We aimed to systematically review qualitative studies to describe the psychosocial impact of hip fracture.
Qualitative studies reporting on the psychosocial impact of hip fracture were selected from a search of five databases (MEDLINE, Cochrane, EMBASE, PsycINFO, and CINAHL) supplemented by reference list checking and citation tracking. Articles were selected and data extracted by two reviewers independently. The quality of included studies was assessed using the Critical Appraisal Skills Programme checklist for qualitative research. Analysis was conducted by adapting a three-step qualitative meta-summary approach. In the third step, reviewers met and grouped codes into themes and subthemes in a thematic synthesis process. The confidence in findings was reported using the Confidence in the Evidence from Reviews of Qualitative research (GRADE CERQual) approach, taking account of methodological quality, coherence, relevance and adequacy.
Fifty-seven studies were included. Data were collected between the peri-operative period to more than 12 months post fracture from 919 participants, 130 carers and 297 clinicians. Most participants with hip fracture were female (73%, 631 of 860 where reported) and median or mean ages, where reported, were at least 70 years for all but three studies. The overarching theme identified was that hip fracture was viewed as a life-altering event: “It’s altered my whole life, believe me”. This life altering event was characterised by a sense of loss: “I’m more house-bound. So I’ve become more of a recluse”. It was also characterised by prolonged negative emotions: “After the hip fracture I have felt depressed for the first time in my life. I feel totally empty. And the gloominess persists”; and fear of the future: “Will I ever be able to control my everyday life again?”. The psychosocial impact can be affected by the negative attitudes of family, friends and clinicians. For some people after hip fracture there was, with time, acceptance of a new reality of not being able to do all the things they used to do. There was moderate to high confidence in these findings.
There is a large body of evidence providing moderate to high certainty confidence that hip fracture is a life altering event characterised by a sense of loss, negative emotions and fear of the future. These reactions can be exacerbated by negative attitudes by carers and clinicians.
Psychosocial management may need to be a component of optimal care to improve outcomes after hip fracture. It is important that physiotherapists provide empathic, person-centred care for all after hip fracture. Some people may require more specialised psychosocial support.
systematic review
qualitative analysis
