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Adams J, Jones GD, Sadler E, Guerra S, Sobolev B, Sackley C, Sheehan KJ. Physiotherapists' perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England. Age Ageing 2023; 52:afad130. [PMID: 37756647 PMCID: PMC10531122 DOI: 10.1093/ageing/afad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Indexed: 09/29/2023] Open
Abstract
PURPOSE to investigate physiotherapists' perspectives of effective community provision following hip fracture. METHODS qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. RESULTS four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. CONCLUSION physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.
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Affiliation(s)
- Jodie Adams
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
- Department of Physiotherapy, Guys and St Thomas’s NHS Foundation Trust, London, UK
| | - Gareth D Jones
- Department of Physiotherapy, Guys and St Thomas’s NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), School of Basic and Medical Biosciences, Kings College London, London, UK
| | - Euan Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Sackley
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
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Backman C, Harley A, Papp S, Webber C, Poitras S, Berdusco R, Beaulé PE, French-Merkley V. Feasibility, acceptability, and preliminary effects of PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP): a protocol for a mixed method study. Pilot Feasibility Stud 2022; 8:124. [PMID: 35690813 PMCID: PMC9188093 DOI: 10.1186/s40814-022-01079-z] [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] [Received: 05/14/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip fractures in older adults are significant contributors to severe functional decline and disability as well as hospitalization and increased health care costs. Research shows that timely referral to geriatric rehabilitation leads to better patient outcomes. Currently, a wide variability in the timing, the frequency, and the choice of appropriate setting for rehabilitation of hip fracture patients exists. AIM Evaluate the feasibility, acceptability, and preliminary effectiveness of PATH4HIP, a pathway intervention for timely transfer of post-operative geriatric hip fracture patients from hospital to rehabilitation to home. METHODS This is a single-arm, pragmatic feasibility study to measure reach, effectiveness, adoption, implementation, and maintenance of PATH4HIP, a pathway for post-operative hip fracture patients from a large academic health science center to a geriatric rehabilitation service in Ottawa, Canada. During a 6-month period, all hip fracture patients, 65 years of age or older who have undergone surgery and have met the eligibility criteria (n = 96), will be transferred to the geriatric rehabilitation service no later than post-operative day 6. Patients (n = 10-12) and clinicians who are working on the orthopedic team (n = 10-12) and on the geriatric rehabilitation service (n = 10-12) will be invited to participate in an interview to share their feedback on the intervention's feasibility and acceptability and to provide suggestions to improve PATH4HIP. Descriptive statistics will be used to summarize results of the quantitative data and content analysis will be used to analyze the qualitative data. The study will be open for recruitment from January to July 2022. DISCUSSION If feasible, PATH4HIP will result in the reduction of the post-operative acute care length of stay to less than or equal to 6 days, while having no detrimental effect on rehabilitation outcomes such as functional gains, or discharge destination.
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Affiliation(s)
- Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa; Affiliate Investigator, Ottawa Hospital Research Institute, Affiliate Investigator, Bruyère Research Institute, 451, Smyth Road, RGN 3239, Ottawa, ON, K1H 8M5, Canada.
| | - Anne Harley
- Bruyere Continuing Care; Assistant Professor Faculty of Medicine, University of Ottawa, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
| | - Steve Papp
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Randa Berdusco
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery at The Ottawa Hospital, Faculty of Medicine, University of Ottawa, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
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