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Scerri A, Innes A, Scerri C. Healthcare professionals' perceived challenges and solutions when providing rehabilitation to persons living with dementia-A scoping review. J Clin Nurs 2023; 32:5493-5513. [PMID: 36710398 DOI: 10.1111/jocn.16635] [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: 09/08/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
AIM This review aimed to map studies related to healthcare professionals' perceptions and attitudes towards the rehabilitation for persons living with dementia and extract what they perceive are the barriers and solutions. BACKGROUND Rehabilitation can improve the quality of life and integration of persons living with dementia into society. However, there are several barriers to accessing rehabilitation services. Healthcare professionals are a source of information to understand the challenges and provide solutions to improve these services. DESIGN Arksey and O' Malley (International Journal of Social Research Methodology, 8, 2005 and 19) five-step framework for scoping reviews and the PRISMA-ScR checklist was used. The PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework was used to identify research and practice recommendations. METHOD Seven databases including Medline Complete, Academic Search Ultimate, Ageline, CINAHL, PsycInfo, Pubmed and Google Scholar were searched. The healthcare professionals' perceived challenges and solutions were categorised using Braun & Clarke (Qualitative Research in Psychology, 3, 2006 and 77) thematic analysis. RESULTS Fifteen articles were selected for review. The challenges and solutions were organised according to their association with three stakeholders; the persons living with dementia/informal caregivers, healthcare professionals and the organisation providing the service. Nine of the studies focused on persons living with dementia following a fall or a hip fracture. Most of the studies focused on the perceptions of allied healthcare professionals, with nurses working in rehabilitation settings being underrepresented. CONCLUSION Healthcare professionals have to consider the complexity of rehabilitating persons living with dementia irrespective of the rehabilitation speciality. Moreover, more studies are needed that focus on the views of rehabilitation nurses. RELEVANCE TO CLINICAL PRACTICE This review provides further evidence of the healthcare professionals' misconceptions about the rehabilitation potential of persons living with dementia. There is a need to educate healthcare professionals about the societal, attitudinal and environmental barriers faced by persons living with dementia and their caregivers. PATIENT CONTRIBUTION No Patient or Public Contribution-scoping review.
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Affiliation(s)
- Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Anthea Innes
- Gilbrea Chair Aging and Mental Health (Health, Aging and Society), McMaster University, Hamilton, Ontario, Canada
| | - Charles Scerri
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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van Dartel D, Wang Y, Hegeman JH, Vermeer M, Vollenbroek-Hutten MMR. Patterns of physical activity over time in older patients rehabilitating after hip fracture surgery: a preliminary observational study. BMC Geriatr 2023; 23:373. [PMID: 37328743 PMCID: PMC10276437 DOI: 10.1186/s12877-023-04054-2] [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: 07/18/2022] [Accepted: 05/20/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND To investigate patterns of continuously monitored physical activity in older patients rehabilitating after hip fracture surgery and the association with patient characteristics. METHODS Physical activity of surgically treated hip fracture patients aged 70 years or older, who were rehabilitating at a skilled nursing home, was continuously monitored using a tri-axial accelerometer. The intensity of physical activity per day was calculated from the accelerometer signals to describe the daily physical activity levels of the enrolled patients. The patterns of three different aspects of physical activity were investigated: overall physical activity, overall variability, and day-to-day variability. Two experts in the geriatric rehabilitation field helped identifying unique physical activity patterns for each aspect based on visual analysis. Eighteen healthcare professionals independently classified each patient in one of the predefined patterns for each aspect. Differences between physical activity patterns and patient characteristics were assessed using a Kruskal-Wallis or Fisher's Exact Test. RESULTS Physical activity data from 66 older patients were used in this preliminary study. A total of six unique patterns were identified for overall physical activity and overall variability, and five unique patterns for the day-to-day variability. The most common pattern found for the overall physical activity and day-to-day variability had a S-shape, which first slowly increased, then steeply increased, and subsequently flattened (n = 23, 34.8%). A N-shape pattern was found the most common pattern for overall variability, which first slowly increased, then steeply increased, then decreased and lastly increased (n = 14, 21.2%). The functionality at admission to rehabilitation, measured with the Barthel Index, and the duration of rehabilitation stay differed between the patterns of physical activity. CONCLUSIONS Multiple patterns of physical activity among older patients during hip fracture rehabilitation were found in this preliminary study. The functionality at admission to rehabilitation and the duration of rehabilitation stay were associated with the different patterns found in this study. Results of this study highlight the importance of personalized hip fracture treatment.
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Affiliation(s)
- Dieuwke van Dartel
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Ying Wang
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Johannes H. Hegeman
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Miriam M. R. Vollenbroek-Hutten
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Board of Directors, Medisch Spectrum Twente, Enschede, The Netherlands
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Dutzi I, Schwenk M, Kirchner M, Jooss E, Bauer JM, Hauer K. Influence of Cognitive Impairment on Rehabilitation Received and Its Mediating Effect on Functional Recovery. J Alzheimers Dis 2021; 84:745-756. [PMID: 34569955 DOI: 10.3233/jad-210620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. OBJECTIVE To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. METHODS Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status. RESULTS Patients with more severe CI received least total therapy hours (TTH) (MMSE < 17, 13.67±6.58 versus MMSE 17-26, 16.12±7.19 and MMSE > 26, 17.79±8.88 h, p = 0.014) and were less often included in occupational therapy (MMSE < 17, 48.9%versus MMSE 17-26, 65.5%and MMSE > 26, 71.4%, p = 0.019) and group-based physiotherapy (MMSE < 17, 73.3%versus MMSE 17-26, 88.5%and MMSE > 26, 81.2%, p = 0.027). Regression models showed that CI negatively impacted TTH (β= 0.24, p = 0.003) and rehabilitation outcome (β= 0.41, p = 0.008). In the mediation model, TTH accounted for 23.18%(p < 0.001) of the relationship between CI and rehabilitation outcome. CONCLUSION Cognitive impairment negatively impacted rehabilitation received. The lower TTH partly mediated the negative association between CI and rehabilitation outcome. Future research should identify specific barriers to therapy provision and optimal length, intensity, and dosage of rehabilitation programs to optimize rehabilitation outcomes in CI.
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Affiliation(s)
- Ilona Dutzi
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Heidelberg, Germany
| | - Michael Schwenk
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Eva Jooss
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Heidelberg, Germany
| | - Jürgen M Bauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Heidelberg, Germany.,Centre for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Heidelberg, Germany
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Chammout G, Kelly-Pettersson P, Hedbeck CJ, Bodén H, Stark A, Mukka S, Sköldenberg O. Primary hemiarthroplasty for the elderly patient with cognitive dysfunction and a displaced femoral neck fracture: a prospective, observational cohort study. Aging Clin Exp Res 2021; 33:1275-1283. [PMID: 32705584 PMCID: PMC8081713 DOI: 10.1007/s40520-020-01651-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND At least one-third of hip fracture patients have some degree of impaired cognitive status, which may complicate their postoperative rehabilitation. AIM We aimed to describe the outcome for elderly patients with cognitive dysfunction operated with hemiarthroplasty (HA) for a femoral neck fracture and to study the impact postoperative geriatric rehabilitation has on functional outcome up to 1 year after surgery. METHODS 98 patients with a displaced femoral neck fracture with a mean age of 86 years were included and followed up to 1 year. The outcomes were hip-related complications and reoperations, the capacity to return to previous walking ability, health-related quality of life, hip function and mortality. RESULTS The prevalence of hip complications leading to a major reoperation was 6% and the 1-year mortality rate was 31%. The lack of geriatric rehabilitation was correlated with poorer outcomes overall and those who receive geriatric rehabilitation were less likely to be confined to a wheelchair or bedridden at the 1-year follow-up. CONCLUSIONS Hemiarthroplasty is an acceptable option for elderly patients with a displaced femoral neck fracture and cognitive dysfunction. A lack of structured rehabilitation is associated with a significant deterioration in walking ability despite a well-functioning hip. However, the causality of this could be due to selection bias of healthier patients being sent to geriatric rehabilitation.
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van Dartel D, Vermeer M, Folbert EC, Arends AJ, Vollenbroek-Hutten MMR, Hegeman JH. Early Predictors for Discharge to Geriatric Rehabilitation after Hip Fracture Treatment of Older Patients. J Am Med Dir Assoc 2021; 22:2454-2460. [PMID: 33933417 DOI: 10.1016/j.jamda.2021.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Data from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included. METHODS Patients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors. RESULTS Higher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively. CONCLUSIONS AND IMPLICATIONS This study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL.
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Affiliation(s)
- Dieuwke van Dartel
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands.
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Ellis C Folbert
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Arend J Arends
- Department of Geriatrics, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
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Zarit SH, Chiusano C, Harrison AS, Sewell L, Krause C, Liu Y. Rehabilitation of persons with dementia: using technology to improve participation. Aging Ment Health 2021; 25:543-550. [PMID: 31941356 DOI: 10.1080/13607863.2020.1711864] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The current study examined how a technology system, "It's Never 2 Late" (iN2L), may help augment traditional rehabilitation strategies for older adults with dementia by improving engagement in therapy sessions and achieving better functional outcomes. METHOD The study used a two group quasi-experimental design. Older adults with dementia (N = 96) were recruited from two rehabilitation departments housed within residential care communities. Participants received daily occupational and physical therapy sessions using treatment as usual (TAU) at one site (n = 49) or treatment with iN2L (n = 47) at the other site. A goal attainment approach was used to assess functional outcomes. It was hypothesized that patients whose therapists used iN2L in treatment will show greater attainment of therapy goals and greater engagement during OT and PT sessions than patients receiving TAU. It was also hypothesized that levels and improvement in engagement will mediate the association of treatment type (iN2L or TAU) with greater goal attainment. RESULTS Participants in the iN2L treatment had significantly higher goal attainment than TAU, significantly higher levels of engagement at baseline, and significantly steeper increases in engagement over the course of therapy. The effects of treatment on goal attainment was significantly mediated by increases in engagement. CONCLUSION Findings suggest that iN2L technology has the potential to increase treatment engagement and enhance rehabilitation outcomes among older adults with dementia.
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Affiliation(s)
- Steven H Zarit
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | | | | - Lynne Sewell
- Presbyterian SeniorCare Network, Oakmont, PA, USA
| | | | - Yin Liu
- Department of Human Development and Family Studies, Utah State University, Logan, UT, USA
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Haslam-Larmer L, Auais M, Donnelly C, Woo K, DePaul V. A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions. Int J Orthop Trauma Nurs 2021; 42:100846. [PMID: 34034064 DOI: 10.1016/j.ijotn.2021.100846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A fragility hip fracture is a serious injury in older adults. After experiencing a fracture, a large percentage of patients do not regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the usage of these early mobility recommendations by health care providers within our institution. An evidence-to-practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence-to-practice gap. There were two aims of this project: a) to describe early mobility activities undertaken on one post surgical unit and, b) to identify if there is an evidence-to-practice gap. METHODS At a large tertiary centre in Toronto, Ontario, medical records from one calendar year were abstracted for older adults (≥65 years of age) recovering from fragility hip fracture repair. Data were collected regarding demographics, co-morbidities, surgery type, post-operative mobility activities, and any post-operative complications. Primary outcomes were: evidence of early mobility activities and a comparison to Health Quality Ontario recommendations for fragility hip fracture care. RESULTS Between 11% and 50% of patients were not participating in early mobility activities. By postoperative day five only two patients had walked over 50 m. Those with low pre-fracture functional ability and a cognitive impairment consistently experienced lower rates of participation compared to patients with high pre-fracture functional ability and no cognitive impairment. Chi-square tests and regression analysis did not reveal any significant associations with variables. CONCLUSIONS There was very limited participation in early mobility activities after surgery. The study was unable to identify any significant relationships between several variables that may impact participation. This chart review identified the processes that have been sustained and highlights potential areas for future interventions.
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Affiliation(s)
- Lynn Haslam-Larmer
- Queen's University, School of Rehab Therapy, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada.
| | - Mohammad Auais
- Queen's University, School of Rehab Therapy, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada
| | - Catherine Donnelly
- Queen's University, School of Rehab Therapy, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada
| | - Kevin Woo
- Queen's University, School of Rehab Therapy, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada
| | - Vincent DePaul
- Queen's University, School of Rehab Therapy, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada
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Mitchell R, Draper B, Brodaty H, Close J, Ting HP, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study. Osteoporos Int 2020; 31:465-474. [PMID: 31897545 DOI: 10.1007/s00198-019-05260-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/05/2019] [Indexed: 12/30/2022]
Abstract
UNLABELLED This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation. INTRODUCTION To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. METHODS A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007-2017 in New South Wales, Australia. RESULTS Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI - 6.6 to - 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5-1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. CONCLUSION Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. HIGHLIGHTS • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.
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Affiliation(s)
- R Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - B Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - H Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - J Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - H P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - R Lystad
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - I Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - L Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - C Sherrington
- School of Public Health, University of Sydney, Sydney, Australia
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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Hunter SW, Divine A. Understanding the factors influencing physiotherapists' attitudes towards working with people living with dementia. Physiother Theory Pract 2020; 37:1448-1455. [PMID: 31964202 DOI: 10.1080/09593985.2019.1710883] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Research suggests healthcare professionals feel uncomfortable or inadequately prepared to provide care to people living with dementia. Importantly, research on the attitudes of physiotherapists toward people with dementia is limited. The objective was to assess personal, educational, and clinical experiences on physiotherapists' attitudes toward working with people with dementia.Methods: An online survey was completed by registered physiotherapists. Data were collected on their dementia knowledge, confidence, and attitudes. Structural equation modeling (SEM) evaluated the factors associated with attitudes of physiotherapists.Results: A total of 231 physiotherapists completed the survey. Participants' scores on knowledge of dementia were excellent. Interactions with people with dementia were positive (67.4%) and access to rehabilitation was important (70.4%). However, most respondents reported a lack of confidence and strategies to successfully deal with cognitive (42.5%) or behavioral (58.3%) symptoms. In the SEM, only education (p = .048) was significantly related to attitude. Specifically, more education was related to more positive attitudes.Conclusions: Scores on knowledge of dementia were high. Yet, most respondents reported reduced confidence from a lack of skills to manage behavioral or cognitive symptoms associated with dementia. More education related to working with people with dementia was significantly related to positive attitudes among physiotherapists.
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Affiliation(s)
- Susan W Hunter
- School of Physical Therapy, Elborn College, University of Western Ontario, London, Ontario, Canada
| | - Alison Divine
- Faculty of Biological Sciences, School of Biomedical Sciences, Sport and Exercise Sciences, University of Leeds, Leeds, UK
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Hunter SW, Armstrong J, Silva M, Divine A. Physiotherapy Students’ Attitudes Toward Working With People With Dementia: A Cross-Sectional Survey. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2019.1690088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Susan W Hunter
- School of Physical Therapy, University of Western Ontario, Room 1588 Elborn College, London, ON, Canada
| | - Jessica Armstrong
- School of Physical Therapy, University of Western Ontario, Room 1588 Elborn College, London, ON, Canada
| | - Mark Silva
- School of Physical Therapy, University of Western Ontario, Room 1588 Elborn College, London, ON, Canada
| | - Alison Divine
- Faculty of Sport and Exercise Psychology, University of Leeds, Leeds, UK
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Mitchell R, Fajardo Pulido D, Ryder T, Norton G, Brodaty H, Draper B, Close J, Rapport F, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals' views. Disabil Rehabil 2019; 43:834-845. [PMID: 31335212 DOI: 10.1080/09638288.2019.1643418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. METHODS Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. RESULTS Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to individual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. CONCLUSIONS The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.IMPLICATIONS FOR REHABILITATIONNeed to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation.Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision.Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability.
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Affiliation(s)
- Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Grace Norton
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - Brian Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Reidar Lystad
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Lara Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | | | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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Loomer L, Downer B, Thomas KS. Relationship between Functional Improvement and Cognition in Short-Stay Nursing Home Residents. J Am Geriatr Soc 2018; 67:553-557. [PMID: 30548843 DOI: 10.1111/jgs.15708] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Improving function is an important outcome of postacute care in skilled nursing facilities (SNFs), but cognitive impairment can limit a resident's ability to improve during a postacute care stay. Our objective was to examine the association between residents' cognitive status on admission and change in self-care and mobility during a Medicare-covered SNF stay. DESIGN Retrospective analysis of Medicare beneficiaries who had a new SNF stay between January and June 2017. SETTING SNFs in the United States. PARTICIPANTS Newly admitted residents with Medicare-covered SNF stays between January and June 2017 (n = 246 395). MEASUREMENTS Residents' self-care and mobility at SNF admission and discharge were determined using items from Section GG (eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting, sit to stand, chair/bed transfer, and toilet transfer) of the Minimum Data Set. Residents were classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired, according to the Cognitive Function Scale. Multivariable regression models controlling for residents' demographic and clinical characteristics and SNF fixed effects were used to identify residents whose discharge scores for self-care and mobility were better or the same as expected according to their cognitive status on admission. RESULTS Residents who were cognitively impaired on admission had lower functional status on admission and were less likely to improve in self-care and mobility compared with residents who were cognitively intact. Approximately 63% of residents who were cognitively intact had discharge scores for self-care and mobility that were better or the same as expected compared with 45% of residents with severe cognitive impairment. CONCLUSIONS Cognitive impairment is associated with poorer self-care and mobility function among SNF residents. These findings have important implications for clinicians, who may need additional support when caring for residents with cognitive impairment to make the same improvements in functional status as residents who are cognitively intact. J Am Geriatr Soc 67:553-557, 2019.
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Affiliation(s)
- Lacey Loomer
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Kali S Thomas
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.,Department of Veterans Affairs Medical Center, Providence, Rhode Island
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Lai YC, Tang PL, Kuo TJ, Hsu CJ. Different impacts of dementia on two-year mortality after osteosynthesis and hemiarthroplasty in treating geriatric hip fractures. Arch Gerontol Geriatr 2018; 79:116-122. [PMID: 30196144 DOI: 10.1016/j.archger.2018.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Geriatric hip fractures are mostly managed by internal fixation (IF) or hemiarthroplasty (HA). Survivorship of dementia patients following these surgeries has not been extensively compared in literature. By analysis of nationwide database, this study aimed to investigate the impact of dementia on two-year mortality after IF and HA in treating geriatric hip fractures. METHOD From retrospective review of Taiwan's National Health Insurance Research Database, we enrolled 153,623 subjects aged 65 years and older with hospitalization for first hip fracture operated by IF (93,029 cases) or HA (60,594 cases) between 2000 and 2011. Postoperative mortality was compared between subjects with and without dementia after adjustments of age, gender, Charlson comorbidity index and hospital level. RESULTS The prevalence of dementia was 5.24% in the IF and 5.29% in the HA group. In the IF group, dementia increased adjusted hazard ratio of one-year (1.06, 95%CI:1.00-1.13) and two-year mortality (1.10, 95%CI:1.05-1.16). However, short and long-term mortality following HA was not significantly impacted by dementia (in-hospital OR:0.79, 95%CI:0.60-1.03; three-month HR:0.99, 95%CI:0.87-1.12; one-year HR:1.01, 95%CI:0.93-1.10; two-year HR:1.03, 95%CI:0.96-1.09). In a subgroup of dementia patients, mortality following IF was 15% higher than HA in one (p = 0.004) and two years (p < 0.001). The negative prognostic factors included female (HR:1.10; 95%CI:1.03-1.18) and aging 65-84 years (HR:1.15; 95%CI:1.00-1.32). CONCLUSION Dementia increased one and two-year mortality following geriatric hip fracture treated by IF, rather than HA. Dementia patients undergoing HA, especially female or 65-84 years old, sustained better one and two-year survival than those receiving IF.
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Affiliation(s)
- Yu-Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Occupational Therapy, Shu Zen junior College of Medicine and Management, Kaohsiung, Taiwan; Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Nursing, Meiho Unervisity, Pingtung, Taiwan; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Tsu-Jen Kuo
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Dental Technology, Shu-Zen junior College of Medicine and Management, Kaohsiung, Taiwan.
| | - Chien-Jen Hsu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Nursing, Fooyin University, Kaohsiung, Taiwan.
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Williams NH, Roberts JL, Din NU, Charles JM, Totton N, Williams M, Mawdesley K, Hawkes CA, Morrison V, Lemmey A, Edwards RT, Hoare Z, Pritchard AW, Woods RT, Alexander S, Sackley C, Logan P, Wilkinson C, Rycroft-Malone J. Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technol Assess 2018; 21:1-528. [PMID: 28836493 DOI: 10.3310/hta21440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Proximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking. OBJECTIVES To develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation. DESIGN Phase I - realist review, survey and focus groups to develop the rehabilitation package. Phase II - parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study. SETTING Recruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge. PARTICIPANTS Older adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area. INTERVENTIONS Participants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients' self-efficacy and increasing the amount and quality of patients' practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions. MAIN OUTCOME MEASURES The primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale - International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers. RESULTS Sixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control, n = 32; intervention, n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen's d = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen's d = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen's d = 0.31) and 1.3 (Cohen's d = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported. CONCLUSIONS Trial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure. TRIAL REGISTRATION Current Controlled Trials ISRCTN22464643. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.
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Affiliation(s)
- Nefyn H Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK.,Betsi Cadwaladr University Health Board, St Asaph, UK
| | | | - Nafees Ud Din
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Nicola Totton
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Kevin Mawdesley
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Claire A Hawkes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew Lemmey
- School of Sports, Health and Exercise Science, Bangor University, Bangor, UK
| | | | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Robert T Woods
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Catherine Sackley
- School of Health and Social Care Research, King's College London, London, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, UK
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Hall AJ, Lang IA, Endacott R, Hall A, Goodwin VA. Physiotherapy interventions for people with dementia and a hip fracture-a scoping review of the literature. Physiotherapy 2017; 103:361-368. [PMID: 28843451 DOI: 10.1016/j.physio.2017.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND People with dementia are 2.7 times more likely to suffer a hip fracture than those without and their management is estimated to cost £0.92 billion per year. Yet there has been little focus on the effectiveness of interventions for this population. OBJECTIVE The aim of this scoping review was to summarise the current available evidence for physiotherapy interventions for people with dementia who fracture their hip as well as to identify gaps in the literature that may require further research. DATA SOURCES A systematic search of the following databases was undertaken-TRIP, CINAHL, Amed, Embase, PEDro, PsycINFO, Cochrane Library, Open Grey, Ethos, ISRCTN, Proquest, PROSPERO and UK Clinical Trials Gateway. STUDY SELECTION Articles were included if they described an intervention which is considered within the scope of a physiotherapist and targeted those with both a hip fracture and dementia. SYNTHESIS METHODS A narrative summary was then undertaken to describe the current state of the literature. RESULTS Twenty six studies were included, of which thirteen were observational, six RCTs, two qualitative, two surveys and three systematic reviews. Only nine studies focused explicitly on physiotherapy interventions. CONCLUSION The findings of this scoping review suggest there is limited evidence to guide physiotherapists in the management of people with dementia who fracture their hip. No evidence was found about perceptions or experiences of patients in this group or of the physiotherapists involved in their care. Further research is needed to develop and evaluate physiotherapy interventions for people with dementia who fracture their hip.
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Affiliation(s)
- A J Hall
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, United Kingdom.
| | - I A Lang
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, United Kingdom
| | - R Endacott
- Centre for Health and Social Care Innovation, Faculty of Health and Human Sciences, Plymouth University, United Kingdom
| | - A Hall
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, United Kingdom
| | - V A Goodwin
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, United Kingdom
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Muir-Hunter SW, Fat GL, Mackenzie R, Wells J, Montero-Odasso M. Defining Rehabilitation Success in Older Adults with Dementia--Results from an Inpatient Geriatric Rehabilitation Unit. J Nutr Health Aging 2016; 20:439-45. [PMID: 26999245 DOI: 10.1007/s12603-015-0585-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To quantify the magnitude of functional recovery in older adults with and without dementia admitted to an inpatient geriatric rehabilitation program by measuring change in measures of global physical function and physical therapy treatment outcomes. DESIGN Retrospective cohort study. SETTING Rehabilitation academic hospital. PARTICIPANTS Consecutive subjects, with (N=65, age 81.9±6.0 y) and without (N=157, age 82.8±7.2 y) a dementia diagnosis, had assessment data at admission and discharge from inpatient geriatric rehabilitation unit. INTERVENTIONS Not applicable. MEASUREMENTS The Functional Independence Measure (FIM) was used to estimate level of independence on activities of daily living. The Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and 2 Minute Walk Test (2MWT) were used to estimate functional mobility and endurance. The FIM (total, motor subscale, cognitive subscale scores) were used to calculate rehabilitation efficacy and efficiency scores. RESULTS After controlling for confounding, there was no group difference for gains on the BBS, TUG, 2MWT; there was no group difference on rehabilitation efficacy and efficiency values based on the FIM motor subscale. The magnitude of the rehabilitation gain using the total FIM score was statistically different between groups, people with dementia having smaller gains. CONCLUSION Older adults with a diagnosis of dementia are capable of making motor function recovery during inpatient sub-acute rehabilitation comparable to their peers without a dementia diagnosis. The metric used to evaluate functional recovery influences the determination of rehabilitation success between groups. Rehabilitation success should be defined among people with a dementia diagnosis by a change in the motor subscale of the FIM, rather than the total FIM score or the gain relative to the maximal FIM score.
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Affiliation(s)
- S W Muir-Hunter
- Dr. Susan Hunter, University of Western Ontario, School of Physical Therapy, Room 1588, Elborn College, London, Ontario, Canada N6G 1H1, Phone: 519-661-2111 ext 88845,
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17
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Muir-Hunter SW, Graham L, Montero Odasso M. Reliability of the Berg Balance Scale as a Clinical Measure of Balance in Community-Dwelling Older Adults with Mild to Moderate Alzheimer Disease: A Pilot Study. Physiother Can 2016; 67:255-62. [PMID: 26839454 DOI: 10.3138/ptc.2014-32] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To measure test-retest and interrater reliability of the Berg Balance Scale (BBS) in community-dwelling adults with mild to moderate Alzheimer disease (AD). Method : A sample of 15 adults (mean age 80.20 [SD 5.03] years) with AD performed three balance tests: the BBS, timed up-and-go test (TUG), and Functional Reach Test (FRT). Both relative reliability, using the intra-class correlation coefficient (ICC), and absolute reliability, using standard error of measurement (SEM) and minimal detectable change (MDC95) values, were calculated; Bland-Altman plots were constructed to evaluate inter-tester agreement. The test-retest interval was 1 week. Results : For the BBS, relative reliability values were 0.95 (95% CI, 0.85-0.98) for test-retest reliability and 0.72 (95% CI, 0.31-0.91) for interrater reliability; SEM was 6.01 points and MDC95 was 16.66 points; and interrater agreement was 16.62 points. The BBS performed better in test-retest reliability than the TUG and FRT, tests with established reliability in AD. Between 33% and 50% of participants required cueing beyond standardized instructions because they were unable to remember test instructions. Conclusions : The BBS achieved relative reliability values that support its clinical utility, but MDC95 and agreement values indicate the scale has performance limitations in AD. Further research to optimize balance assessment for people with AD is required.
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Affiliation(s)
- Susan W Muir-Hunter
- School of Physical Therapy; Gait and Brain Lab, Parkwood Hospital, Lawson Health Research Institute
| | - Laura Graham
- Neurotrauma Rehab Program, Parkwood Hospital, London, Ont
| | - Manuel Montero Odasso
- Gait and Brain Lab, Parkwood Hospital, Lawson Health Research Institute; Schulich School of Medicine & Dentistry, Division of Geriatric Medicine; Department of Epidemiology and Biostatistics, University of Western Ontario
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Mitchell R, Harvey L, Brodaty H, Draper B, Close J. Hip fracture and the influence of dementia on health outcomes and access to hospital-based rehabilitation for older individuals. Disabil Rehabil 2016; 38:2286-95. [PMID: 26765956 DOI: 10.3109/09638288.2015.1123306] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND For older individuals who sustain a hip fracture, the presence of dementia can influence their access to hospital-based rehabilitation. PURPOSE This study compares the characteristics and health outcomes of individuals with and without dementia following a hip fracture; and access to, and outcomes following, hospital-based rehabilitation in a population-based cohort. METHOD An examination of hip fractures involving individuals aged 65 years and older with and without dementia using linked hospitalisation, rehabilitation and mortality records during 2009-2013. RESULTS There were 8785 individuals with and 23 520 individuals without dementia who sustained a hip fracture. Individuals with dementia had a higher age-adjusted 30-d mortality rate compared to individuals without dementia (11.7% versus 5.7%), a lower proportion of age-adjusted 28-d re-admission (17.3% versus 24.4%) and a longer age-adjusted mean length of stay (22.2 versus 21.9 d). Compared to individuals without dementia, individuals with dementia had 4.3 times (95% CI: 3.90-4.78) lower odds of receiving hospital-based rehabilitation. However, when they did receive rehabilitation they achieved significant motor functional gain at discharge compared to admission using the Functional Independence Measure, but to a lesser extent than individuals without dementia. CONCLUSION Within a population-based cohort, older individuals with dementia can benefit from access to, and participation in, rehabilitation activities following a hip fracture. This will ensure that they have the best chance of returning to their pre-fracture physical function and mobility. Implications for Rehabilitation Older individuals with dementia can benefit from rehabilitation activities following a hip fracture. Early mobilisation of individuals post-hip fracture surgery, where possible, is advised. Further work is needed on how best to work with individuals with dementia after a hip fracture in residential aged care to maximise any potential functional gains.
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Affiliation(s)
- Rebecca Mitchell
- a Australian Institute of Health Innovation, Macquarie University , North Ryde, Australia ;,b Falls and Injury Prevention Group , Neuroscience Research Australia, University of New South Wales , Randwick, Australia
| | - Lara Harvey
- b Falls and Injury Prevention Group , Neuroscience Research Australia, University of New South Wales , Randwick, Australia
| | - Henry Brodaty
- c Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales , Kensington, Australia ;,d Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales , Kensington, Australia
| | - Brian Draper
- c Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales , Kensington, Australia ;,d Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales , Kensington, Australia
| | - Jacqueline Close
- b Falls and Injury Prevention Group , Neuroscience Research Australia, University of New South Wales , Randwick, Australia ;,e Prince of Wales Clinical School , University of New South Wales , Kensington, Australia
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Evaluation of patient-centered rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment. BMC Geriatr 2013; 13:136. [PMID: 24330470 PMCID: PMC4028934 DOI: 10.1186/1471-2318-13-136] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/04/2013] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to evaluate outcomes for older persons post-hip fracture repair, including those with cognitive impairment (CI), following implementation of a novel model of care – the Patient-Centered Rehabilitation Model including persons with CI (PCRM-CI). The PCRM-CI is an interdisciplinary rehabilitation program that incorporates education for healthcare professionals (HCPs), including nurses, which is focused on geriatric care including management of dementia and delirium, support for HCPs from an Advanced Practice Nurse, and family support and education. Primary outcome measures were mobility gain from admission to discharge and whether or not patients returned home post-discharge. Methods The PCRM-CI intervention was evaluated using a quasi-experimental design, following implementation in two community hospital inpatient rehabilitation units. One hundred forty-nine patients aged 65 and older participated as patients in the usual care (76) or PCRM-CI intervention (73) groups. Patient mobility was assessed at admission and discharge by the Functional Independence Measure Motor Subscale (FIMM); the difference in mobility scores was defined as mobility gain. Patient discharge location was also captured to determine whether or not patients returned home from inpatient rehabilitation. Results No difference in mobility gain was found between the usual care and PCRM-CI groups as measured by the FIMM. Patients in the intervention group were more likely to return home post-discharge than those in the usual care group (p = 0.02). Conclusions Results of the PCRM-CI evaluation suggest that older adults with CI can successfully be rehabilitated post-hip fracture repair using this novel, interdisciplinary rehabilitation program. Trial registration This trial has been registered with the US National Institutes of Health (ID: NCT01566136)
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Buddingh S, Liang J, Allen J, Koziak A, Buckingham J, Beaupre LA. Rehabilitation for long-term care residents following hip fracture: a survey of reported rehabilitation practices and perceived barriers to delivery of care. J Geriatr Phys Ther 2013; 36:39-46. [PMID: 22576242 DOI: 10.1519/jpt.0b013e3182569b4f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE In Canada, residents of long-term care (LTC) facilities are frequently transferred back to their residential facilities to continue recovery 1 week following hip fractures. Limited evidence is available regarding rehabilitation services in LTC facilities following hip fracture or rehabilitation practices after hip fracture for persons with dementia. We previously performed a systematic review of the impact of rehabilitation after hip fractures on persons with dementia. The purpose of this project was to augment our systematic review findings and determine current reported rehabilitation practices of rehabilitation professionals working in LTC facilities with hip-fractured patients with dementia and examine perceived barriers to the delivery of rehabilitation. METHODS We performed a survey study of rehabilitation professionals working in LTC facilities in a Canadian province, using a modified Delphi Consensus approach and a Web-based survey format. The survey was constructed on the basis of our systematic literature review and through discussions with clinical experts. A 2-round modified Delphi consensus approach was used to attain consensus among respondents. Examination of agreement and disagreement among respondents in the areas of (1) current practice and (2) perceived barriers to care was undertaken. RESULTS A total of 42 respondents completed round 1 and 27 respondents completed round 2. Respondents were primarily female and working as physical therapists or occupational therapists. Most worked at facilities that employed at least 1 physical therapist and 1 occupational therapist. Treatment strategies for patients with hip fracture focused on return to independent ambulation and transfers. Although cognition was seen as a barrier to treatment, respondents implemented strategies to mitigate this barrier. Inadequate time and staffing were also seen as barriers to effective treatment. DISCUSSION Rehabilitation professionals working in LTC facilities reported that the residents with dementia can and should participate in rehabilitation following hip fractures; however, they identified time and staffing constraints in addition to cognitive impairment as barriers. CONCLUSIONS Current research in LTC facilities is very sparse and little is known about the rehabilitation care provided in these facilities. Further research is needed to determine the most effective rehabilitation interventions following hip fractures for residents of LTC facilities with dementia.
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Affiliation(s)
- Sarah Buddingh
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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McGilton KS, Davis A, Mahomed N, Flannery J, Jaglal S, Cott C, Naglie G, Rochon E. An inpatient rehabilitation model of care targeting patients with cognitive impairment. BMC Geriatr 2012; 12:21. [PMID: 22631877 PMCID: PMC3444411 DOI: 10.1186/1471-2318-12-21] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/25/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The course and outcomes of hip fracture patients are often complicated by the presence of dementia and delirium, referred to as cognitive impairment (CI), which limits access to in-patient rehabilitation. In response to this concern, members of our team developed and piloted an in-patient rehabilitation model of care (Patient-Centred Rehabilitation Model; PCRM) targeting patients with hip fracture and CI (PCRM-CI). We are now conducting a 3-year study comparing an inpatient rehabilitation model of care for community dwelling individuals with hip fracture and CI (PCRM-CI) to usual care to determine whether it results in improved mobility at the time of discharge from inpatient rehabilitation. METHODS/DESIGN A non-equivalent pre-post design is being used to evaluate the PCRM-CI compared to usual care. All community dwelling (private home or retirement home) patients following a hip fracture are eligible to participate. Recruitment of both cohorts is taking place at two facilities. Target accrual is 70 hip fracture patients in the PCRM-CI cohort and 70 patients in the usual care cohort. We are also recruiting 70 health care providers (HCPs), who are being trained to implement the PCRM-CI, and their unit managers. Patient data are collected at baseline, discharge, and 6 months post-discharge from an inpatient rehabilitation program. Evaluations include mobility, physical function, and living arrangement. Additional outcome variables are being collected from medical records and from the patients via their proxies. Data on the prevalence and severity of dementia and delirium are being collected. Staff data are collected at baseline and one year after implementation of the model to determine change in staff knowledge and attitudes toward patients with hip fracture and CI. Bi-monthly semi-structured interviews with unit managers have been conducted to examine factors and barriers influencing the model implementation. Data collection began in 2009 and is expected to be completed in 2012. The control cohort of 70 patients has been recruited, and 45 patients have been accrued to the intervention group to date. DISCUSSION Evaluation of this model of care is timely given the increasing proportion of persons with cognitive impairment and hip fractures. TRIAL REGISTRATION The study is registered at http://clinicaltrials.gov, Identifier NCT01566136.
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Affiliation(s)
- Katherine S McGilton
- Department of Research, Toronto Rehabilitation Institute, E.W. Bickle Centre for Continuing Care, 130 Dunn Avenue, Toronto, ON, M6K 2R7, Canada
- L. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Aileen Davis
- Toronto Western Research Institute, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Nizar Mahomed
- Toronto Western Research Institute, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - John Flannery
- MSK Rehabilitation Program, Toronto Rehabilitation Institute, Hillcrest Centre, 47 Austin Terrace, Toronto, ON, M5R 1Y8, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Cheryl Cott
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Gary Naglie
- Department of Research, Toronto Rehabilitation Institute, E.W. Bickle Centre for Continuing Care, 130 Dunn Avenue, Toronto, ON, M6K 2R7, Canada
- Department of Medicine, Baycrest Geriatric Health Care Centre, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Elizabeth Rochon
- Department of Research, Toronto Rehabilitation Institute, E.W. Bickle Centre for Continuing Care, 130 Dunn Avenue, Toronto, ON, M6K 2R7, Canada
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Allen J, Koziak A, Buddingh S, Liang J, Buckingham J, Beaupre LA. Rehabilitation in patients with dementia following hip fracture: a systematic review. Physiother Can 2012; 64:190-201. [PMID: 23449813 DOI: 10.3138/ptc.2011-06bh] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. METHODS Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle-Ottawa Scale was used to assess validity. RESULTS A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. CONCLUSIONS People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings. Purpose: Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Methods: Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle–Ottawa Scale was used to assess validity. Results: A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. Conclusions: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.
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Muir SW, Yohannes AM. The Impact of Cognitive Impairment on Rehabilitation Outcomes in Elderly Patients Admitted with a Femoral Neck Fracture. J Geriatr Phys Ther 2009; 32:24-32. [DOI: 10.1519/00139143-200932010-00006] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Rehabilitation in broad terms is a process aimed at restoring a person's functional capacity particularly in relation to activities of daily living. Studies have shown that hospitalization of older patients is a major risk factor for an often irreversible decline in function, and that functional decline from baseline occurs as early as day two of admission. Rehabilitation is therefore often required for older patients following an admission to an acute hospital. Older patients admitted for rehabilitation are more likely to be functionally impaired and are more medically complex than younger patients.
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