Early coordinated rehabilitation in acute phase after hip fracture – a model for increased patient participation

Abstract

BackgroundStudies have shown that patients with hip fracture treated in a Comprehensive Geriatric Care (CGC) unit report better results in comparison to orthopaedic care. Furthermore, involving patients in their healthcare by encouraging patient participation can result in better quality of care and improved outcomes. To our knowledge no study has been performed comparing rehabilitation programmes within a CGC unit during the acute phase after hip fracture with focus on improving patients’ perceived participation and subsequent effect on patients’ function.MethodsA prospective, controlled, intervention performed in a CGC unit and compared with standard care. A total of 126 patients with hip fracture were recruited who were prior to fracture; community dwelling, mobile indoors and independent in personal care. Intervention Group (IG): 63 patients, mean age 82.0 years and Control Group (CG): 63 patients mean age 80.5 years. Intervention: coordinated rehabilitation programme with early onset of patient participation and intensified occupational therapy and physiotherapy after hip fracture surgery. The primary outcome measure was self-reported patient participation at discharge. Secondary outcome measures were: TLS-BasicADL; Bergs Balance Scale (BBS); Falls Efficacy Scale FES(S); Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) at discharge and 1 month and ADL staircase for instrumental ADL at 1 month.ResultsAt discharge a statistically significant greater number of patients in the IG reported higher levels of participation (p < 0.05) and independence in lower body hygiene (p < 0.05) and dressing (p < 0.001). There were however no statistically significant differences at discharge and 1 month between groups in functional balance and confidence, performance measures or risk for falls.ConclusionThis model of OT and PT coordinated inpatient rehabilitation had a positive effect on patients’ perceived participation in their rehabilitation and ADL at discharge but did not appear to affect level of recovery or risk for future falls at 1 month. A large proportion of patients remained at risk for future falls at 1 month in both groups highlighting the need for continued rehabilitation after discharge.Trial registrationClinicalTrials.gov Identifier: NCT03301584 (Retrospectively registered: 4th October 2017).Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0640-z) contains supplementary material, which is available to authorized users.

Patient participation in dialysis care—A qualitative study of patients’ and health professionals’ perspectives

“…Our findings provide a range of routes to partake and engage, suggesting that staff have multiple opportunities to facilitate patient participation, based on the patients’ willingness, wishes and needs. Yet, staff turnover and a perceived or actual lack of time have been found to hamper patient participation, as will the current lack of basic means to conceptualize patient participation in everyday interactions . Although staff can promote patient participation by supporting patients to take on the responsibility they elect, forming a team with the patient, engaging in a mutual relationship, and collaborating for the sake of the individual's health and autonomy, clinical tools to support consensus regarding patient participation in dialysis care are warranted.…”

“…They also share their gained knowledge and experiences with staff and fellow patients, thereby participating in and influencing their own care. Consequently, HCPs in dialysis care who recognize the individual's experience and priorities facilitate not only the patient's active involvement in their care, but also the defining of participation according to their own preferences.…”

See me, teach me, guide me, but it’s up to me! Patients’ experiences of recovery during the acute phase after hip fracture

“…While positive results were reported in the form of increased patient participation and greater independence in ADL in this study [22], there is limited knowledge concerning patients' experiences, and factors influencing their recovery, and no study performed investigating the impact of TLS-BasicADL on promoting patient participation in the acute phase after hip fracture.…”

“…A recent clinical trial evaluating a model of early coordinated rehabilitation in acute phase after hip fracture reported increased patient participation and increased independence in activities of daily living (ADL) compared to standard care [22]. This intervention focussed on earlier and closer collaboration between the patient, the occupational therapist (OT), and the physiotherapist (PT).…”

Translation, Reliability and Validity of the Spanish Version of the Modified New Mobility Score (NMS-ES)

“…The NMS has the potential to support research, registries, and hip fracture clinical care, which nowadays are focused on the development of new ways of treatment, apart from the traditional rehabilitation protocol in the balance and walking ability during the hospital stay [ 1 , 2 , 20 , 21 ]. It provides a self-reported pre-fracture functional baseline for clinicians to monitor the recovery process [ 10 ].…”