“I struggle to count my blessings”: recovery after hip fracture from the patients’ perspective

Abstract

BackgroundRecovery outlooks of physical functioning and quality of life after hip fracture have not changed significantly over the past 25 years. Previous research has mainly dealt with causalities and acute treatment, while the recovery process from the patients’ perspective has been less comprehensively described. Expanded knowledge of what the patients consider important in their recovery process may have important consequences for how these patients are treated in the future and thereby on future patient outcomes. The aim presently is therefore to explore how elderly patients with hip fracture enrolled in an ongoing RCT have experienced their recovery process.MethodThe study was qualitative in design. Eight frail elderly in recovery after hip fracture (aged 69–91) were interviewed in their home four months after their fracture. The interviews covered issues related to their experiences of facilitators and barriers throughout the different stages in the recovery process. The patients were already enrolled in an ongoing randomized controlled trial, examining the effects of habitual functional training during their short term stays at nursing homes. The patients were chosen strategically according to age, gender, and participation in rehabilitation. The interviews were recorded, transcribed and subjected to a method of systematic text condensation inspired by Giorgi’s phenomenological method.ResultsThe results revealed that the patients’ experiences of the recovery process fell into three main themes: “Feeling vulnerable”, “A span between self-reliance and dependency” and “Disruption from a normal life”. The feeling of gloominess and vulnerability persisted throughout. Being in recovery was also experienced as a tension between self-reliance and dependency; a disrupted life where loss of mobility and the impact of age was profoundly present.ConclusionBeing in recovery after hip fracture was experienced as a life breaking event. Based on these findings, increased focus on individualized treatment to each patient through each stage of the recovery process should be emphasized.

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

“…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].…”

“…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].…”

“…Patients described the hip fracture as a shocking, or even life-shattering event that had put their life on hold [23, 26, 28,29]. They addressed their new situation very differently, however; some were able to stay active or seek others' help in trying to remain in control of their life, while others felt resignation, hesitant and unable to actively take control and plan for the future [23, 26-28, 30, 33, 38].…”

“…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].…”

“…They felt a sense of meaninglessness and had lost hope for the future [26,32]. Some reported being depressed [29] or losing "the spark of life" [26,32].…”