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Walløe S, Roikjær SG, Hansen SMB, Zangger G, Mortensen SR, Korfitsen CB, Simonÿ C, Lauridsen HH, Morsø L. Content validity of patient-reported measures evaluating experiences of the quality of transitions in healthcare settings-a scoping review. BMC Health Serv Res 2024; 24:828. [PMID: 39039533 PMCID: PMC11265152 DOI: 10.1186/s12913-024-11298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
No reviews so far have been conducted to define the constructs of patient-experienced quality in healthcare transitions or to identify existing generic measures of patients' experience of the quality within healthcare transitions. Our aim was to identify domains relevant for people experiencing healthcare transitions when evaluating the quality of care they have received, map the comprehensiveness of existing patient-reported experience measures (PREM), and evaluate the PREMs' content validity. The method was guided by the Joanna Briggs Institutes' guidance for scoping reviews. The search was performed on 07 December 2021 and updated 27 May 2024, in the electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO). The search identified 20,422 publications, and 190 studies were included for review. We identified 30 PREMs assessing at least one aspect of adults' experience of transitions in healthcare. Summarising the content, we consider a model with two domains, organisational and human-relational, likely to be adequate. However, a more comprehensive analysis and adequate definition of the construct is needed. None of the PREMs were considered content valid.
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Affiliation(s)
- Sisse Walløe
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark.
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.
| | - Stine Gundtoft Roikjær
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Neurology, Center for Neurological Research, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Health, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sebrina Maj-Britt Hansen
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Sofie Rath Mortensen
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Christoffer Bruun Korfitsen
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Cochrane Denmark & Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark, Odense, Denmark
| | - Charlotte Simonÿ
- Department of Physio- and Occupational Therapy, Research- and Implmentation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Health, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Morsø
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
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Prieto-Moreno R, Mora-Traverso M, Estévez-López F, Molina-Garcia P, Ortiz-Piña M, Salazar-Graván S, Cruz-Guisado V, Gago ML, Martín-Matillas M, Ariza-Vega P. Effects of the ActiveHip+ mHealth intervention on the recovery of older adults with hip fracture and their family caregivers: a multicentre open-label randomised controlled trial. EClinicalMedicine 2024; 73:102677. [PMID: 38911836 PMCID: PMC11192790 DOI: 10.1016/j.eclinm.2024.102677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Background Mobile health (mHealth) systems are a promising alternative for rehabilitation of hip fracture, addressing constrained healthcare resources. Half of older adults fails to recover their pre-fracture routines, which imposes a burden on caregivers. We aimed to test the effectiveness of the 3-month ActiveHip + mHealth intervention on physical and psychological outcomes of older adults with hip fracture and their family caregivers. Methods In a multicentre open-label randomised controlled trial conducted across 3 hospitals in Andalusia (Spain), patients older than 65 with a hip fracture, who were previously independent and lacked cognitive impairment were recruited alongside with their caregivers. Participants were randomly allocated (1:1) to the intervention group (ActiveHip+) or control (usual care) group. The intervention group underwent a 12-week health education and tele-rehabilitation programme through the ActiveHip + mHealth intervention. The primary outcome, physical performance, was assessed using the Short Physical Performance Battery at three time points: at hospital discharge (baseline), 3-month after surgery (post intervention) and 1-year after surgery follow-up. Primary analyses of primary outcomes and safety data followed an intention-to-treat approach. This study is registered at ClinicalTrials.gov, NCT04859309. Findings Between June 1st, 2021 and June 30th, 2022 data from 105 patients and their caregivers were analysed. Patients engaged in the ActiveHip + mHealth intervention (mean 7.11 points, SE 0.33) showed higher physical performance compared with patients allocated in the control group (mean 5.71 points, SE 0.32) at 3 months after surgery (mean difference in change from baseline 1.40 points, SE 0.36; puncorrected = 0.00011). These benefits were not maintained at 1-year after surgery follow-up (mean difference in change from baseline 0.19 points, SE 0.47; puncorrected = 0.68). No adverse events, including falls and refractures, were reported during the tele-rehabilitation sessions. At 3-months, the intervention group had 2 falls, compared to 4 in the control group, with no observed refractures. At the 1-year follow-up, the intervention group experienced 7 falls and 1 refracture, while the control group had 13 falls and 2 refractures. Interpretation This study suggests that the ActiveHip + mHealth intervention may be effective for recovering physical performance in older adults with hip fracture. Importantly, the implementation of ActiveHip + into daily clinical practice may be feasible and has already been adopted in 18 hospitals, mostly in Spain but also in Belgium and Portugal. Thus, ActiveHip + could offer a promising solution when rehabilitation resources are limited. However, its dependence on caregiver support and the exclusion of participants with cognitive impairment makes it necessary to be cautious about its applicability. In addition, the non-maintenance of the effectiveness at 1-year follow-up highlights the need of refinement the ActiveHip + intervention to promote long-lasting behavioural changes. Funding EIT Health and the Ramón y Cajal 2021 Excellence Research Grant action from the Spanish Ministry of Science and Innovation.
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Affiliation(s)
- Rafael Prieto-Moreno
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
- SPORT Research Group (CTS-1024), CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, 04009, Almería, Spain
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
| | - Marta Mora-Traverso
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sport Science, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Fernando Estévez-López
- SPORT Research Group (CTS-1024), CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, 04009, Almería, Spain
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Mariana Ortiz-Piña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Susana Salazar-Graván
- Orthopaedic Surgery and Traumatology Service, University Hospital Virgen de las Nieves, Granada, Spain
| | - Víctor Cruz-Guisado
- Department of Physical Medicine and Rehabilitation, University Hospital Jerez de la Frontera, Cadiz, Spain
| | - Marta Linares Gago
- Department of Physical Medicine and Rehabilitation, University Hospital Puerto Real, Cadiz, Spain
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health Through Physical Activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sport Science, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
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Pliannuom S, Pinyopornpanish K, Buawangpong N, Wiwatkunupakarn N, Mallinson PAC, Jiraporncharoen W, Angkurawaranon C. Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49482. [PMID: 38865706 PMCID: PMC11208838 DOI: 10.2196/49482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/07/2023] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. OBJECTIVE This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. METHODS We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=-7.89; 95% CI -10.34 to -5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). CONCLUSIONS Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population.
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Affiliation(s)
- Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Poppy Alice Carson Mallinson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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Ariza-Vega P, Prieto-Moreno R, Mora-Traverso M, Molina-García P, Ashe MC, Martín-Matillas M. Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study. Disabil Rehabil Assist Technol 2024; 19:1009-1018. [PMID: 36308295 DOI: 10.1080/17483107.2022.2138999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Hip fracture results in an older person's loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. MATERIALS AND METHODS Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n = 2), caregivers (n = 3), and health providers (n = 2)] with 45 participants (14 older adults, 21 caregivers and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording sessions, transcription and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. RESULTS Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. CONCLUSIONS Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Molina-García
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
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Wang L, Wang X, Zhang R, He C. Emerging trends and prospects in telerehabilitation for hip fracture: Bibliometric and visualization study. Digit Health 2024; 10:20552076241255465. [PMID: 38798887 PMCID: PMC11128182 DOI: 10.1177/20552076241255465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background Telerehabilitation provide distant physical rehabilitation services and help overcome the barriers associated with face-to-face interventions for hip fractures. This study aims to analyse the progress of the application of telerehabilitation in hip fracture and reveal its research profile, hotspots and development trends. Methods The articles and reviews related to telerehabilitation in hip fracture were retrieved from 1992 to 2024. A bibliometric visualization and comparative analysis of countries, institutions, journals, authors, references and keywords were conducted using Java-based CiteSpace and VOSviewer. Results A total of 79 documents were obtained. Spain was the most academically influential country. The University of Granada was the most prolific institution. The author Ariza-vega P listed first in terms of publications and citations. Most publications were published in high academic impact journals. The major frontier keywords were "older adults," "functional recovery," "reliability," "mortality," "rehabilitation," "mobility" and "quality of life." The most popular keywords from 2020 to 2024 were "geriatric medicine," "family caregiver" and "digital health." Conclusions The historical and prospective perspective in telerehabilitation following hip fracture were presented. A primary focus in the early years was the impact of telerehabilitation on functional independence for hip fracture patients. Future outcomes are expected to include patient satisfaction, health-related quality of life and psychiatric symptoms. Exercise was also designed to eliminate travel burdens and strengthen self-efficacy, and improve the physical and psychosocial function of hip fracture patients. This work will provide a fundamental reference as well as a directional guide for future research.
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Affiliation(s)
- Liqiong Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xiangxiu Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Ruishi Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chengqi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
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Djukanovic I, Hellström A, Wolke A, Schildmeijer K. The meaning of continuity of care from the perspective of older people with complex care needs-A scoping review. Geriatr Nurs 2024; 55:354-361. [PMID: 38171186 DOI: 10.1016/j.gerinurse.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
People aged 65 years or older with complex care needs are at risk of fragmented care. This may jeopardise patient safety. Complex care needs are defined as care needs that require the performance of time-consuming processes such as reviewing medical history, providing counselling, and prescribing medications. A scoping review was conducted with the aim of mapping the literature regarding continuity of care from the perspective of older people with complex care needs. Search results from seven databases (PubMed, Cinahl, PsycInfo, ASSIA, Web of Science, Google Scholar, Scopus, DOAJ), grey literature (BASE), and a hand-search search of key journals were used. A deductive analysis based on aspects of continuity of care was performed. The search resulted in 5704 records. After a title and abstract screening, 93 records remained. In total, 18 articles met the inclusion criteria and were included in the scoping review. Older people´s sense of continuity of care increases when fewer healthcare workers are involved in their care but help from skilled professionals is more important than meeting the same person. It is vital for older people's feeling of continuity of care that discharge planning involves them, their families, and care providers in an organised way.
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Affiliation(s)
- Ingrid Djukanovic
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar SE-39182, Sweden.
| | - Amanda Hellström
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar SE-39182, Sweden
| | - Anna Wolke
- Linnaeus University, University Library, Kalmar SE-39182, Sweden
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Carbone S, Berta W, Law S, Kuluski K. Long-term care transitions during a global pandemic: Planning and decision-making of residents, care partners, and health professionals in Ontario, Canada. PLoS One 2023; 18:e0295865. [PMID: 38100397 PMCID: PMC10723734 DOI: 10.1371/journal.pone.0295865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
The COVID-19 pandemic appears to have shifted the care trajectories of many residents and care partners in Ontario who considered leaving LTC to live in the community for a portion or the duration of the pandemic. This type of care transition-from LTC to home care-was highly uncommon prior to the pandemic, therefore we know relatively little about the planning and decision-making involved. The aim of this study was to describe who was involved in LTC to home care transitions in Ontario during the COVID-19 pandemic, to what extent, and the factors that guided their decision-making. A qualitative description study involving semi-structured interviews with 32 residents, care partners and health professionals was conducted. Transition decisions were largely made by care partners, with varied input from residents or health professionals. Stakeholders considered seven factors, previously identified in a scoping review, when making their transition decisions: (a) institutional priorities and requirements; (b) resources; (c) knowledge; (d) risk; (e) group structure and dynamic; (f) health and support needs; and (g) personality preferences and beliefs. Participants' emotional responses to the pandemic also influenced the perceived need to pursue a care transition. The findings of this research provide insights towards the planning required to support LTC to home care transitions, and the many challenges that arise during decision-making.
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Affiliation(s)
- Sarah Carbone
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Smith TO, Khoury R, Hanson S, Welsh A, Grant K, Clark AB, Ashford PA, Hopewell S, Pfeiffer K, Logan P, Crotty M, Costa ML, Lamb S. Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER): multicentre randomised controlled feasibility trial with embedded qualitative study in England. BMJ Open 2023; 13:e073611. [PMID: 38070926 PMCID: PMC10729129 DOI: 10.1136/bmjopen-2023-073611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. DESIGN Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study. SETTING National Health Service (NHS) providers in five English hospitals. PARTICIPANTS Community-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers. INTERVENTION Usual care: usual NHS care. EXPERIMENTAL usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme comprised three, 1 hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting predischarge. After discharge, patients and caregivers were supported through three telephone coaching sessions. RANDOMISATION AND BLINDING Central randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding. MAIN OUTCOME MEASURES Data collected at baseline and 4 months post randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals. RESULTS 102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine per cent (515/1311) of patients screened were eligible. Eleven per cent (56/515) of eligible patients consented to be randomised. Forty-eight per cent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable. CONCLUSIONS The HIP HELPER programme was acceptable to patient-caregiver dyads and health professionals. The COVID-19 pandemic impacting on site's ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT. TRIAL REGISTRATION NUMBER ISRCTN13270387.
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Affiliation(s)
- Toby O Smith
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Reema Khoury
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Allie Welsh
- School of Education, University of East Anglia, Norwich, UK
| | - Kelly Grant
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - K Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Smith TO, Langford S, Ward K, Gray R. Unpaid caregiving for people following hip fracture: longitudinal analysis from the English Longitudinal Study of Ageing. Eur Geriatr Med 2023; 14:1249-1260. [PMID: 37537519 PMCID: PMC10754765 DOI: 10.1007/s41999-023-00843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE To determine the provision and its change over time in unpaid care for people following hip fracture. METHODS Data were sought from the English Longitudinal Study of Ageing (ELSA) cohort. We identified participants who self-reported experiencing a hip fracture, who had clinical and caregiving data in the previous and subsequent two data collection waves. Demographic and clinical data were collected in addition to data on provision of unpaid care, who provided care and the frequency of needs being met. RESULTS The analysed cohort consisted of 246 participants [150 females (61%), mean age 78.9 years (standard deviation: 8.6)]. There was an increase in the number of participants requiring unpaid care between the Pre-Fracture and Fracture Wave (29% vs. 59%), which plateaued in the subsequent two waves (56%; 51%). Although both spouse and daughters provided the most unpaid care to participants over this study period, there was an increase in support provided during the Fracture Wave by both sons and daughters. This increased support offered by spouses continued until Post-Fracture Wave 2 when this plateaued. Support provided by friends increased from 3 to 8% and brothers and sisters increased from 0 and 1% Pre-Fracture to 8% by Post-Fracture Wave 2. CONCLUSION These findings provide insights into who, what and how unpaid carers support people following hip fracture over time. Given the level of support unpaid carers offer, and previously reported carer stress and burden, undertaking clinical trials to assess the effectiveness of carer-patient support interventions would be valuable.
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Affiliation(s)
- Toby O Smith
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
| | - S Langford
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - K Ward
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - R Gray
- James Paget Hospital, Gorleston, Norfolk, UK
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10
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Moyers PA. Patient Consumerism and Its Influence on the Future of Occupational Therapy. Am J Occup Ther 2023; 77:7705090010. [PMID: 37796620 DOI: 10.5014/ajot.2023.050384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
The cost of care is shifting to the individual in the form of high-deductible health plans and health savings accounts. The public demands and expects innovation in health care and health delivery and is using quality and cost data to make purchasing decisions. Public expectations for convenience are demonstrated in the use of walk-in clinics, telemedicine, and other technologies. As a result of the responsibility for paying and managing one's own health, consumerism involves a curated approach to selecting health services. This Health Policy Perspectives column examines how consumerism influences health care policy, in particular occupational therapy service delivery. Issues that consumerism creates include (1) a lack of publicly shared cost and quality data about occupational therapy; (2) confusion in measurement of client-centered care, patient satisfaction, and patient experience; (3) inadequate incorporation of patient shared decision-making throughout the occupational therapy process; and (4) payment model restrictions in service delivery. Occupational therapy practitioners must help consumers learn, through patient shared decision-making, that occupational therapy is evidence based and produces desired outcomes, thereby both improving the quality and lowering the cost of health care. Occupational therapy practitioners must advocate for lower cost and convenient service options in the community through an array of technologies. Practice scholarship of the clinical doctorate in occupational therapy must focus on conducting consumer research related to patient experience; enhancing service delivery through quality improvement; and innovating practice for new sites and methods of service delivery, including the use of technology.
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Affiliation(s)
- Penelope A Moyers
- Penelope A. Moyers, EdD, OT, FAOTA, is Adjunct Professor, Department of Occupational Therapy, Nova Southeastern University, Fort Lauderdale, FL;
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Liebzeit D, Jaboob S, Bjornson S, Geiger O, Buck H, Arbaje AI, Ashida S, Werner NE. A scoping review of unpaid caregivers' experiences during older adults' hospital-to-home transitions. Geriatr Nurs 2023; 53:218-226. [PMID: 37598425 DOI: 10.1016/j.gerinurse.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
The objective of this scoping review is to examine current evidence regarding unpaid/family caregivers' experiences during older adults' hospital-to-home transitions to identify gaps and opportunities to involve caregivers in transitional care improvement efforts. Eligible articles focused on caregiver experience, outcomes, or interventions during older adults' hospital-to-home transitions. Our review identified several descriptive studies focused on exploring the caregiver experience of older adult hospital-to-home transitions and caregiver outcomes (such as preparedness, strain, burden, health, and well-being). Qualitative studies revealed challenges at multiple levels, including individual, interpersonal, and systemic. Few interventions have targeted or included caregivers to improve discharge education and address support needs during the transition. Future work should target underrepresented and marginalized groups of caregivers, and caregivers' collaboration with community-based services, social networks, or professional services. Work remains in developing and implementing interventions to support both older adult and caregiver needs.
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Affiliation(s)
- Daniel Liebzeit
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA.
| | - Saida Jaboob
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Samantha Bjornson
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Olivia Geiger
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Harleah Buck
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Alicia I Arbaje
- Department of Medicine, Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Nicole E Werner
- Indiana University School of Public Health- Bloomington, Bloomington, IN, USA
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12
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Cano F, Alves E, João A, Oliveira H, Pinho LG, Fonseca C. A rapid literature review on the health-related outcomes of long-term person-centered care models in adults with chronic illness. Front Public Health 2023; 11:1213816. [PMID: 37670836 PMCID: PMC10477001 DOI: 10.3389/fpubh.2023.1213816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction The strong association between age and the increasing prevalence of chronic diseases, makes it imperative to promote self-care throughout life. Systematic knowledge on the health findings of person-centered care models may contribute to designing effective healthcare strategies to promote empowerment for self-care in long-term care. Objective To assess the association between the implementation of person-centered care models that promote self-care training in long-term care and health-related outcomes, among adults with chronic illness. Methods A rapid review of the literature was performed following the Cochrane rapid review methodology. The electronic databases CINAHL, MedicLatina, MEDLINE, and Psychology and Behavioral Sciences Collection were searched for randomized experimental studies, published between 2017 and 2022, that implemented interventions based on person-centered models to promote self-care in adults aged ≥18 years with chronic diseases and needing long-term health care. Verification of the eligibility of the articles and the extraction of data were performed by two independent investigators. Quantitative data on the health-related variables assessed were collected and, through narrative synthesis, health outcomes were grouped into individual, institutional and societal levels. Results Eight studies, mostly conducted in European countries, were included. All satisfied more than 60% of the methodological quality score. A large variability among studies was found regarding the number of participants, the data collection period and duration of the intervention, the samples selected and the care model implemented. A high number of health-related outcomes (n = 17) were analyzed in the studies, using 52 different instruments. The main health-related outcomes were multidimensional, with implications at the individual, institutional and societal levels. The promotion of overall health and wellbeing (n = 4), the implementation of patient-centered care models (n = 1), the positive and more frequent interactions with health professionals (2), the decrease on staff psychosocial distress (n = 1), and the absence of added costs (n = 1), while improving family caregivers' skills (n = 1) were the main health-related outcomes described. Conclusion There is a need to develop robust experimental studies focused on the views and experiences of all stakeholders and conducted in different countries and cultures. Short-, medium- and long-term health outcomes should be measured using internationally accepted and validated scales for chronic patients.
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Affiliation(s)
- Fátima Cano
- Local Health Unit of Baixo Alentejo, Beja, Portugal
| | - Elisabete Alves
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
| | - Ana João
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
| | - Henrique Oliveira
- Instituto de Telecomunicações, Lisbon, Portugal
- Polytechnic Institute of Beja, Beja, Portugal
| | - Lara Guedes Pinho
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
| | - César Fonseca
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
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Ansah JP, Chia AWY, Koh VJW, Lai WX, Koh JSB, Goh KS, Yeo W, Howe TS, Seow DCC, Mamun K, Balasubramanian D, Varman SD, Yeo AKS, Elamin A, Chan AWM, Matchar DB. Systems modelling as an approach for eliciting the mechanisms for hip fracture recovery among older adults in a participatory stakeholder engagement setting. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1184484. [PMID: 37424878 PMCID: PMC10327561 DOI: 10.3389/fresc.2023.1184484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
Introduction Due to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, psychological, and social factors often affects the recovery trajectories of older adults with hip fractures, often complicating the recovery process. Methods This research aims to actively engage stakeholders (including doctors, physiotherapists, hip fracture patients, and caregivers) using the systems modeling methodology of Group Model Building (GMB) to elicit the factors that promote or inhibit hip fracture recovery, incorporating a feedback perspective to inform system-wide interventions. Hip fracture stakeholder engagement was facilitated through the Group Model Building approach in a two-half-day workshop of 25 stakeholders. This approach combined different techniques to develop a comprehensive qualitative whole-system view model of the factors that promote or inhibit hip fracture recovery. Results A conceptual, qualitative model of the dynamics of hip fracture recovery was developed that draws on stakeholders' personal experiences through a moderated interaction. Stakeholders identified four domains (i.e., expectation formation, rehabilitation, affordability/availability, and resilience building) that play a significant role in the hip fracture recovery journey.. Discussion The insight that recovery of loss of function due to hip fracture is attributed to (a) the recognition of a gap between pre-fracture physical function and current physical function; and (b) the marshaling of psychological resilience to respond promptly to a physical functional loss via uptake of rehabilitation services is supported by findings and has several policy implications.
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Affiliation(s)
- John Pastor Ansah
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, United States
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Aloysius Wei-Yan Chia
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Vanessa Jean Wen Koh
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Wei Xuan Lai
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kiat Sern Goh
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - William Yeo
- Orthopaedic Diagnostics Centre, Singapore General Hospital, Singapore, Singapore
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Kaysar Mamun
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
| | | | | | - Andy Kuei Siong Yeo
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - Amal Elamin
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom
| | - Angelique Wei-Ming Chan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - David Bruce Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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14
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O’Neill M, Kornas K, Liang C, Diemert L, Ayanian T, Chang M, Rosella LC. Experiences and Reported Outcomes of Patients and Caregivers Enrolled in an Integrated Care Program for Thoracic Surgery: A Qualitative Evaluation. Int J Integr Care 2023; 23:11. [PMID: 37151781 PMCID: PMC10162348 DOI: 10.5334/ijic.6540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/19/2023] [Indexed: 05/09/2023] Open
Abstract
Background Health care delivery is often poorly coordinated and fragmented. Integrated care (IC) programs represent one solution to improving continuity of care. The aim of this study was to understand experiences and reported outcomes of patients and caregivers in an IC Program that coordinates hospital and home care for thoracic surgery. Methods A process evaluation was undertaken using qualitative methods. We conducted semi-structured interviews with 10 patients and 8 caregivers who received IC for thoracic surgery and were discharged between June 2019 and April 2020. A phenomenological approach was used to understand and characterize patient and caregiver experiences. Thematic analysis began with a deductive approach complemented by an inductive approach. Results Four major themes evolved from patient and caregiver interviews, including 1) coordination and timeliness of patient care facilitated by an IC lead; 2) the provision of person-centred care and relational continuity fostered feelings of partnership with patients and caregivers; 3) clear communication and one shared digital record increased informational continuity; and 4) impacts of IC on patient and caregiver outcomes. Conclusions Patients and caregivers generally reported this IC Program met their health care needs, which may help inform how future IC programs are designed.
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Affiliation(s)
- Meghan O’Neill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CA
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CA
| | - Catherine Liang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CA
| | - Lori Diemert
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CA
| | | | | | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CA
- ICES, Toronto, Ontario, CA
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, CA
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, CA
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15
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Oksholm T, Gissum KR, Hunskår I, Augestad MT, Kyte K, Stensletten K, Drageset S, Aarstad AKH, Ellingsen S. The effect of transitions intervention to ensure patient safety and satisfaction when transferred from hospital to home health care-A systematic review. J Adv Nurs 2023; 79:2098-2118. [PMID: 36762670 DOI: 10.1111/jan.15579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/08/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
AIM The aim of this systematic review is to describe and evaluate the effectiveness of transition interventions to safeguard patient safety and satisfaction during patients' transition from hospital to home health care. DESIGN Systematic review. DATA SOURCES MEDLINE, Ovid Nursing Database, PsycINFO, EMBASE, CINAHL, Clinical Trials and SveMed+ was systematic searched in January 2019 and September 2020 to identify peer-reviewed papers. No language, geographical or publication date restrictions. REVIEW METHODS Cochrane Handbook for Systematic Reviews of Interventions was used. Data analysis focused on aggregated data and a descriptive synthesis. Risk of bias was rated using Cochrane risk-of-bias tool. RESULTS In total, 10,524 references were identified in the literature search, twenty-six articles were included. The interventions were divided into three main groups: (i). systematic patient education pre-discharge; (ii). establishment of contact with the local healthcare services pre-discharge and (iii). follow-up initiated by nurses from the hospital at home post-discharge. The studies either used one intervention or combined two or three interventions. We considered the intervention to improve patient safety or satisfaction when they reported statistically significant results. Only four interventions increased both patient safety and satisfaction, seven interventions increased patient safety and thirteen increased patient satisfaction. Interventions that appear to be quite similar, with the same duration, measured different effects on patients' satisfaction and safety. Interventions that ensured patient safety did not necessarily facilitate patient satisfaction and vice versa. CONCLUSION Interventions can improve patient safety and satisfaction during transfer. However, interventions that improve patient safety or satisfaction do not always match. IMPACT This review suggests that transition interventions can improve patients' safety and satisfaction. However, to compare the impact of future interventions is it important to use standardized measurement tools of satisfaction. There is a need to try out tailored interventions, where interventions are customized to the needs of each patient.
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Affiliation(s)
- Trine Oksholm
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Karen Rosnes Gissum
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Irene Hunskår
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | | | - Kristin Kyte
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Kari Stensletten
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Sigrunn Drageset
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sidsel Ellingsen
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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16
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Fernández-González M, Lozano-Lozano M, Martín-Martín L, Ortiz-Piña M, Martín-Matillas M, Ariza-Vega P. Is a telerehabilitation programme for older adults with hip fracture associated with burden of family caregivers who provide support? Digit Health 2023; 9:20552076231213574. [PMID: 38025098 PMCID: PMC10656811 DOI: 10.1177/20552076231213574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Objective @ctivehip is a home-based multidisciplinary telerehabilitation programme for older adults with hip fracture, conducted with the assistance of their family caregivers. This programme was useful in improving their functional recovery. Nevertheless, we were concerned about how the programme might have affected caregivers, whose assistance was essential for supporting older adults in using new technologies and ensuring their safety during the exercises and activities at home. The aim of the present study was to compare the burden, psychological factors and physical fitness of the family caregivers of older adults who opted the @ctivehip telerehabilitation programme versus those family caregivers of older adults who received the face-to-face rehabilitation provided by the Andalusian Public Healthcare System (in Spain). Methods In this single-blinded, non-randomized clinical trial, participants were older adults with hip fracture and their family caregivers. The telerehabilitation group (n = 30) underwent a 12-week multidisciplinary telerehabilitation programme, and the comparative group (n = 32) received face-to-face rehabilitation. Caregivers outcomes measured were (i) the burden using the Zarit Burden Interview, (ii) the anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and (iii) the Physical Fitness with the International Fitness Scale (IFIS). Results There were not statistically significant differences on caregiver burden between family caregivers in the @ctivehip and the comparative group, although there was a trend towards lower values [[Mean (95%CI); 14.73 (9.09 to 20.37) vs 16.03 (10.63 to 21.43); p = 0.771] as well as for anxiety and depression [5.66 (3.21 to 8.78) vs 11.19 (8.52 to 13.86); p = 0.022]. Likewise achieved better, though not statistically significant, scores in physical fitness [19.37 (17.94 to 20.81) vs 17.15 (15.77 to 18.53); p = 0.055]. Conclusion Caregiver burden is not associated with telerehabilitation. In addition, telerehabilitation is associated with lower anxiety and depression levels among family caregivers who opt for this programme. Physical fitness is not related with telerehabilitation.
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Affiliation(s)
- María Fernández-González
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Mario Lozano-Lozano
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- “Cuídate” Support Unit for Oncology Patients, Sport and Health University Research Institute (iMUDS), Granada, Spain
| | - Lydia Martín-Martín
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- “Cuídate” Support Unit for Oncology Patients, Sport and Health University Research Institute (iMUDS), Granada, Spain
| | - Mariana Ortiz-Piña
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sport Science, University of Granada, Granada, Spain
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Bowley JJ, Faulkner K, Finch J, Gavaghan B, Foster M. Understanding the Experiences of Rural- and Remote-Living Patients Accessing Sub-Acute Care in Queensland: A Qualitative Descriptive Analysi. J Multidiscip Healthc 2022; 15:2945-2955. [PMID: 36582587 PMCID: PMC9793724 DOI: 10.2147/jmdh.s391738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The challenges associated with equitable healthcare access are often more pronounced for individuals living in rural and remote locations, compared to those in metropolitan locations. This study examined the health care transitions of rural- and remote-living patients with on-going sub-acute needs, following acute hospital discharge. This was done with the aim of exploring these patients' experiences of client-centeredness and continuity of care, and identifying common challenges faced by rural and remote sub-acute patients accessing and transitioning to and through sub-acute care in a non-metropolitan context. Materials and Methods Semi-structured interviews were conducted with 37 sub-acute patients. A qualitative descriptive approach was used to analyze the interview data and explore key emergent themes in relation to client-centeredness, continuity of care, and sub-acute transition challenges. Results Interview participants' average length of stay in sub-acute care was 31.6 days (range = 8-86 days), with most transitioning from larger regional and metropolitan hospitals to on-going rural or remote sub-acute care (n = 19; 53%). Client-centeredness was primarily characterized by the quality of interpersonal experiences with staff, patient and familial involvement in care planning, and the degree to which patients felt their wishes were respected and advocated for. Continuity of care was characterized by access to and participation in rehabilitation services, and access to family and social supports. Challenges associated with sub-acute transitions were explored. Discussion The findings suggest important implications for health care providers, including the need to implement earlier and more frequent opportunities for patient involvement throughout the sub-acute journey. The results offer a unique perspective on the way that continuity of care is experienced and conceptualized by rural and remote patients, suggesting a revision of what is required to achieve equitable care continuity for rural and remote residents receiving care far from home. Conclusion It is pertinent for health care providers to consider the unique complexities associated with accessing on-going health care as a rural or remote Australian resident, and to develop mechanisms that support equitable access and continuity and facilitate continuity of care closer to home.
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Affiliation(s)
- Jessica J Bowley
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Queensland, Australia,Correspondence: Jessica J Bowley, The Hopkins Centre, Griffith University, 170 Kessels Road, Brisbane, Queensland, Australia, Tel +61 3735 8136, Email
| | - Kirstie Faulkner
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Jennifer Finch
- Allied Health Professions’ Office of Queensland, Clinical Excellence Queensland, Brisbane, Queensland, Australia
| | - Belinda Gavaghan
- Allied Health Professions’ Office of Queensland, Clinical Excellence Queensland, Brisbane, Queensland, Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Queensland, Australia
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18
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Cadel L, Kuluski K, Everall AC, Guilcher SJT. Recommendations made by patients, caregivers, providers, and decision-makers to improve transitions in care for older adults with hip fracture: a qualitative study in Ontario, Canada. BMC Geriatr 2022; 22:291. [PMID: 35392830 PMCID: PMC8988316 DOI: 10.1186/s12877-022-02943-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older adults frequently experience fall-related injuries, including hip fractures. Following a hip fracture, patients receive care across a number of settings and from multiple different providers. Transitions between providers and across settings have been noted as a vulnerable time, with potentially negative impacts. Currently, there is limited research on how to improve experiences with transitions in care following a hip fracture for older adults from the perspectives of those with lived experienced. The purpose of this study was to explore service recommendations made by patients, caregivers, healthcare providers, and decision-makers for improving transitions in care for older adults with hip fracture. Methods This descriptive qualitative study was part of a larger longitudinal qualitative multiple case study. Participants included older adults with hip fracture, caregivers supporting an individual with hip fracture, healthcare providers, and decision-makers. In-depth, semi-structured interviews were conducted with all participants, with patients and caregivers having the opportunity to participate in follow-up interviews as they transitioned out of hospital. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Results A total of 47 participants took part in 65 interviews. We identified three main categories of recommendations: (1) hospital-based recommendations; (2) community-based recommendations; and (3) cross-sectoral based recommendations. Hospital-based recommendations focused on treating patients and families with respect, improving the consistency, frequency, and comprehensiveness of communication between hospital providers and between providers and families, and increasing staffing levels. Community-based recommendations included the early identification of at-risk individuals and providing preventative and educational programs. Cross-sectoral based recommendations were grounded in enhanced system navigation through communication and care navigators, particularly within primary and community care settings. Conclusions Our findings highlighted the central role primary care can play in providing targeted, integrated services for older adults with hip fracture. The recommendations outlined have the potential to improve experiences with care transitions for older adults with hip fracture, and thus, addressing and acting on them should be a priority.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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19
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Murthy S, Clapp JT, Burson RC, Fleisher LA, Neuman MD. Physicians' perspectives of prognosis and goals of care discussions after hip fracture. J Am Geriatr Soc 2022; 70:1487-1494. [PMID: 34990017 PMCID: PMC9106823 DOI: 10.1111/jgs.17642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hip fracture often represents a major transition in patients' health, with a 1-year mortality rate between 25% and 30% and a challenging recovery course. Caring for hip fracture patients presents opportunities for goals of care discussions that include prognostic information and guidance about functional dependence. METHODS We conducted qualitative, semi-structured interviews with 23 attending physicians involved with the care of hip fracture patients, including orthopedic surgeons, anesthesiologists, internists, and geriatricians, across 13 health systems in the United States and Canada. Questions addressed knowledge and interpretation of prognosis, discussing prognosis and goals of care, and timing and prioritization of surgery. Interviews were analyzed using a constructivist grounded theory approach to identify themes and develop a coding taxonomy. RESULTS Physicians agreed that hip fracture had a considerable 1-year mortality, felt that it was important to discuss prognostic outcomes and the recovery process, wanted to elucidate patients' priorities, and often promoted timely surgery. Physicians perceived challenges when discussing mortality data with new patients in an acute setting. They more easily discussed outcomes related to functional dependence and quality of life. Some physicians used iterative communication as a strategy to have in-depth conversations in a busy perioperative setting. CONCLUSION Providing timely, compassionate care for hip fracture patients is challenging. There are opportunities to study iterative communication to encourage dialogue at key points of patient care to better discuss prognosis and recovery and bolster coordinated multidisciplinary care that focuses on patients' goals and values.
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Affiliation(s)
- Sushila Murthy
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin T Clapp
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Randall C Burson
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lee A Fleisher
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Ariza-Vega P, Prieto-Moreno R, Castillo-Pérez H, Martínez-Ruiz V, Romero-Ayuso D, Ashe MC. Family Caregivers' Experiences with Tele-Rehabilitation for Older Adults with Hip Fracture. J Clin Med 2021; 10:jcm10245850. [PMID: 34945145 PMCID: PMC8708159 DOI: 10.3390/jcm10245850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/17/2023] Open
Abstract
Background: There is a knowledge gap for implementing tele-rehabilitation (telerehab) after hip fracture. We recently conducted a clinical trial (ClinicalTrials.gov Identifier: NCT02968589) to test a novel online family caregiver-supported rehabilitation program for older adults with hip fracture, called @ctivehip. In this qualitative substudy, our objective was to use semi-structured interviews to explore family caregivers experience with the telerehab program. Methods: Twenty-one family caregivers were interviewed between three and six months after the older adults completed @ctivehip. One occupational therapist with research and clinical experience, but not involved in the main trial, conducted and transcribed the interviews. We conducted a multi-step content analysis, and two authors completed one coding cycle and two recoding cycles. Results: Family caregivers who enrolled in @ctivehip were satisfied with the program, stated it was manageable to use, and perceived benefits for older adults’ functional recovery after hip fracture. They also suggested improvements for the program content, such as more variety with exercises, and increased monitoring by health professionals. Conclusions: This work extends existing literature and generates research hypotheses for future studies to test telerehab content and program implementation.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (P.A.-V.); (D.R.-A.)
- Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, 18071 Granada, Spain
| | - Rafael Prieto-Moreno
- Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, 18071 Granada, Spain
- Correspondence:
| | | | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain;
- Center for Biomedical Research in Network of Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
| | - Dulce Romero-Ayuso
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (P.A.-V.); (D.R.-A.)
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, Department of Family Practice, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
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21
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Zalmay P, Collis J, Wilson H. Patients Lacking the Capacity to Consent to Hip Fracture Surgery May Be Undergoing Major Operations Without Their Next of Kin Being Involved in Best-Interests Decisions: A Quality Improvement Report. Cureus 2021; 13:e20322. [PMID: 35028219 PMCID: PMC8742997 DOI: 10.7759/cureus.20322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Cognitively impaired patients with a hip fracture may be undergoing major operations without attempts being made to involve their next of kin (NoK) in best-interest decisions. Methods We used the Plan-Do-Study-Act (PDSA) methodology to guide our quality improvement (QI) project. Cognitively impaired hip fracture patients were identified retrospectively by searching the hip fracture database of a medium-sized district general hospital (DGH). Their medical notes were reviewed for documented attempts at contacting their NoK prior to surgery as well as on completion of the NoK section of the Consent Form Four. Intervention A simple feedback intervention was delivered in the form of a mixed verbal and visual presentation to the orthopaedic registrars responsible for obtaining consent from these patients. Results Post-intervention, there were documented attempts at contacting the NoK before surgery for all patients, a significant improvement from only 80%. There was also a significant increase in completion of the NoK section of the consent form, from 30% to 64.3%. Conclusions Simple audit and feedback interventions can produce significant positive changes in communication between clinicians and the NoK of cognitively impaired patients with hip fractures. Further interventions have been implemented to sustain these improvements.
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Affiliation(s)
- Pardis Zalmay
- Trauma and Orthopaedics, Royal Surrey County Hospital NHS Foundation Trust, London, GBR
| | - Justin Collis
- Trauma and Orthopaedics, Medway Maritime NHS Foundation Trust, Gillingham, GBR
| | - Helen Wilson
- Geriatrics, Royal Surrey County Hospital NHS Foundation Trust, London, GBR
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22
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Smith T, Clark L, Khoury R, Man MS, Hanson S, Welsh A, Clark A, Hopewell S, Pfeiffer K, Logan P, Crotty M, Costa M, Lamb SE. A feasibility study to assess the design of a multicentre randomized controlled trial of the clinical and cost-effectiveness of a caregiving intervention for people following hip fracture surgery. Bone Jt Open 2021; 2:909-920. [PMID: 34753296 PMCID: PMC8636304 DOI: 10.1302/2633-1462.211.bjo-2021-0136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. Methods This will be a mixed-methods feasibility RCT, recruiting 60 patients following hip fracture surgery and their informal caregivers. Patients will be randomized to usual NHS care, versus usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme will comprise of three, one-hour, one-to-one training sessions for the patient and caregiver, delivered by a nurse, physiotherapist, or occupational therapist. Training will be delivered in the hospital setting pre-patient discharge. It will include practical skills for rehabilitation such as: transfers and walking; recovery goal setting and expectations; pacing and stress management techniques; and introduction to the HIP HELPER Caregiver Workbook, which provides information on recovery, exercises, worksheets, and goal-setting plans to facilitate a ‘good’ recovery. After discharge, patients and caregivers will be supported in delivering rehabilitation through three telephone coaching sessions. Data, collected at baseline and four months post-randomization, will include: screening logs, intervention logs, fidelity checklists, quality assurance monitoring visit data, and clinical outcomes assessing quality of life, physical, emotional, adverse events, and resource use outcomes. The acceptability of the study intervention and RCT design will be explored through qualitative methods with 20 participants (patients and informal caregivers) and 12 health professionals. Discussion A multicentre recruitment approach will provide greater external validity across population characteristics in England. The mixed-methods approach will permit in-depth examination of the intervention and trial design parameters. The findings will inform whether and how a definitive trial may be undertaken to test the effectiveness of this caregiver intervention for patients after hip fracture surgery. Cite this article: Bone Jt Open 2021;2(11):909–920.
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Affiliation(s)
- Toby Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lucy Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Reema Khoury
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Mei-See Man
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allie Welsh
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allan Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Klaus Pfeiffer
- Department of Geriatric Rehabilitation, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Flinders University, Adelaide, Australia
| | - Matthew Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,University of Oxford, Oxford, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK.,University of Exeter, Exeter, UK
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23
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2021; 33:2405-2443. [PMID: 34287785 DOI: 10.1007/s40520-021-01898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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Ropke A, Lund K, Thrane C, Juhl C, Morville AL. Developing an individualised cross-sectoral programme based on activities of daily living to support rehabilitation of older adults with hip fracture: a qualitative study. BMJ Open 2021; 11:e044539. [PMID: 34145009 PMCID: PMC8215248 DOI: 10.1136/bmjopen-2020-044539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently. DESIGN Qualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles. SETTINGS University Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities. PARTICIPANTS One research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists). RESULTS Three generic categories were identified: (1) 'Challenge older adults with goal-oriented ADL tasks', (2) 'Implement strategies to enhance independent and safe performance of ADL tasks', and (3) 'Communicate the important information to the target group and across sectors'. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call. CONCLUSIONS Engaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme. TRIAL REGISTRATION NUMBER This article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID: NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID: NCT04207788; Pre-results.
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Affiliation(s)
- Alice Ropke
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karina Lund
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Camilla Thrane
- Health Promotion and Rehabilitation, Municipality of Herlev, Herlev, Denmark
| | - Carsten Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne-Le Morville
- ADULT Research Group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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25
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Guilcher SJT, Maunula L, Cadel L, Everall AC, Li J, Kuluski K. Caregiving for older adults with hip fractures: Exploring the perspectives of caregivers, providers and decision-makers in Ontario, Canada. Arch Gerontol Geriatr 2020; 93:104321. [PMID: 33359957 DOI: 10.1016/j.archger.2020.104321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Caregivers play an important role in providing physical, emotional and social support to individuals with hip fracture. This study sought to explore perceptions of caregiving for older adults with hip fractures by comparing experiences of caregivers, providers and decision-makers. METHODS Semi-structured interviews were conducted both in-person and by telephone with caregivers, providers and decision-makers (n=32) from one rural and one urban hospital selected from two health regions in Ontario, Canada. Interviews were audio-recorded and transcribed verbatim. The data were coded descriptively and interpretively, and compared within and across participants types. RESULTS Three main themes reflected tensions between caregivers and providers/decision-makers. Firstly, differing expectations of caregiver roles were identified. Several caregivers wanted more participation in the decision-making process but often felt excluded, while others expressed feeling stressed due to the expectations placed on them. Conversely, providers and decision-makers often described caregivers needing to strike a balance between providing supportive care while avoiding becoming too involved. Secondly, different expectations of what the healthcare system and providers could provide, with tensions particularly around timing of discharge were noted. Finally, there were differing perceptions of information needs. Providers spoke about the importance of providing education to caregivers and perceived themselves to be providing appropriate education. However, caregivers often described poor communication and not having a clear understanding of next steps and the care plan. CONCLUSION Managing and tailoring expectations, improving communication (e.g., content, timing) and the consistency of information shared with caregivers from different providers could facilitate more positive caregiving experiences and interactions.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, M5SM2; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, M5T 3M6.
| | - Laena Maunula
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, M5SM2
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, M5SM2; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada, L5B 1B8
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, M5SM2
| | - Joyce Li
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, M5T 3M6
| | - Kerry Kuluski
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, M5T 3M6; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada, L5B 1B8
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26
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Chi-Lun-Chiao A, Chehata M, Broeker K, Gates B, Ledbetter L, Cook C, Ahern M, Rhon DI, Garcia AN. Patients' perceptions with musculoskeletal disorders regarding their experience with healthcare providers and health services: an overview of reviews. Arch Physiother 2020; 10:17. [PMID: 32983572 PMCID: PMC7517681 DOI: 10.1186/s40945-020-00088-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives This overview of reviews aimed to identify (1) aspects of the patient experience when seeking care for musculoskeletal disorders from healthcare providers and the healthcare system, and (2) which mechanisms are used to measure aspects of the patient experience. Data sources Four databases were searched from inception to December 20th, 2019. Review methods Systematic or scoping reviews examining patient experience in seeking care for musculoskeletal from healthcare providers and the healthcare system were included. Independent authors screened and selected studies, extracted data, and assessed the methodological quality of the reviews. Patient experience concepts were compiled into five themes from a perspective of a) relational and b) functional aspects. A list of mechanisms used to capture the patient experience was also collected. Results Thirty reviews were included (18 systematic and 12 scoping reviews). Relational aspects were reported in 29 reviews and functional aspects in 25 reviews. For relational aspects, the most prevalent themes were “information needs” (education and explanation on diseases, symptoms, and self-management strategies) and “understanding patient expectations” (respect and empathy). For functional aspects, the most prevalent themes were patient’s “physical and environmental needs,” (cleanliness, safety, and accessibility of clinics), and “trusted expertise,” (healthcare providers’ competence and clinical skills to provide holistic care). Interviews were the most frequent mechanism identified to collect patient experience. Conclusions Measuring patient experience provides direct insights about the patient’s perspectives and may help to promote better patient-centered health services and increase the quality of care. Areas of improvement identified were interpersonal skills of healthcare providers and logistics of health delivery, which may lead to a more desirable patient-perceived experience and thus better overall healthcare outcomes. Trial registration Systematic review registration: PROSPERO (CRD42019136500).
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Affiliation(s)
- Alan Chi-Lun-Chiao
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Durham, North Carolina USA
| | - Mohammed Chehata
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Durham, North Carolina USA
| | - Kenneth Broeker
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Durham, North Carolina USA
| | - Brendan Gates
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Durham, North Carolina USA
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina USA
| | - Chad Cook
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Duke Clinical Research Institute, Durham, North Carolina USA
| | - Malene Ahern
- University of Wollongong, Australian Health Services Research Institute, Sydney, New South Wales Australia
| | - Daniel I Rhon
- Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX USA
| | - Alessandra N Garcia
- College of Pharmacy & Health Sciences, Physical Therapy Program, Lillington, North Carolina USA
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27
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Shen MH, Yang CT, Wu CC, Huang HL, Lin YE, Shyu YIL, Chung SC. Resuming Normal Life as a Family Caregiver During Drip-Like Recovery of Older Persons With Cognitive Impairment Recovering From Hip Surgery: A Grounded Theory. J Nurs Scholarsh 2020; 52:250-260. [PMID: 32246742 DOI: 10.1111/jnu.12554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was undertaken to develop a theoretical framework explaining family caregiving processes for older persons with cognitive impairment recovering from hip fracture surgery. DESIGN AND METHODS In this grounded theory study, data were collected in audio-recorded face-to-face interviews with 21 family caregivers. Among these caregivers, 14 cared for hip-fractured persons with cognitive impairment, and seven cared for those without cognitive impairment. Caregivers were interviewed five times after patients' discharge: at 1 week and at 1, 3, 6, and 12 months. Data were analyzed by constant comparative analysis. FINDINGS The core category explaining the family caregiving process for hip-fractured persons with cognitive impairment was "resuming normal life during drip-like recovery." This category captures the slowness of the recovery process, as slow as dripping water. During the early postoperative period, caregivers attempted to gain control of the postoperative situation, using various maintenance and improvement strategies to deal with the chaos in individuals and the family and to protect hip-fractured persons with cognitive impairment from further harm. The goal of recovery was to get back to their original life. CONCLUSIONS Family caregivers of hip-fractured older persons with cognitive impairment needed to deal with more complex chaotic situations, exerted more efforts to administer safety measures, and required more time to achieve a stable life pattern. CLINICAL RELEVANCE Since postoperative recovery was perceived as extremely slow, family caregivers of hip-fractured older persons with cognitive impairment should be patient regarding recovery and be informed before hospital discharge of different strategies to resume normal life during postoperative recovery.
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Affiliation(s)
- Mei-Hsing Shen
- Research Assistant, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Tzu Yang
- Lambda Beta Chapter-At-Large, Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Professor and Deputy Director, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huei-Ling Huang
- Associate Professor, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yueh-E Lin
- Supervisor, Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Lambda Beta Chapter-At-Large, Distinguished Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Professor and Group Project Leader, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Research Fellow, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Consultant, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Professor, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Shih-Chi Chung
- Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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