1) To document engagement with recovery and refracture prevention recommendations among a diverse cohort of people experiencing a low-trauma hip fracture and; 2) To understand the barriers and enablers to the adoption of recommendations using Andersen’s Behavioural Model of Health Service Utilisation.
This study adopted a sequential explanatory mixed-methods design. Consecutive
community-dwelling adults attending a tertiary trauma hospital between December 2022 and November 2023 were prospectively followed from initial presentation to 16-weeks. Sociodemographic information, pre-morbid health profile, acute management and discharge/transfer of care details were extracted from the medical record. At 16-weeks post-fracture, participants were contacted to ascertain residence, participation in a sub-acute hip fracture clinic, pain and mobility status, self-reported health status using the EQ5D5L and engagement with recovery and refracture prevention recommendations (exercise/falls prevention, nutritional management and pharmacotherapy). A purposive sample of participants from different cultural backgrounds and with varying engagement with post-discharge recommendations were then invited to participate in a semi-structured interview exploring their perspectives of recovery and barriers and enablers to recommendation adoption. Data were analysed using a combination of descriptive methods and inductive thematic analysis before integration using Andersen’s Behavioural Model of Health Service Utilisation.
This highly diverse sample comprised 136 eligible patients 75% from culturally diverse backgrounds and 49% non-English speaking. All were surgically managed, >2/3rds experienced an acute-care complication and 68% were discharged to inpatient-based rehabilitation. Of the 127 patients contactable at 16-weeks, 95% continued to be living at home, 84% required a mobility aid, and approximately half reported moderate or worse function (walking 42%, self-care 45% and usual activities 57%). Engagement with recovery and refracture prevention was sub-optimal, with less than a third participating in balance exercise, 20% consulting a dietician and only 64% of anti-resorptive eligible patients reporting compliance with therapy. Interviews with 20 patients/carers yielded themes of ‘normalisation of deterioration’, ‘osteoporosis health literacy’ and ‘patient-carer empowerment’ underpinning engagement with recovery/refracture prevention recommendations.
There is a need to optimise engagement beyond the sub-acute period with refracture prevention among patients sustaining a hip fracture. Promoting osteoporosis health literacy and fostering an accurate representation of the fracture cause (osteoporosis Vs fall) is important for addressing sub-optimal engagement with refracture recommendations.
- Simplifying messaging with a focus on Mobility, Nutrition and Medication (MNM) during the acute-care period may help empower people experiencing a hip fracture to address their refracture risk.
- Physiotherapists can play a leading role in supporting patients to optimise engagement with refracture prevention recommendations.
Refracture
Osteoporosis
