The Journey of Recovery: Caregivers’ Perspectives From a Hip Fracture Telerehabilitation Clinical Trial

This is an Accepted Manuscript of an article published by OXFORD UNIV PRESS INC in Physical Therapy & Rehabilitation Journal on March 2021, available at: doi: 10.1093/ptj/pzaa220.”Objective: To explore family caregivers’ perspectives of the recovery process of older adults with hip fracture, and describe experiences from caregivers who (i) used the online intervention or (ii) received home-based care provided by the Andalusian Public Health Care System. Methods: This was an exploratory secondary study with informal family caregivers who had an older adult family member with hip fracture enrolled in a novel telerehabilitation (telerehab) clinical trial. Forty-four caregivers of older adults with hip fracture were interviewed at 6-9 months after their family member’s hip fracture. Results: Caregivers shared concerns of family members’ survival and recovery; they recounted increased stress and anxiety due to the uncertainty of new tasks associated with providing care and the impact on their lifestyle. Although most caregivers were satisfied with the health care received, they made suggestions for better organization of hospital discharge, and requests for home support. The main reasons why caregivers and their family member chose the telerehab program were to, enhance recovery after fracture, gain knowledge for managing at home, and the convenience of completing the exercises at home. There were more family caregivers in the control group who expressed a high level of stress and anxiety, and they also requested more social and health services compared with caregivers whose family member received telerehab. Conclusions: Family caregivers are an essential component of recovery after hip fracture by providing emotional and physical support. However, future clinical interventions should evaluate person-centered interventions to mitigate possible stress and anxiety experienced by family caregivers. Impact statement: Family caregivers’ perspectives are necessary in the co-design of management strategies for older adults after hip fracture.This study was supported by the Foundation for Progress and Health, Ministry of Andalusia, Spain, Grant number: PI-0372- 201

Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study

“This is an accepted version of an article published by Taylor & Francis in Disability and Rehabilitation-Assistive Technology on October 2022, available at: doi: 10.1080/17483107.2022.2138999.”Introduction Hip fracture results in an older person’s loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. Methods Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n=2), caregivers (n=3), and health providers (n=2)] with 45 participants (14 older adults, 21 caregivers, and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording, transcription, and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. Results Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. Conclusions Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture. Keywords: tele-rehabilitation; telemedicine; hip fracture; older adults with hip fracture; family caregivers; health providers; mobile applications; medical informaticsThis study was supported by EIT Health [210752]

Development and Evaluation of a Post–Hip Fracture Instructional Workshop for Caregivers

“This is an original manuscript of an article published by Lippincott Williams & Wilkins in Journal of Geriatric Physical Therapy on July 2020, available at: doi: 10.1519/JPT.0000000000000230.”Background and Purpose: A hip fracture is an unexpected traumatic event and mostly the informal caregivers of patients with an acute hip fracture have only short time to learn the new skills of postoperative care and handling of the patient. This sudden responsibility changes the life of the caregiver who perceives a higher level of preoccupation. The objective of this study was to develop and test feasibility for a post-hip fracture in-patient instructional workshop for caregivers of older adults with hip fracture, and to establish their knowledge of hip fracture recovery, and perceptions of the utility and satisfaction with the workshop. Methods: This two-part study was conducted at the (blinded for per-review) from September 2016 to April 2017. We invited caregivers, of consecutive patients (60 years or older) hospitalized for a surgically-treated fall-related hip fracture, to attend an informational and skill-development hospital-based workshop (60-90 minutes in duration) on management strategies post discharge. Following the workshop, we invited caregivers to complete a questionnaire to obtain their knowledge about care after hip fracture, and their perceived concerns. Furthermore, we request they provide feedback on workshop utility and satisfaction (0 to 10 points) and suggestions for improvement. Results and Discussion: Over eight months we delivered 42 workshops. There 103 caregivers who attended the sessions and enrolled in the study, mean (SD) age 52.1 (12.8) years and most of them (69%) were women. Caregivers’ main concern was apprehension for delivering physical care to their family member/friend (75%), followed by lack of time (42%). Caregivers who were employed were 3.16 times as likely to be concerned about time availability to provide care for their family member/friend. The median (Q1-Q3) of both workshop utility and satisfaction was 10 (10,10), minimum-maximum: 7-10. Conclusions: Caregivers in this study stated that the workshop was useful and satisfactory. As caregivers play such a vital role in recovery after hip fracture providing knowledge and skill development as part of healthcare delivery may support more person-centered care

Upper limb bone health : cadaveric, imaging and clinical studies with special emphasis on peripheral quantitative computed tomography

Introduction: Osteoporotic fractures are a major health care problem. A radial fracture is an important risk factor for osteoporosis that should initiate the assessment of bone health. Purpose: 1) To validate pQCT measures of bone in aged cadaveric radii. 2) To examine side-side differences in radial bone variables after disuse. 3) To test a novel intervention for secondary prevention of osteoporosis after an index radial fracture. Methods: Study Design: Part 1: Parts 1A and 1B are descriptive cadaveric studies. Part 2: Cross-sectional observational studies of bone response to disuse; Part 3: Part 3A is a 6-month intervention of secondary prevention of osteoporosis following a fragility fracture. Part 3B uses a questionnaire to ascertain barriers to investigation after fracture. Participants: Part 1: Cadaveric specimens from women (73 to 88 years) for Parts 1A and 1B. Part 2A: Women (52-87 years) who sustained a distal radius fracture and Part 2B: women and men (52 to 79 years) who had suffered a stroke. Part 3A: Women and men (50-90 years) with a fragility fracture; and Part 3B: physicians in British Columbia. Results: Part 1: With different pQCT acquisition-analysis protocols, total bone area varied by 3-34%; cortical area varied by 3-30% and total content by 6-45% from a criterion standard. Total bone content of the distal radius explained between 74 and 81% of bone strength. Part 2: There was a significant decrease in bone strength in participants who had upper limb disuse because of stroke or fracture. Part 3: A patient and physician intervention improved bone health investigation rate by a factor of 3.1 times (RR) after fragility fracture. BC doctors reported few barriers to investigating osteoporosis. Summary: Peripheral QCT acquisition and analysis protocols significantly influenced outcome variables. Patients do not have "normal" bone strength after fracture or stroke. In particular, there is an increased risk for non-dominant radial fractures to have lower bone strength and be associated with poorer limb function, compared with a dominant radial fracture. Physicians report no barriers to investigation after a fragility radial fracture and a systematic intervention may best address secondary prevention of osteoporosis.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat

Translation, inter-rater reliability, agreement, and internal consistency of the Spanish version of the cumulated ambulation score in patients after hip fracture

“This is an original manuscript of an article published by Taylor & Francis in Disability and Rehabilitation on March 2019, available at: doi: 10.1080/09638288.2019.1577499.”Purpose: To translate the Cumulated Ambulation Score (CAS) into Spanish (CAS-E) and to examine the interrater reliability and agreement of the CAS-E. Materials and Methods: Two occupational therapists, independently reviewed 60 patients consecutively admitted to a traumatology service of a public hospital with a hip fracture, and rated the three CAS activities from 0 to 2, within the first post-surgery week. We determined the internal consistency of CAS-E using Cronbach’s α coefficient. To test reliability, we used weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD). We determined the systematic between-rater bias using the McNemar–Bowker test. Results: No between-rater bias was seen, and the Cronbach’s α for the CAS-E was 0.89. The weighted kappa was ≥ 0.83 for the three individual activities and the total CAS-E, while the observed agreement was ≥ 0.87. The SEM and the SRD for the total CAS-E (0-6 points) were 0.18 and 0.83 points, respectively. Conclusions: We present the CAS for use in Spanish speaking countries and provide evidence for excellent relative and absolute reliability of the CAS-E to assess basic mobility for patients with hip fracture in an acute care hospital

Translation, inter-rater reliability, agreement, and internal consistency of the Spanish version of the cumulated ambulation score in patients after hip fracture

Purpose: To translate the Cumulated Ambulation Score into Spanish, and to examine its inter-rater reliability, agreement and internal consistency. Materials and Methods: Two occupational therapists independently used the Spanish version of the Cumulated Ambulation Score (three activities scored from 0–2 points) to assess 60 consecutive patients with hip fracture within the first post-surgery week at a traumatology service of a public hospital. We used linear weighted kappa (κ) statistics to determine inter-rater reliability, percent agreement to assess measurement error, Cronbach’s α coefficient to establish the internal consistency, and the McNemar–Bowker test to evaluate for systematic between-rater differences. Results: The κ was ≥ 0.83 for the three individual activities and the total score, the percent agreement was ≥ 0.87, and Cronbach’s α was 0.89 with no observed systematic between-rater difference. Conclusions: This study provides evidence for almost perfect inter-rater reliability, excellent internal consistency, and high percent agreement of the Spanish version of the Cumulated Ambulation Score. Due to the strong psychometric properties, and its ease of use, we suggest it be used in Spanish speaking countries to assess early basic mobility status of patients with hip fracture until independence is reached.Implications for rehabilitationThe Spanish version of the Cumulated Ambulation Score is a reliable outcome measure to assess basic mobility of patients with hip fracture.We suggest the Spanish version of the Cumulated Ambulation Score be used in Spanish speaking settings to indicate small changes in basic mobility of patients with hip fracture until an independent level is reached.The Spanish version of the Cumulated Ambulation Score can be used with a high reliability by experienced and inexperienced occupational therapists, corresponding to the already established reliability when used by physicians and physiotherapists. The Spanish version of the Cumulated Ambulation Score is a reliable outcome measure to assess basic mobility of patients with hip fracture. We suggest the Spanish version of the Cumulated Ambulation Score be used in Spanish speaking settings to indicate small changes in basic mobility of patients with hip fracture until an independent level is reached. The Spanish version of the Cumulated Ambulation Score can be used with a high reliability by experienced and inexperienced occupational therapists, corresponding to the already established reliability when used by physicians and physiotherapists.</p