Open Access Open Access  Restricted Access Subscription or Fee Access

Patient-reported outcomes at acute hospital stay and four months after hip fracture surgery. A register and questionnaire study

Berit Gesar, Carina Baath, Hanne Hedin, Ami Hommel

Abstract


Introduction: The large and increasing number of hip fracture patients, in combination with the large impact that this is having on daily living activities, is emphasizing the importance of identifying factors that have a detrimental impact on post-operative outcomes. There are benefits to planning the ward in a way that prevents a steep decline in recovery after hip fracture surgery. Adding the patient`s perspective into the healthcare assessment, via shared healthcare decision-making, allows the patient’s needs and preferences to be taken fully into account. The aim of this study was to identify factors that predict how patients recover after hip fracture surgery.

Methods: A descriptive quality register/questionnaire study in acute orthopaedic wards, 2 to 5 days after surgery, with a follow-up 4 months later. The patients included were ≥65 years of age and had been previously healthy and living independently before the hip fracture.

Results: The participants in this study had returned to their own homes after 4 months, but only 21% reported themselves as being fully or almost fully recovered. In several domains of recovery, all 3 age groups (65-74, 75-84 and 85-97) reported different challenges both during their acute hospital stay and at the 4 months follow-up. The recovery phase is heterogeneous and requires individual care. The way that this is planned has an influence on patient outcome.

Conclusion: Patients sustaining a hip fracture are heterogeneous and different age groups experience different challenges. At 4 months follow-up, one fifth of the participants reported themselves fully or almost fully recovered and most of them had returned to their own homes. The Swedish National Hip Fracture Register and the patient-reported questionnaires employed in this study are appropriate tools to audit further development of healthcare to improve quality of life after hip fracture surgery.

Keywords


Clinical outcomes, hip fractures, needs preferences, nursing, patient perspectives, patient-reported outcomes, person-centered healthcare, quality of life, quality register, questionnaire, recovery, shared clinical decision-making, Swedish National Hip Fr

Full Text:

PDF

References


Bergstrom, U., Jonsson, H., Gustafson, Y., Pettersson, U., Stenlund, H. & Svensson, O. (2009). The hip fracture incidence curve is shifting to the right. Acta Orthopaedica 80 (5) 520-524.

Cummings-Vaughn, L.A. & Gammack, J.K. (2011). Falls, osteoporosis, and hip fractures. Medical Clinics of North America 95 (3) 495-506, x.

Hommel, A. & Baath, C. (2016). A national quality register as a tool to audit items of the fundamentals of care to older patients with hip fractures. International Journal of Older People Nursing 11 (2) 85-93.

Dyer, S.M., Crotty, M., Fairhall, N., Magaziner, J., Beaupre, L.A., Cameron, I.D., Sherrington, C. & Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group. (2016). A critical review of the long-term disability outcomes following hip fracture. BMC Geriatrics 16, 158.

Liem, I.S., Kammerlander, C., Suhm, N., Kates, S.L. & Blauth, M. (2014). Literature review of outcome parameters used in studies of Geriatric Fracture Centers. Archives of Orthopaedic and Trauma Surgery 134 (2) 181-187.

Crotty, M., Unroe, K., Cameron, I.D., Miller, M., Ramirez, G. & Couzner, L. (2010). Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people. Cochrane Database of Systematic Reviews (1):CD007624.

Taylor, N.F., Barelli, C. & Harding, K.E. (2010). Community ambulation before and after hip fracture: a qualitative analysis. Disability and Rehabilitation 32 (15) 1281-1290.

McCance, T., McCormack, B. & Dewing, J. (2011). An exploration of person-centredness in practice. Online Journal of Issues in Nursing 16 (2) 1. Available at: http://dx.doi.org.ludwig.lub.lu.se/10.3912/OJIN.Vol16No02Man01. Last accessed October 4, 2017.

Moerman, S., Vochteloo, A.J., Tuinebreijer, W.E., Maier, A.B., Mathijssen, N.M. & Nelissen, R.G. (2016). Factors associated with the course of health-related quality of life after a hip fracture. Archives of Orthopaedic and Trauma Surgery 136 (7) 935-943.

Magaziner, J., Chiles, N. & Orwig, D. (2015). Recovery after Hip Fracture: Interventions and Their Timing to Address Deficits and Desired Outcomes-Evidence from the Baltimore Hip Studies. Nestle Nutrition Institute Workshop Series 83, 71-81.

Gesar, B., Hommel, A., Hedin, H. & Baath, C. (2016). Older patients' perception of their own capacity to regain pre-fracture function after hip fracture surgery - an explorative qualitative study. International Journal of Orthopaedic and Trauma Nursing 24, 50-58.

The International Alliance of Patient`s Organisations (IAPO). (2016). Declaration on Patient-Centred Health Care 2016. available at: https://www.iapo.org.uk/patient-centred-healthcare. Last accessed October 4, 2017.

Gesar, B., Baath, C., Hedin, H. & Hommel, A. (2017). Hip fracture; an interruption that has consequences four months later. A qualitative study. International Journal of Orthopaedic and Trauma Nursing 26, 43-48.

American Society of Anesthesiologists. (2014). ASA Physical Status Classification System 2014. Available at: https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system. Last accessed December 5, 2017.

Pfeiffer, E. (1975). A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients. Journal of the American Geriatrics Society 23 (10) 433-441.

Hommel, A. & Thorngren, K.G. (2017). The Swedish National Registry of hip fracture patient care, RIKSHÖFT. Available at: http://rikshoft.se/about-rikshoft/2017 Last accessed October 4, 2017.

Hellstrom, K. & Lindmark, B. (1999). Fear of falling in patients with stroke: a reliability study. Clinical Rehabilitation 13 (6) 509-517.

Allvin, R., Ehnfors, M., Rawal, N., Svensson, E. & Idvall, E. (2009). Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability. Journal of Evaluation in Clinical Practice 15 (3) 411-419.

Wittrup-Jensen, K.U., Lauridsen, J., Gudex, C. & Pedersen, K.M. (2009). Generation of a Danish TTO value set for EQ-5D health states. Scandinavian Journal of Public Health 37 (5) 459-466.

van Reenen, M. & Oppe, M. (2015). EQ-5D-3L User Guide. Basic information on how to use the EQ-5D-3L instrument. Available at: https://euroqol.org/wp-content/uploads/2016/09/EQ-5D-3L_UserGuide_2015.pdf. Last accessed October 4, 2017.

Magaziner, J., Hawkes, W., Hebel, J.R., Zimmerman, S.I., Fox, K.M., Dolan, M., Felsenthal, G. & Kenzora, J. (2000). Recovery from hip fracture in eight areas of function. Journals of Gerontology Series A, Biological Sciences and Medical Sciences 55 (9) M498-507.

Nordstrom, P., Michaelsson, K., Hommel, A., Norrman, P.O., Thorngren, K.G. & Nordstrom, A. (2016). Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission. Journal of the American Medical Directors Association 17 (1) 91.e1-7.

Murphy, J. & Isaacs, B. (1982). The post-fall syndrome. A study of 36 elderly patients. Gerontology 28 (4) 265-270.

Beard, J.R., Officer, A., de Carvalho, I.A., Sadana, R., Pot, A.M., Michel, J.P., Lloyd-Sherlock, P., Epping-Jordan, J.E., Peeters, G.M.E.E.G., Mahanani, W.R., Thiyagarajan, J.A. & Chatterji, S. (2016). The World report on ageing and health: a policy framework for healthy ageing. Lancet 387 (10033):2145-2154.

Allvin, R., Berg, K., Idvall, E. & Nilsson, U. (2007). Postoperative recovery: a concept analysis. Journal of Advanced Nursing 57 (5) 552-558.

McCormack, B. (2016). Person-Centredness and Fundamentals of Care - Dancing with Beauty Rather than Fighting Ugliness. Nursing Leadership 29 (1) 17-25.

Kitson, A.L., Muntlin Athlin, A. & Conroy, T. (2014). Anything but basic: Nursing's challenge in meeting patients’ fundamental care needs. Journal of Nursing Scholarship 46 (5) 331-339.

Bryant, L.L., Corbett, K.K. & Kutner, J.S. (2001). In their own words: a model of healthy aging. Social Science & Medicine 53 (7) 927-941.




DOI: http://dx.doi.org/10.5750/ejpch.v6i1.1505

Refbacks

  • There are currently no refbacks.