Elderly patients’ perspectives on treatment, care and rehabilitation after hip fracture: A qualitative systematic review

Abrahamsen, Charlotte; Nørgaard, Birgitte

doi:10.1016/j.ijotn.2020.100811

Cited by 16 publications

(20 citation statements)

References 33 publications

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“…We believe that rehabilitation professionals need to consider this when planning appropriate interventions. This was also reported in a systematic review about older adults’ preferences of their care and rehabilitation after hip fracture [ 24 ]. According to the review, it is vital that health care staff are sensitive to the older adult´s experience of worries and obstacles to be able to provide adequate support during the rehabilitation process.…”

Section: Discussionsupporting

confidence: 60%

“…To succeed with rehabilitation, health care professionals should involve older adults as collaborators in the rehabilitation, help them to plan and set goals, and treat them as experts on their own health [ 6 , 18 , 23 ]. In addition, it seems important that the older adult has confidence in the rehabilitation professionals, receives adequate information, and is treated with dignity and respect [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Older adults' perspectives on rehabilitation and recovery one year after a hip fracture – a qualitative study

2022

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Background In order to improve quality of care and recovery after hip fracture we need to include the perspectives of the individual older adults when evaluating different rehabilitation interventions. The aim of this study was therefore to explore older adults’ experiences of their rehabilitation after a hip fracture and of the recovery process during the 12 months following the fracture. Methods Qualitative interviews were conducted with 20 older adults (70–91 years of age) who had participated in a randomised controlled trial evaluating the effects of early discharge followed by geriatric interdisciplinary home rehabilitation compared to in-hospital care according to a multifactorial rehabilitation program. Ten participants from each group were interviewed shortly after the one-year follow-up when the study was completed. Data were analysed with qualitative content analysis. Results The analysis resulted in four themes: Moving towards recovery with the help of others; Getting to know a new me; Striving for independence despite obstacles; and Adapting to an altered but acceptable life. The participants emphasised the importance of having access to rehabilitation that was provided by skilled staff, and support from family members and friends for well-being and recovery. They experienced a change in their self-image but strove for independence despite struggling with complications and functional limitations and used adaptive strategies to find contentment in their lives. Conclusions Rehabilitation interventions provided by competent health care professionals, as well as support from family members and friends, were emphasised as crucial for satisfactory recovery. Participants’ experiences further highlight the importance of targeting both physical and psychological impacts after a hip fracture. To improve recovery, rehabilitation providers should customise future interventions to suit each individual´s wishes and needs and provide rehabilitation in various settings throughout the recovery process. Trial registration The trial is registered at Current Controlled Trials Ltd, ICRCTN 15738119. Date of registration 16/06/2008, retrospectively registered.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Older adults' perspectives on rehabilitation and recovery one year after a hip fracture – a qualitative study

2022

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“…Nevertheless, the present results support the results of previous studies from different countries. 4-6,9,52,54,55,67-73 An international survey would improve the external validity of our findings. Another potential limitation is that the opinions of patients with stroke and patients with fracture might have been overstated in the current sample.…”

Section: Discussionmentioning

confidence: 80%

“…Previous qualitative studies of individuals with physical disabilities have reported that information regarding the benefits of rehabilitation programs is an important factor in increasing patients' motivation. 6,9,52,[54][55][56] Additionally, rehabilitation programs that combine exercise therapy with information provision and therapeutic patient education have shown positive outcomes in patients with a range of neurological and orthopedic disorders. [57][58][59][60][61][62][63][64] Regarding the influence of the level of task difficulty on motivation, an experimental study has reported that participants exert less effort in difficult trials compared to easy trials.…”

Section: Comparison Of Patients' and Clinicians' Perceptions Of Facto...mentioning

confidence: 99%

Patients’ and Clinicians’ Perceptions of Motivational Factors in Rehabilitation

Oyake

Yamauchi

Inoue

et al. 2022

Preprint

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Importance: Patient motivation is an important determinant of rehabilitation outcomes. Differences in patients' and clinicians' perceptions of motivational factors can potentially hinder patient-centered care. Objective: To compare patients' and clinicians' perceptions of the most important factors in motivating patients for rehabilitation. Design: This multicenter descriptive cross-sectional survey was conducted from January to March 2022. Setting: Thirteen hospitals with a convalescent rehabilitation ward. Participants: Patients with neurological or orthopedic disorders undergoing inpatient rehabilitation and clinicians, including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists, were selected purposively based on the inclusion criteria. Main Outcomes and Measures: Patients and clinicians were asked to choose the most important factor from a list of potential motivational factors. The main outcome was patients' and clinicians' perceptions of the relative importance of various motivational factors for rehabilitation. Results: We obtained data from 479 patients and 401 clinicians. Response rates in the patient and clinician surveys were 92.1% and 62.2%, respectively. The most common primary reasons for patients' hospitalizations were stroke (45.5%) and fracture (42.2%). Approximately half of the clinicians were physical therapists (49.9%). "Realization of recovery," "goal setting," and "practice related to the patient's experience and lifestyle" were the three factors most frequently selected as most important by both patients and clinicians, chosen by 10.4%-26.5% of patients and 9.5%-36.7% of clinicians. Only five were rated as most important by 5% of clinicians; however, nine factors were selected by 5% of patients. Of these nine motivational factors, "medical information" (odds ratio: 5.19; 95% confidence interval: 2.24-11.60) and "control of task difficulty" (odds ratio: 2.70; 95% confidence interval: 1.32-5.80) were selected by a significantly higher proportion of patients than clinicians. Conclusions and Relevance: The three most frequently endorsed motivational factors were identical for patients and clinicians. The preferences of patients were more diverse than those of clinicians, and some motivational factors were preferred by patients over clinicians. Therefore, when determining motivational strategies, rehabilitation clinicians should consider individual patient preferences in addition to utilizing the core motivational factors supported by both parties.

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“…A systematic review by Abrahamsen and Nørgaard (2020) about elderly patients’ perspectives on treatment, care and rehabilitation after a hip fracture, reports that the preoperative pain experienced by patients with hip fracture was severe and intense. That is somewhat contradictory to the present results, where some participants reported that they did not experience pain in the preoperative phase while other participants expressed how pain in movement was the worst, and they preferred not to move the leg on their own or have staff move the leg – they preferred no movements at all.…”

Section: Discussionmentioning

confidence: 99%

Between Heaven and Hell: Experiences of Preoperative Pain and Pain Management among Older Patients with Hip Fracture

2022

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Introduction Among older adults, hip fracture is a common and serious consequence of a fall. Preoperative pain is common and often severe among patients with hip fracture. Opioids are usually used but have many side effects. One alternative is a femoral nerve block, which has been shown to reduce pain and lower the need for opioids. However, to our knowledge no study has explored qualitatively how patients with hip fracture experience treatment with femoral nerve block. Objective The aim of this study was to explore experiences of preoperative pain and pain management among older patients with hip fracture who had received a femoral nerve block. Method A qualitative design with semi-structured interviews (n = 23) conducted 2–6 days after surgery. Inclusion criteria were Swedish-speaking patients aged 70 years or older with hip fracture admitted to the orthopedic ward, treated with femoral nerve block before nursing actions. Data were analyzed with qualitative content analysis. Results Our result revealed one theme, hovering between heaven and hell, with five subthemes: how the pain was described – no pain, to worst pain and everything in between; they were dealing with pain in their own way; felt dependent on staff´s willingness to relieve pain; pain management could be lifesaving and a near-death experience; and how they experienced memory loss with respect to the pain and pain management. Conclusion The experience of pain and pain management was described as hovering between heaven and hell. We conclude that independent of which pain management given, staff should have an individualized pain mangement approach towards the patient in order to achieve well managed pain.

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Elderly patients’ perspectives on treatment, care and rehabilitation after hip fracture: A qualitative systematic review

Cited by 16 publications

References 33 publications

Older adults' perspectives on rehabilitation and recovery one year after a hip fracture – a qualitative study

Older adults' perspectives on rehabilitation and recovery one year after a hip fracture – a qualitative study

Patients’ and Clinicians’ Perceptions of Motivational Factors in Rehabilitation

Between Heaven and Hell: Experiences of Preoperative Pain and Pain Management among Older Patients with Hip Fracture

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