Developing an individualised cross-sectoral programme based on activities of daily living to support rehabilitation of older adults with hip fracture: a qualitative study

Abstract

ObjectivesTo develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently.DesignQualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles.SettingsUniversity Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities.ParticipantsOne research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists).ResultsThree generic categories were identified: (1) ‘Challenge older adults with goal-oriented ADL tasks’, (2) ‘Implement strategies to enhance independent and safe performance of ADL tasks’, and (3) ‘Communicate the important information to the target group and across sectors’. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call.ConclusionsEngaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme.Trial registration numberThis article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID: NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID: NCT04207788; Pre-results.

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

“…To date, there have been several qualitative studies exploring healthcare professional perspectives of variation in access to, and delivery of, rehabilitation after hip fracture [17][18][19][20][21][22][23][24]. These studies have mainly focused on individual professional groups [17,24] and highlight resource constraints [17,18,22,24], poor patient engagement [17,19,[22][23][24], and limited multidisciplinary team engagement [17,18,20,21,23] as key contributors of unwarranted variation in rehabilitative care across hospitals.…”

HIP Fracture REhabilitation Program for older adults with hip fracture (HIP-REP) based on activity of daily living: a feasibility study

“…This indicating that the older adults understand the purpose of the intervention and are motivated to participate in the development of the study. At the design stage of the intervention [ 8 ] it was important to consider that the participants in the study are frail older adults [ 27 ], and that their vulnerable situation is likely to influence the recruitment rate. A Cochrane review [ 28 ] highlights that a suitable recruitment strategy could be a face-to-face meeting between the patient and a staff member dedicated to the recruitment tasks.…”

“…The program was conducted over a total of 8 weeks as described in study the by Ropke et al [ 8 ] (Supplementary Table S 1 ) with preliminary interviews, baseline tests, five activity-based interventions each lasting between 1 and 1.5 hours, and a phone call 10-weeks post-operation. The follow-up evaluation for this study was performed after 12 weeks.…”

“…The intervention thus varies in personal activity of daily living (PADL) and instrumental activity of daily living (IADL) tasks, content and complexity, based on the older participant’s need and priorities. The HIP-REP program was guided by the Occupational Therapy Intervention Process Model (OTIPM) [ 14 ], with a focus on occupational performance for both the intervention and the evaluation, as described in the manual and as described in more detail by Ropke et al [ 8 ]. Thirteen OTs underwent a 3-h theoretical and practical introduction, supported by a manual and detailed intervention instructions, before supervising the older adults with HFs during the intervention.…”

“…Therefore, an individually customized intervention program based on ADL the HIP fracture REhabilitation Program (HIP-REP), comprised of a 12-week intervention was recently developed in a collaboration between older adults with HF and healthcare professionals (HCP) [ 8 ]. The development of the HIP-REP was inspired by the Medical Research Council’s (MRC) framework for developing complex interventions [ 9 ].…”