Healthcare professionals’ perspectives on rehabilitating persons with cognitive impairment

Abstract

Background and Objectives Despite emerging evidence that persons with cognitive impairment (CI) (including dementia and/or delirium) can be rehabilitated post-hip fracture surgery, there still remains a paucity of research on best practice rehabilitation strategies that help healthcare providers effectively rehabilitate persons with CI. Therefore, this qualitative study explores healthcare professionals’ (HCPs) perspectives who have been successfully providing rehabilitation for people with CI. Research Design and Methods Sixteen HCPs with a specialty in rehabilitating persons with CI from one inpatient rehabilitation facility with various professional backgrounds were purposively sampled using a maximum diversity sampling strategy. Three focus group discussions were conducted to explore their experiences of providing rehabilitation to persons with CI. A hybrid inductive–deductive approach was used to analyze the data. Findings HCPs acknowledged that older adults with CI deserved the opportunity for inpatient rehabilitation and that good outcomes were achievable; however, their knowledge, skills, and attitudes required reframing. The analysis identified three essential components to rehabilitation: (1) staff education and support, (2) tailored rehabilitation approaches, and (3) care partner involvement and support. Discussion and Implications Rehabilitation of persons with CI post-hip fracture surgery is achievable, and HCPs can learn to modify their practices to achieve positive patient outcomes. The attitudes of the healthcare team members had to be shifted to embrace the belief that persons with CI can be rehabilitated. However, it takes a steep learning curve, creativity, ingenuity, and tailored approaches to rehabilitate persons with CI successfully. This involves knowing the individual, maintaining routines, and learning the best ways to engage and motivate the person. As well, care partners’ knowledge and understanding of the individual improved the chances of a successful rehabilitation stay and discharge. Essential to the success of rehabilitation of persons with CI includes a supportive management team to help create the processes to enable their staff to succeed.

Rehabilitation interventions for persons with hip fracture and cognitive impairment: A scoping review

“…Of these quantitative studies, three did not have a comparator. The one qualitative study used a case study design [ 49 ]. The majority of included articles were published from 2010 onwards (n = 14) [ 41 , 42 , 44 – 50 , 53 – 57 ].…”

“…The majority of studies focused on and included older adults (defined as 60, 65, or 70 years and older) [ 41 – 48 , 50 , 52 , 54 – 57 ] and all but one study [ 49 ] had participants with a mean age of 75 years or older. Six articles included only participants with cognitive impairment and hip fracture [ 41 , 42 , 47 , 50 , 53 , 57 ], while the remaining 11 articles included both those with and without cognitive impairment [ 43 – 46 , 48 , 49 , 51 , 52 , 54 – 56 ]. The Mini Mental State Examination (MMSE) was most commonly used to assess cognitive status followed by the Short Portable Mental Status Questionnaire (SPMSQ).…”

“…About half of the interventions (n = 8) were specific to physical rehabilitation [ 41 – 43 , 47 , 50 – 53 ], while the other half (n = 9) incorporated content into the intervention that addressed additional aspects of the patients’ care journey or support (e.g. discharge planning, patient and family education, nutrition) [ 44 – 46 , 48 , 49 , 54 – 57 ]. The physical rehabilitation component of the interventions most commonly incorporated standing, walking with or without support, range of motion, balance exercises, and functional strength.…”

“…Of the two interventions that were delivered by a single profession, physiotherapists were responsible [ 42 , 50 ]. About half of the articles (n = 9) described modifying or tailoring the intervention to the individuals’ needs [ 42 – 46 , 49 , 52 , 54 , 55 ]. This was usually dependent on how the patient was progressing with their physical rehabilitation [ 43 – 46 , 52 , 54 ]; however, one article described modifications or adaptations that were made for individuals depending on their level of cognitive impairment [ 42 ].…”

“…study design [49]. The majority of included articles were published from 2010 onwards (n = 14) [41,42,[44][45][46][47][48][49][50][53][54][55][56][57].…”