The primary aim was to develop an app-based rehabilitation concept for geriatric patients following femur fractures. Additionally, the study sought to determine the prerequisites for successful implementation and to define the specific requirements for the app.
The study was conducted in two phases. The first phase included an online survey and a focus group. The rehabilitation concept and its prerequisites were identified using the domains of the Consolidated Framework for Implementation Research (CFIR): (A) Innovation, (B) Inner Setting, (C) Outer Setting, and (D) Individual. In the second phase, the "thinking-aloud" approach was used to gather insights into the app's functional requirements.
Participants in both phases included patients and their caregivers—both with and without prior experience using health apps—as well as physiotherapists and doctors experienced in caring for patients after femur fractures. Individuals who participated in the first phase were excluded from the second phase.
Participants in the first phase (n=6) recommended a rehabilitation concept that starts during inpatient rehabilitation, incorporates an app with essential information and a personalized training program, and is supplemented by in-person sessions (A). Additionally, patients and caregivers should receive training on using the app during their inpatient stay (B). The concept should allow patients to decide whether and to what extent they wish to involve caregivers in their rehabilitation process (D). The ultimate goal of the concept is to enhance patients’ functional independence.
The successful implementation of this concept depends on several factors, including patients' cognitive and physical abilities (D) and stakeholders' willingness to acquire the skills needed to use the app (D). Internal structures within the inpatient setting should be reorganized to support the use of the concept (B), and a sustainable reimbursement structure would be necessary (C).
In the second phase (n=19), participants identified several key requirements for the app: it should feature a simple design, easy navigation, video chat capabilities, and the ability to visualize rehabilitation progress.
The results of this study culminated in the development of the PROGRES(S) concept. When designing and implementing an app-based rehabilitation concept like PROGRES(S), it is crucial to consider all dimensions of the CFIR.
If PROGRES(S) proves feasible and acceptable, it could complement existing rehabilitation programs for geriatric patients with femur fractures. This concept could provide essential support to patients who otherwise might have limited or no access to rehabilitation services. The inclusion of PROGRES(S) is expected to promote patients’ functional independence.
digital health
implementation science
