Understanding the Impact of an Empowerment-Oriented Practice and Engagement in Older Adults with Hip Fractures

The focus of this PhD thesis examined the rehabilitation process for older adults who experienced hip fractures within the context of the intervention ‘Rehabilitation for Life’. These fractures cause significant problems for affected individuals, highlighting the need for better rehabilitation and care strategies that can improve their functional outcomes and quality of life. Healthcare providers from different disciplines and different sectors must work together to provide comprehensive rehabilitation and care. Unfortunately, this does not always happen, leading to communication gaps. Comprehensive rehabilitation and care models need to be implemented to help bridge these gaps. Traditional rehabilitation programmes often fail to engage patients effectively, leading to less-than-optimal results. To provide the best possible care, patients must be involved in the decision-making process and must maintain active engagement in their care. This thesis aims to identify strategies that can improve rehabilitation programmes to benefit patients.

Study I: This was a quantitative study that aimed to evaluate the correlation between Patient Activation Measure 13 (PAM-13) levels and physical function, mobility and activities of daily living in older adults undergoing rehabilitation and care following hip fracture. Functional outcomes were assessed using Timed Up and Go (TUG), the New Mobility Score (NMS) and the Barthel-20 Index. The study included 239 older adults with hip fractures who were divided into four groups based on PAM-13 levels representing their ability to manage their health. Despite finding no significant differences in baseline demographics among the PAM-13 groups, results showed that patients with higher activation levels had shorter hospital stays. Patients at all PAM-13 levels had significant improvements in functional outcomes over time, with faster TUG times and higher NMS and Barthel-20 scores. A secondary analysis comparing participants undergoing the ‘Rehabilitation for Life’ programme with those receiving ‘Usual Rehabilitation’ found no difference in PAM-13 scores at discharge or the followup assessments.

Study II: This study investigated healthcare professionals’ perspectives on rehabilitating and care of older adults with hip fractures within the ‘Rehabilitation for Life’ programme. Sixteen experienced nurses and physiotherapists shared insights during focus group interviews. Three main themes emerged: 1) The importance of structured rehabilitation plans for effective interventions; 2) The transformative role of healthcare centres in providing support and motivation; and 3) The challenges of balancing strength and functionality in patient-centred rehabilitation. Participants emphasized the need for familiarity with rehabilitation and care programmes, the supportive environment of healthcare centres and the importance of tailoring interventions to individual functional goals.

Study III: This study aimed to explore the experiences of older adults who participated in the ‘Rehabilitation for Life’ intervention to support their recovery after hip fracture. The study conducted in-depth interviews with 16 participants and identified five key themes in the rehabilitation process. These themes included the following: 1) The importance of receiving adequate information and care during hospital stays; 2) The need for early visits from healthcare professionals after discharge; 3) The value of social support during training; 4) The appreciation for empathetic and skilled staff; and 5) The acceptance of a new identity post-injury. Despite the challenges posed by hip fractures, the participants expressed their desire to regain mobility and independence. 

Overall, the three studies offer valuable insights into the rehabilitation process for hip fractures. They emphasize the need for structured plans, supportive environments, and personalized approaches to ensure successful recovery. Addressing the physical, psychological, and social aspects of rehabilitation is essential for meeting the diverse needs of patients. The findings highlight the complexity of hip fracture rehabilitation and stress the importance of a multidisciplinary approach across sectors.