Evaluating recovery following hip fracture: a qualitative interview study of what is important to patients

Abstract

ObjectiveTo explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services.DesignSemistructured interviews exploring the experience of recovery from hip fracture at two time points—4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summarising the participant's experience overall.Participants31 participants were recruited, of whom 20 were women and 12 were cognitively impaired. Mean age was 81.5 years. Interviews were provided by 19 patients, 14 carers and 8 patient/carer dyad; 10 participants were interviewed twice.SettingSingle major trauma centre in the West Midlands of the UK.ResultsStable mobility (without falls or fear of falls) for valued activities was considered most important by participants who had some prefracture mobility and were able to articulate what they valued during recovery. Mobility was important for managing personal care, for day-to-day activities such as shopping and gardening, and for maintenance of mental well-being. Some participants used assistive mobility devices or adapted to their limitations. Others maintained their previous limited function through increased care provision. Many participants were unable to articulate what they valued as hip fracture was perceived as part of their decline with age. The fracture and problems from other health conditions were an inseparable part of one health experience.ConclusionsPrefracture mobility, adaptations to reduced mobility before or after fracture, and whether or not patients perceive themselves to be declining with age influence what patients consider important during recovery from hip fracture. No single patient-reported outcome measure could evaluate quality of care for all patients following hip fracture. General health-related quality of life tools may provide useful information within clinical trials.

Understanding informal carers’ experiences of caring for older people with a hip fracture: a systematic review of qualitative studies

“…Carers have important information about the patient background (i.e. health status) [50] and they suggested that their information about the patient and their family dynamic should be assessed at hospital admission [43,44]. Despite carers´ perception that they are the "glue" some of them also felt that the healthcare providers had a more educated understanding of the patient's condition; therefore they saw themselves as mainly receiving information but not providing it [44].…”

Older patients' perception of their own capacity to regain pre-fracture function after hip fracture surgery – an explorative qualitative study

“…The studies consider all types of patients, not only healthy ones (Archibald, 2003;Griffiths et al, 2015;Olsson et al, 2007;Ziden, Wenestam, Hansson-Scherman, 2008) Olsson et al (2007) described three groups of patients based on perceptions of responsibility in the rehabilitation process: 1) autonomous, self-sufficient patients who take care of themselves and search for relevant information; 2) modest, frail patients in need of more support who want information but do not ask for it; and 3) heedless, patients who are already dependent, not aware of their own responsibility and not interested in information.…”

“…Individual changes concerning the relationship with one`s own body can cause social and existential changes in relationships with others and to one`s life situation as a whole (Ziden et al, 2008). The ability to adapt to reduced mobility was considered to decline with age, but striving to regain pre-fracture mobility was important for managing personal care and day-to-day activities (Griffiths et al, 2015). Patients with hip fractures all worried about their future ability to walk again (Griffiths et al, 2015;Olsson et al, 2007;Ziden et al, 2008).…”

“…The ability to adapt to reduced mobility was considered to decline with age, but striving to regain pre-fracture mobility was important for managing personal care and day-to-day activities (Griffiths et al, 2015). Patients with hip fractures all worried about their future ability to walk again (Griffiths et al, 2015;Olsson et al, 2007;Ziden et al, 2008). The importance of psychological and social factors in the recovery process was investigated in patients who were independent before the hip fracture (Taylor et al, 2010).…”

Patient-reported outcome measures in older people with hip fracture: a systematic review of quality and acceptability

“…Older, more frail patients often view their limitations as a consequence of ageing, or experience difficulties disentangling the impact of the hip fracture from the wide range of co-morbidities they experience [74]. Similar difficulties associated with the impact of multiple comorbidities have been reported in other patient populations, for example, in mental health [87].…”