Multidisciplinary team healthcare professionals’ perceptions of current and optimal acute rehabilitation, a hip fracture example A UK qualitative interview study informed by the Theoretical Domains Framework

Abstract

Objective To understand multidisciplinary team healthcare professionals’ perceptions of current and optimal provision of acute rehabilitation, perceived facilitators and barriers to implementation, and their implications for patient recovery, using hip fracture as an example. Methods A qualitative design was adopted using semi-structured telephone interviews with 20 members of the acute multidisciplinary healthcare team (occupational therapists, physiotherapists, physicians, nurses) working on orthopaedic wards at 15 different hospitals across the UK. Interviews were audio-recorded, transcribed verbatim, anonymised, and then thematically analysed drawing on the Theoretical Domains Framework to enhance our understanding of the findings. Results We identified four themes: conceptualising a model of rehabilitative practice, which reflected the perceived variability of rehabilitation models, along with facilitators and common patient and organisational barriers for optimal rehabilitation; competing professional and organisational goals, which highlighted the reported incompatibility between organisational goals and person-centred care shaping rehabilitation practices, particularly for more vulnerable patients; engaging teams in collaborative practice, which related to the expressed need to work well with all members of the multidisciplinary team to achieve the same person-centred goals and share rehabilitation practices; and engaging patients and their carers, highlighting the importance of their involvement to achieve a holistic and collaborative approach to rehabilitation in the acute setting. Barriers and facilitators within themes were underpinned by the lack or presence of adequate ways of communicating with patients, carers, and multidisciplinary team members; resources (e.g. equipment, staffing, group classes), and support from people in leadership positions such as management and senior staff. Conclusions Cornerstones of optimal acute rehabilitation are effective communication and collaborative practices between the multidisciplinary team, patients and carers. Supportive management and leadership are central to optimise these processes. Organisational constraints are the most commonly perceived barrier to delivering effective rehabilitation in hospital settings, which exacerbate silo working and limited patient engagement.

Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review

“…Effective communication was believed to mitigate concerns about falling and activity restriction by attending medical concerns, increasing access to formal care, providing positive feedback, advice on health consequences, and strategies for safe mobility and ADL engagement [ 43 – 47 ]. Effective communication strategies have been considered crucial by clinicians for engaging patients and improving outcomes after hip fracture [ 62 , 63 ]. One cross-sectional study of low quality suggested no association between the use of multiple medications and concerns about falling, even though this may reflect frailty and was associated with concerns about falling after hip fracture in a recent study [ 18 ].…”

Applying the Theoretical Domains Framework to the Implementation of Medicaid Coverage for Doula Services: Doulas’ Perceptions of Barriers and Facilitators in the State of Florida

“…The Theoretical Domains Framework (TDF) provides a useful ‘first step’ toward recognizing and classifying barriers and facilitators that impact implementation of services for Medicaid recipients (Cane, O’Connor, & Michie, 2012). By structuring qualitative data as barriers and facilitators, the TDF permits for targeted intervention (Guerra, Lambe, Manolova, Sadler, & Sheehan, 2022). Comprised of 14 validated domains (knowledge; skills; social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; intention; goals; memory, attention, and decision processes; environmental context and resources; social influences; emotion; and behavioral regulation) to help organize social, cognitive, environmental, and affective influences on one’s behavior, the TDF has previously been applied in qualitative health research to determine healthcare professionals’ perceptions across a variety of settings (Guerra et al, 2022; Pearse, Keogh, Rickard, & Fung, 2021).…”

“…By structuring qualitative data as barriers and facilitators, the TDF permits for targeted intervention (Guerra, Lambe, Manolova, Sadler, & Sheehan, 2022). Comprised of 14 validated domains (knowledge; skills; social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; intention; goals; memory, attention, and decision processes; environmental context and resources; social influences; emotion; and behavioral regulation) to help organize social, cognitive, environmental, and affective influences on one’s behavior, the TDF has previously been applied in qualitative health research to determine healthcare professionals’ perceptions across a variety of settings (Guerra et al, 2022; Pearse, Keogh, Rickard, & Fung, 2021). Previous work has documented the TDF’s usefulness for the synthesis of qualitative evidence related to ‘policy-urgent’ questions (Shaw, Holland, Pattison, & Cooke, 2016), making Florida’s Medicaid reimbursement process an area ripe for exploration.…”

Model of multidisciplinary teamwork in hip fracture care: a qualitative interview study

“…Studies about provision of acute rehabilitation for hip fracture with clinical leaders and physiotherapists have highlighted the importance of communication between professionals and patients in rehabilitation for hip fracture 12 13. Similarly, a recent interview-based study by Guerra and colleagues with healthcare professionals explored acute rehabilitation and implementation 14. The study found that communication and collaboration are central to provision of effective rehabilitation and that organisational constraints are seen as a barrier to such provision.…”