE
  To understand the postoperative acute-care physiotherapy course for First Nations people returning after total hip replacement (THR) to remote communities with limited rehabilitation services and to evaluate length of stay and attainment of functional milestones after THR to determine to what extent an urban-based clinical pathway is transferrable to and effective for First Nations patients in a rural setting.
  
  
  METHODS
  Data were collected retrospectively by reviewing charts of patients who underwent THR in the Northwest Ontario catchment area from 2007 through 2012.
  
  
  RESULTS
  For the 36 patient charts reviewed, median length of stay (LOS) at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) was 7.5 days (range 2-335); median LOS from time of surgery at the regional hospital (Thunder Bay Regional Health Centre) to discharge from SLMHC was 13.5 days; and median time for mobilizing and stairs was 9 days (range 1-93).
  
  
  CONCLUSIONS
  Commonly accepted urban clinical pathways are not a good fit for smaller rural hospitals from which First Nations patients return to remote communities without rehabilitation services. LOS in a rural acute-care facility is similar to LOS in an urban rehabilitation facility.
authors.affiliation: Sinclair Physical Therapy Services.
authors.forename: Cameal
authors.initials: C
authors.lastname: Sinclair
authors.affiliation: Sioux Lookout Meno Ya Win Health Centre.
authors.forename: Nicole
authors.initials: N
authors.lastname: Brunton
authors.affiliation: Clinical Research Centre, Kingston General Hospital; Department of Public Health Sciences, Queen's University, Kingston, Ont.
authors.forename: Wilma M
authors.initials: WM
authors.lastname: Hopman
authors.affiliation: Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout.
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
keywords: arthroplasty, hip replacement; osteoarthritis; postoperative care; rural health
references.citation: JAMA. 1998 Mar 18;279(11):847-52
references.pmid: 9515999
references.citation: J Rheumatol. 1995 Mar;22(3):482-7
references.pmid: 7783066
references.citation: JAMA. 1996 Mar 20;275(11):858-65
references.pmid: 8596224
references.citation: Chronic Dis Can. 2010 Dec;31(1):22-6
references.pmid: 21176412
references.citation: J Bone Joint Surg Br. 2011 Apr;93(4):464-9
references.pmid: 21464483
references.citation: J Bone Joint Surg Am. 2009 Apr;91(4):761-72
references.pmid: 19339559
references.citation: BMC Med. 2009 Jul 01;7:32
references.pmid: 19570193
references.citation: J Community Health. 1998 Feb;23(1):59-73
references.pmid: 9526726
references.citation: Med J Aust. 1999 Jan 18;170(2):59-62
references.pmid: 10026684
references.citation: Arthritis Care Res. 1994 Jun;7(2):78-84
references.pmid: 7857997
references.citation: Ont Health Technol Assess Ser. 2005;5(8):1-91
references.pmid: 23074477
references.citation: HSS J. 2011 Feb;7(1):16-20
references.pmid: 22294953
references.citation: Jt Comm J Qual Improv. 1996 Sep;22(9):617-28
references.pmid: 8904690
references.citation: J Arthroplasty. 2003 Jun;18(4):453-7
references.pmid: 12820088