Ortho-geriatricians: Please share your views on acute rehabilitation after hip fracture!

Miss Lambe is a Research Assistant in hip fracture rehabilitation at King’s College London. She tweets @katie_b_lambe. Dr Sheehan is a UKRI Future Leaders Fellow, Senior Lecturer in Rehabilitation/Health Services Research, and a physiotherapist. She tweets @KatieJSheehan.

The average patient with a hip fracture is 83 years old, frail, and has at least one pre-existing health problem¹. These patients often struggle to overcome the stress of their injury and subsequent surgery. Patients with hip fractures describe rehabilitation as the key to their recovery². In the context of acute rehabilitation, patients with hip fractures often picture this recovery as returning home³. However, 22% of patients with hip fractures transition from independent living to a nursing home⁴.

Healthcare professionals argue that rehabilitation after a hip fracture could mean the difference between patients returning home and admission to a nursing home ⁴, ⁵. Yet, the optimal rehabilitation remains unclear. This is highlighted by the detail in the NICE guidance being limited to daily mobilisation and regular physiotherapy review,6 the absence of recent Cochrane systematic reviews, the conclusion of insufficient evidence to recommend practice change from earlier Cochrane reviews,⁷,⁸ and uncertainty with respect to the appropriate management of patient subgroups9.

In 2017, an audit of rehabilitation after a hip fracture was conducted and highlighted national variation in the duration, frequency, and type of acute rehabilitation5. The underlying mechanism for the reported variation and current provision is unclear, although we do know that optimal rehabilitation requires ongoing input from a variety of health professionals¹⁰.

In this research, funded by UK Research & Innovation, we aim to complete a series of semi-structured interviews with ortho-geriatricians to further understand health professionals' perceptions of current and potential provision of acute rehabilitation after a hip fracture and implications for recovery.  Perspectives from this discipline will enrich findings from our recently completed qualitative interviews with physiotherapists on their perceptions of mechanisms for variation in rehabilitation after a hip fracture.

Our objectives are to:

• Explore allied health professionals’ (including but not limited to ortho-geriatricians’) perceptions of current and potential provision of rehabilitation after a hip fracture; and
• Explore implications for recovery

We are aiming to recruit ortho-geriatricians with a minimum of two years of experience working with patients in acute rehabilitation after a hip fracture in the UK. Interviews will be conducted over the telephone and will last no longer than one hour.

This research aims to improve patient and caregiver outcomes of acute rehabilitation after a hip fracture. We will then share what we learn with healthcare policymakers, people who have broken a hip and their families, and healthcare professionals who work with them in scientific articles, reports, news articles, blogs, presentations, and via social media. The results will help to inform decisions to improve care for patients with a broken hip.

For more information and to participate, please email kate [dot] lambe [at] kcl [dot] ac [dot] uk or katie [dot] sheehan [at] kcl [dot] ac [dot] uk

References

1. Royal College of Physicians. National Hip Fracture Database (NHFD) Annual Report London; 2017.

2. Stott-Eveneshen S, Sims-Gould J, McAllister MM, et al. Reflections on Hip Fracture Recovery from Older Adults Enrolled in a Clinical Trial. Gerontol Geriatr Med. 2017; 3 : 2333721417697663.

3. Salkeld G, Cameron ID, Cumming RG, et al. Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ. 2000;320(7231):341-6.

4. Nikitovic M, Wodchis W, Krahn M, et al. Direct health-care costs attributed to hip fractures among seniors:a matched cohort study. Osteoporos Int. 2013;24(2):659-69.

5.Royal College of Physicians. Recovering after a hip fracture: helping people understand physiotherapy in the NHS. Physiotherapy ‘Hip Sprint’ audit report London; 2018.

6. National Clinical Guideline Centre, (2011) [The Management of Hip Fracture in Adults]. London: www.ncgc.ac.uk.

7. Crotty M, Unroe K, Cameron ID, et al. Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people. Cochrane Database Syst Rev. 2010(1):CD007624.

8. Handoll HH, Sherrington C, Mak JC. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database SystRev. 2011(3):CD001704.

9. Hall AJ, Watkins R, Lang IA, et al. The experiences of physiotherapists treating people with dementia who fracture their hip. BMCGeriatr. 2017;17(1):91.

10. Handoll HHG, Cameron ID, Mak JCS, et al. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database of Systematic Reviews; 2009