Patient Perspectives on Engagement in Recovery after Hip Fracture: A Qualitative Study

Abstract

Purpose. To understand older adults' engagement in their recovery experience and rehabilitation after a fall-related hip fracture. Method. 50 community-dwelling older adults recovering from a recent (3–12 months) hip fracture (32 women, 18 men) participated in telephone interviews using a semistructured format at 6 and 12 months after recruitment into the study. Interviews were conducted as part of a mixed-methods study designed to test the effect of a postoperative hip fracture management program (B4 Clinic). Results. Three substantive themes were identified in the qualitative data: (1) managing expectations; (2) engaging in physical activity; and (3) there is life after fracture. Participants shared valuable insight into how their expectations for their recovery period compared to their lived experience and the role of physical activity in their ability to return to their prefracture activities. Conclusions. Our findings reflect older adults' expectations for recovery from hip fracture. Encouraging engagement in rehabilitative exercises and addressing expectations prior to hospital discharge may improve patients' adherence to rehabilitation programs, functional outcomes, and postoperative quality of life. Implications for rehabilitation include the necessity for early and ongoing engagement of rehabilitation professionals.

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

“…To be able to get up, and walk, and back into bed.' [15] 'That I can go to the toilet and take care of myself without having to always press the call button.' [6] Others talked more about long-term goals, including getting back to how they were before the fracture, getting back to a normal life, to be able to cycle, travel, cook, meet friends and being able to walk outdoors again.…”

“…' … I'm worried about how it will be when I come home, and I know that I won't be able to go out … I haven't said this to anyone before now, but that's how I feel, I am, I'm worried about it.' [15] 'You don't know how it will be when we come home … my son would rather I went into a home, so I get help. I can come home if the firemen carry me up … then I can come home, but I can't walk on my own.'…”

“…The value of the patients' perspective has attracted increasing interest over the past decade to further improve care pathways, quality of care and outcomes for patients. To gain a better understanding of the concepts of practice of relevance to patients, we must first know how patients experience care and adapt processes accordingly [13,15]. Studies have highlighted the need for HCPs to understand the psychological factors that can impact on the recovery process [16,17], to acknowledge differences in patients willingness to participate in rehabilitation [18].…”

“…Studies have highlighted the need for HCPs to understand the psychological factors that can impact on the recovery process [16,17], to acknowledge differences in patients willingness to participate in rehabilitation [18]. It is furthermore important to recognise patients' preferences [14,15], their perceptions of their own capability to regain pre-fracture function [19], and what patients consider important to enhance their recovery [20,21].…”

A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

“…A review of the literature identi es several variables that have the potential to impact early mobility after a fragility hip fracture. These variables include age (18)(19)(20)(21)(22), sex (20,23), type of fracture (18,22), a low baseline functional status (21,22,24,25), residence prior to admission, comorbidities (18,26), cognitive impairment (27,28), time to surgery and anesthetic approach (29), pain management (28)(29)(30)(31), and medical interventions or environmental barriers (29,31). The data extraction form was designed to include these variables.…”