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Taylor NF, Rimayanti MU, Peiris CL, Snowdon DA, Harding KE, Semciw AI, O'Halloran PD, Wintle E, Williams S, Shields N. Hip fracture has profound psychosocial impacts: a systematic review of qualitative studies. Age Ageing 2024; 53:afae194. [PMID: 39238124 PMCID: PMC11377188 DOI: 10.1093/ageing/afae194] [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: 04/12/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Hip fracture is a common and serious traumatic injury for older adults characterised by poor outcomes. OBJECTIVE This systematic review aimed to synthesise qualitative evidence about the psychosocial impact of hip fracture on the people who sustain these injuries. METHODS Five databases were searched for qualitative studies reporting on the psychosocial impact of hip fracture, supplemented by reference list checking and citation tracking. Data were synthesised inductively and confidence in findings reported using the Confidence in the Evidence from Reviews of Qualitative research approach, taking account of methodological quality, coherence, relevance and adequacy. RESULTS Fifty-seven studies were included. Data were collected during the peri-operative period to >12 months post fracture from 919 participants with hip fracture (median age > 70 years in all but 3 studies), 130 carers and 297 clinicians. Hip fracture is a life altering event characterised by a sense of loss, prolonged negative emotions and fear of the future, exacerbated by negative attitudes of family, friends and clinicians. For some people after hip fracture there is, with time, acceptance of a new reality of not being able to do all the things they used to do. There was moderate to high confidence in these findings. CONCLUSIONS Hip fracture is a life altering event. Many people experience profound and prolonged psychosocial distress following a hip fracture, within a context of negative societal attitudes. Assessment and management of psychosocial distress during rehabilitation may improve outcomes for people after hip fracture.
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Affiliation(s)
- Nicholas F Taylor
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health Clinical Research Office, Eastern Health, 2/5 Arnold Street, Box Hill, Victoria 3128, Australia
| | - Made U Rimayanti
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria 3086, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Casey L Peiris
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria 3086, Australia
- Royal Melbourne Hospital, Parkville, Melbourne 3052, Victoria Australia
| | - David A Snowdon
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria 3086, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria 3133, Australia
| | - Katherine E Harding
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health Clinical Research Office, Eastern Health, 2/5 Arnold Street, Box Hill, Victoria 3128, Australia
| | - Adam I Semciw
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health, Northern Health, Epping, Victoria 3076, Australia
| | - Paul D O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3086, Australia
- Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Elizabeth Wintle
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Scott Williams
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Nora Shields
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Victoria 3086, Australia
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Molendijk-van Nieuwenhuyzen K, Belt-van Opstal R, Hakvoort L, Dikken J. Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study. BMC Geriatr 2024; 24:476. [PMID: 38816688 PMCID: PMC11140891 DOI: 10.1186/s12877-024-05023-z] [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: 11/17/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization. METHODS This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed. RESULTS The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit. CONCLUSION Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.
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Affiliation(s)
| | | | | | - Jeroen Dikken
- De Haagse Hogeschool, Faculteit Gezondheid, Voeding & Sport, Johanna Westerdijkplein 75, 2521 EN, The Hague, The Netherlands
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Zare Z, Ghane G, Shahsavari H, Ahmadnia S, Ghiyasvandian S. Social Life After Hip Fracture: A Qualitative Study. J Patient Exp 2024; 11:23743735241241174. [PMID: 38559664 PMCID: PMC10981218 DOI: 10.1177/23743735241241174] [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] [Indexed: 04/04/2024] Open
Abstract
The return to social life after a hip fracture is a major concern for patients and a determinant factor in their recovery. However, patients' perceptions of social life after hip fracture are variable and context-dependent. By identifying these perceptions and strategies of patients, interventions can be strengthened and modified. The aim of this study was to identify patients' perceptions of their social life after hip fracture. This qualitative study used inductive content analysis. Twenty patients with hip fractures who were referred to Tehran University of Medical Sciences hospitals were purposefully selected and included in the study. Data were collected through individual, face-to-face, in-depth, semi-structured interviews conducted by a researcher experienced in carrying out such interviews. The interviews were recorded, immediately transcribed verbatim, and analyzed in MAXQDA-10. The interviewing process continued until data saturation was reached. The data analysis led to the extraction of three categories: Disruption of normal social life, Minimal social life, and Social isolation. The results indicated that the social life of these patients is influenced by physical conditions and contextual factors and progresses over time. All patients experienced meaningful disruption of their social life after experiencing hip fractures and movement limitations. The interdisciplinary perspectives provided by these findings can increase awareness of patients' post-fracture social life perceptions and conditions. These findings can also be used to design future programs for interdisciplinary interventions (involving sociology and medical sciences) to improve social life and increase the ability to return to a normal social life. Recovery management for patients with hip fractures should be preventive and organized by an all-around team (involving medicine, psychology, and sociology) based on patient-centered, community-based, and modern care strategies.
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Affiliation(s)
- Zahra Zare
- Department of Operating Room, School of Allied Medical Science, Tehran University of Medical Sciences, Tehran, Iran
| | - Golnar Ghane
- Department of Medical Surgical Nursing; School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- Department of Medical Surgical Nursing; School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Ahmadnia
- Department of Sociology, School of Social Sciences, University of Allameh Tabataba'i, Tehran, Iran
| | - Shahrzad Ghiyasvandian
- Department of Medical Surgical Nursing; School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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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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Welsh A, Hanson S, Pfeiffer K, Khoury R, Clark A, Ashford PA, Hopewell S, Logan P, Crotty M, Costa M, Lamb S, Smith T, Hip Helper Study C. Perspectives of informal caregivers who support people following hip fracture surgery: a qualitative study embedded within the HIP HELPER feasibility trial. BMJ Open 2023; 13:e074095. [PMID: 37977867 PMCID: PMC10660837 DOI: 10.1136/bmjopen-2023-074095] [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: 03/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to illuminate the perspectives of informal caregivers who support people following hip fracture surgery. DESIGN A qualitative study embedded within a now completed multicentre, feasibility randomised controlled trial (HIP HELPER). SETTING Five English National Health Service hospitals. PARTICIPANTS We interviewed 20 participants (10 informal caregivers and 10 people with hip fracture), following hip fracture surgery. This included one male and nine females who experienced a hip fracture; and seven male and three female informal caregivers. The median age was 72.5 years (range: 65-96 years), 71.0 years (range: 43-81 years) for people with hip fracture and informal caregivers, respectively. METHODS Semistructured, virtual interviews were undertaken between November 2021 and March 2022, with caregiver dyads (person with hip fracture and their informal caregiver). Data were analysed thematically. FINDINGS We identified two main themes: expectations of the informal caregiver role and reality of being an informal caregiver; and subthemes: expectations of care and services; responsibility and advocacy; profile of people with hip fracture; decision to be a caregiver; transition from hospital to home. CONCLUSION Findings suggest informal caregivers do not feel empowered to advocate for a person's recovery or navigate the care system, leading to increased and unnecessary stress, anxiety and frustration when supporting the person with hip fracture. We suggest that a tailored information giving on the recovery pathway, which is responsive to the caregiving population (ie, considering the needs of male, younger and more active informal caregivers and people with hip fracture) would smooth the transition from hospital to home. TRIAL REGISTRATION NUMBER ISRCTN13270387.Cite Now.
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Affiliation(s)
- Allie Welsh
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Reema Khoury
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Allan 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
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sallie Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Toby Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- University of Warwick, Coventry, UK
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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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Participating in the Illness Journey: Meanings of Being a Close Relative to an Older Person Recovering from Hip Fracture-A Phenomenological Hermeneutical Study. NURSING REPORTS 2022; 12:733-746. [PMID: 36278766 PMCID: PMC9624350 DOI: 10.3390/nursrep12040073] [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: 08/30/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 01/24/2023] Open
Abstract
When an older person suffers an acute event, such as a hip fracture, it influences the whole family. Research shows that while close relatives want to be a part of the older person's life during recovery it is associated with a high perceived level of stress and burden. To provide in-depth knowledge of close relatives' experiences in this situation, the aim of this study was to elucidate meanings of being a close relative to an older person recovering from hip fracture surgery.This study has a qualitative descriptive phenomenological hermeneutical design. Narrative interviews were conducted with ten close relatives. Analysis was conducted using phenomenological hermeneutical interpretation which provided a deeper understanding of the close relatives' lived experiences of their older person's recovery from hip fracture surgery. The structural analysis revealed two themes; "Participating in the illness journey", which was constructed of the subthemes of facing the unimaginable yet expected, encountering healthcare personnel, and noticing recovery and "Putting oneself aside", which was constructed of the subthemes of placing daily life on hold, giving support, and feeling concern and fear.
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Fernandez MA, Achten J, Parsons N, Griffin XL, Png ME, Gould J, McGibbon A, Costa ML. Cemented or Uncemented Hemiarthroplasty for Intracapsular Hip Fracture. N Engl J Med 2022; 386:521-530. [PMID: 35139272 DOI: 10.1056/nejmoa2108337] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available. METHODS We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075). RESULTS A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P = 0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups. CONCLUSIONS Among patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).
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Affiliation(s)
- Miguel A Fernandez
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Juul Achten
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Nicholas Parsons
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Xavier L Griffin
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - May-Ee Png
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Jenny Gould
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Alwin McGibbon
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Matthew L Costa
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
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