‘Balancing risk’ after fall‐induced hip fracture: the older person's need for information

McMillan, Laura; Booth, Jo; Currie, Kay; Howe, Tracey

doi:10.1111/opn.12028

Cited by 21 publications

(73 citation statements)

References 30 publications

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“…The patient need for information from health-care professionals and the importance of this in successful rehabilitation has also been previously identified. 298 A qualitative study of physiotherapist perceptions of rehabilitation also found that there is tailoring of care to patients' individual needs, based on their own goals and level of support available. 185 A study into the challenges of team working in the rehabilitation of hip fracture patients also demonstrated that there are breakdowns in communication within multidisciplinary teams and issues relating to the organisation of resources and services that lead to variation in patient care.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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Section: Comparison With Previous Literaturementioning

confidence: 99%

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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“…Six studies had been conducted in Sweden, three in the UK, two in Canada; the remaining five in Denmark, Norway, New Zealand, Australia or the USA. The studies covered data gathered at admission [23, 24], two weeks [25], one month [26], two to four months [27][28][29][30] or six to 12 months after discharge from hospital [31][32][33]. One study had a time frame from three months to 22 years after fracture [34]; the remaining four studies gave no indication of the time of interviewing [35][36][37][38].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The patients were thus wary of performing common daily activities, such as using a low armchair, worrying that they might not be able to rise from it, or cleaning, doing the laundry, shopping, going for a walk outdoors, driving a car or using public transportation [26, 28,38]. Overall, the unreliability of their body and their sense of fragility left them feeling vulnerable [23,26,27,29,30,37].…”

Section: ) Physical Healthmentioning

confidence: 99%

“…They were also anxious about relapse [30] and treatment [36], adverse events and overmedication [35]. Concern was also expressed about further complications [38], their future ability to walk [23], dependency [23, 27,38], the discharge and return to the home [23, 25, 27,35] and the future in general [26, 29,38]. Some patients' mood was negatively affected by the changed life situation brought about by the limitations in agility and their increased insecurity and fear [32].…”

Section: ) Mental Healthmentioning

confidence: 99%

“…However, patients admitted from and returning to their own homes were especially determined to regain their independence [25, [28][29][30][31]37] and return to normality [27,29,30,34].…”

Section: ) Personal Goalsmentioning

confidence: 99%

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Patient perspectives on treatment, care and rehabilitation after hip fracture: A meta-aggregative systematic review

Abrahamsen¹,

Nørgaard²

2019

Preprint

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Background: Hip fracture surgery is a distressing and life-changing event for patients. The treatment, care and rehabilitation of hip fracture patients governed by evidence-based recommendations, the patients' preferences are often not represented. The aim of this systematic review is to identify elderly hip fracture patients' priorities during their care trajectory.Methods: A meta-aggregative approach was applied to present findings on patient perspectives. Data were extracted from the findings in the Results section of each study, categorized by similarity in meaning by both authors as either "health-related outcomes" or "healthcare-related experiences".The quality of the presented evidence was evaluated, and all studies were assessed using the Critical Appraisal Skills Programme (CASP) checklist. Results: Sixteen qualitative studies met the inclusion criteria. The health-related outcomes category included: 1) symptoms and complications, 2) physical health, 3) mental health and 4) social relationships and 5) personal goals. Healthcare-related experiences revolved around: 1) waiting time, 2) information, 3) being treated with respect, 4) participation and 5) discharge. Conclusions: This systematic review provides an overview of hip fracture patients' perspectives on important aspects of care, treatment and training during their trajectory, thereby contributing to the development of a patient-derived measure of hip fracture. Background The consequences of a hip fracture can be considerable. Mortality rates of up to 10% during admission [1] and 20-36% after 12 months [2, 3] are documented. Between 40 and 60% of hip fracture survivors recover their pre-fracture functional level while 40-70% regain their level of independence for basic activities of daily living [4, 5]. Impaired mobility alongside reduced social independence affects quality of life [6-8]. Several continental and national orthopaedic associations have published evidence-based recommendations for the treatment, care and rehabilitation of hip fracture patients, including recommendations on mobilization strategies, the timing of surgery, pain management, post-operative prevention, rehabilitation programmes and patient information [9, 10]. Patient's preferences are not

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The Psychological Health of Patients and their Caregivers

Falaschi

Eleuteri

2020

Practical Issues in Geriatrics

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Hip-fracture (HF) patients are among the most vulnerable of hospitalised patients. The associated caregiving rehabilitation task often falls to a member of the patient’s family. Informal caregivers are an important resource for elderly patients suffering from a hip fracture because they play a key role during their recovery. A mutual relationship seems to exist between the patient’s psychological well-being and the caregiver’s burden, so that improvements in the state of health of the one boost that of the other, and vice versa. This datum confirms the importance of using a bio-psycho-social approach when dealing with both patients and caregivers and evaluating the HF patient’s and caregiver’s psychological status. In this chapter, we illustrate why the psychological status of patients and their caregivers is important in the management and outcome of hip fracture, how it should be assessed and how it could be positively influenced by the orthogeriatric team.

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‘Balancing risk’ after fall‐induced hip fracture: the older person's need for information

Abstract: The concept of balancing risk aims to help healthcare professionals understand the older person's perspective of hip fracture and to recognise the efforts that people make to guard against further injury and dependence in the early postdischarge period.

Cited by 21 publications

References 30 publications

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Patient perspectives on treatment, care and rehabilitation after hip fracture: A meta-aggregative systematic review

The Psychological Health of Patients and their Caregivers

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