Demographic Characteristics and Functional Levels of Patients With Fragility Fractures Who Accept Tele-rehabilitation as an Alternative to Face-to-face Home Rehabilitation

Abstract

There is a gap in the evidence on telerehabilitation (TR) for people with fragility fractures. It is unclear whether this group with recent falls who are often frail with cognitive changes will accept tele-rehabilitation and functional gains can be achieved using this approach. Prospective observational study of consecutive patients admitted with femoral or pelvic fracture to a hospital-based home rehabilitation service (HRS) between January and November 2017. Using tablets, multidisciplinary rehabilitation was provided via videoconferencing and use of exercise apps. Patients chose a face-to-face visit or TR. Information on demographic characteristics, functional levels, the total number of therapy sessions, TR episodes, reasons for non-acceptance of TR, and patient-reported experience using TR was collected. Fifty-two patients with hip and pelvic fractures were admitted to the HRS and 35 (67.3%) received TR. Patients who did not accept TR were older, frailer and more likely to be female than those who received TR. Of the 17 who did not receive TR, 6 were deemed unsuitable by staff due to hearing, vision or cognitive problems and 3 refused. The TR group achieved acceptable functional gains. In the TR group on average, participants had 13.63 (± 7.29) home visits however they only elected to have 3.43 (± 2.48) sessions delivered via TR. TR was acceptable to a subset of hip fracture patients but face-to-face was the preferred mode of delivery. More research is needed to understand patients’ preferences and beliefs, and the influence of clinician attitudes on uptake of TR.

Barriers and Enablers to the Use of Web-Based Applications for Older Adults and Their Caregivers Post-Hip Fracture Surgery: A Descriptive Qualitative Study

“…The preference for face-to-face communication has been reported by patients in similar studies examining the use of digital health interventions by older adults. 20,21,33 However, studies examining the effectiveness of 7 Indeed, participants in our study (n=3 patients, n=4 caregivers) identified the opportunity for written instructions in the web-based application as an incentive to use, and described web-based applications as having the potential to improve overall communication with their healthcare providers (n=1 patient, n=4 caregivers). Overall, patients more frequently expressed belief statements indicating low motivation for using web-based applications than caregivers, such as not finding web-based applications important to use (n=7, 38.9%), and having no intention of using a web-based application (n=3, 16.7%).…”

“…The preference for face-to-face communication has been reported by patients in similar studies examining the use of digital health interventions by older adults. 20 , 21 , 33 However, studies examining the effectiveness of different modes of communication in healthcare settings, have found that verbal instructions are often remembered incorrectly, if at all, by patients. 7 Indeed, participants in our study (n=3 patients, n=4 caregivers) identified the opportunity for written instructions in the web-based application as an incentive to use, and described web-based applications as having the potential to improve overall communication with their healthcare providers (n=1 patient, n=4 caregivers).…”

“…Overall, patients more frequently expressed belief statements indicating low motivation for using web-based applications than caregivers, such as not finding web-based applications important to use (n=7, 38.9%), and having no intention of using a web-based application (n=3, 16.7%). Morris et al 21 found that acceptability and uptake of digital technology by older adults with hip fractures were negatively impacted by low self-efficacy and lack of familiarity with technology. Indeed, three of the most important barriers for patients were the need for basic computer skills (n=7, 70%), a lack of confidence with the use of web-based applications (n=6, 60%), and the belief that one is unable to use web-based applications due to age (n=6, 60%).…”

“… 20 Low uptake of technology interventions, specifically by older adults who have experienced a hip fracture may be related to decreased self-efficacy, lack of familiarity with technology, or acceptability of such interventions. 21 Yet, the feasibility of web-based applications with older adults has been previously demonstrated, 22 , 23 especially by using a holistic, integrative approaches that include the active participation of patient networks including caregivers and care providers. 20 …”

“…20 Low uptake of technology interventions, specifically by older adults who have experienced a hip fracture may be related to decreased self-efficacy, lack of familiarity with technology, or acceptability of such interventions. 21 Yet, the feasibility of web-based applications with older adults has been previously demonstrated, 22,23 especially by using a holistic, integrative approaches that include the active participation of patient networks including caregivers and care providers. 20 The purpose of this study was to describe the barriers and enablers to the use of web-based applications designed to help manage the personalized needs of older adults and their caregivers post-hip fracture surgery while transitioning from hospital to geriatric rehabilitation to home.…”