Publications (2)0.77 Total impact
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ABSTRACT: BACKGROUND AND PURPOSE:: In Canada, residents of long- term care (LTC) fac ilities are frequently transferred back to their residential facilities to continue recovery 1 week following hip fractures. Limited evidence is available regarding rehabilitation services in LTC facilities following hip fracture or rehabilitation practices after hip fracture for persons with dementia. We previously performed a systematic review of the impact of rehabilitation after hip fractures on persons with dementia. The purpose of this project was to augment our systematic review findings and determine current reported rehabilitation practices of rehabilitation professionals working in LTC facilities with hip-fractured patients with dementia and examine perceived barriers to the delivery of rehabilitation. METHODS:: We performed a survey study of rehabilitation professionals working in LTC facilities in a Canadian province, using a modified Delphi Consensus approach and a Web- based survey format. The survey was constructed on the basis of our systematic literature review and through discussions with clinical experts. A 2-round modified Delphi consensus approach was used to attain consensus among respondents. Examination of agreement and disagreement among respondents in the areas of (1) current practice and (2) perceived barriers to care was undertaken. RESULTS:: A total of 42 respondents completed round 1 and 27 respondents completed round 2. Respondents were primarily female and working as physical therapists or occupational therapists. Most worked at facilities that employed at least 1 physical therapist and 1 occupational therapist. Treatment strategies for patients with hip fracture focused on return to independent ambulation and transfers. Although cognition was seen as a barrier to treatment, respondents implemented strategies to mitigate this barrier. Inadequate time and staffing were also seen as barriers to effective treatment. DISCUSSION:: Rehabilitation professionals working in LTC facilities reported that the residents with dementia can and should participate in rehabilitation following hip fractures; however, they identified time and staffing constraints in addition to cognitive impairment as barriers. CONCLUSIONS:: Current research in LTC facilities is very sparse and little is known about the rehabilitation care provided in these facilities. Further research is needed to determine the most effective rehabilitation interventions following hip fractures for residents of LTC facilities with dementia.
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ABSTRACT: Purpose: Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Methods: Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle-Ottawa Scale was used to assess validity. Results: A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. Conclusions: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.