Orthopaedic physiotherapists’ perceptions of mechanisms for observed variation in the implementation of physiotherapy practices in the early postoperative phase after hip fracture. A UK qualitative study
Orthopaedic physiotherapists’ perceptions of mechanisms for observed variation in the implementation of physiotherapy practices in the early postoperative phase after hip fracture. A UK qualitative study
OBJECTIVE: to explore physiotherapists' perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit. METHODS: a qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at seven hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings. RESULTS: four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting 'postoperative physiotherapy' as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services. CONCLUSION: physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care and allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice, which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles.
acute care, audit, fracture neck of femur, normalisation process theory, older people, rehabilitation
1961-1970
Volkmer, Brittannia
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Sadler, Euan
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Lambe, Kate
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Martin, Finbarr C.
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Ayis, Salma
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Beaupre, Lauren
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Cameron, Ian D.
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Gregson, Celia L.
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Johansen, Antony
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Kristensen, Morten Tange
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Magaziner, Jay
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Sackley, Catherine
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Smith, Toby O.
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Sobolev, Boris
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Sheehan, Katie J.
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10 November 2021
Volkmer, Brittannia
5f01ffdc-97fb-456b-aabf-b75abf1f5b8d
Sadler, Euan
e5891abe-c97b-4e74-b9b3-6d7c43435360
Lambe, Kate
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Martin, Finbarr C.
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Ayis, Salma
b1826a86-a85a-4f62-8927-ec6b4581f668
Beaupre, Lauren
b7f18f20-e3fc-4598-b307-b2241a1c618e
Cameron, Ian D.
fabf6d99-dfed-44d6-8a65-54ac11d54194
Gregson, Celia L.
80857f6f-294c-4373-9125-104b723356e7
Johansen, Antony
95076f9e-76f4-4e48-bb4e-0dc9e86cf784
Kristensen, Morten Tange
f22f54e9-c877-4d51-b979-f28c5bf90dd8
Magaziner, Jay
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Sackley, Catherine
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Smith, Toby O.
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Sobolev, Boris
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Sheehan, Katie J.
447f5cdf-c9a9-466d-af26-f992ecf90265
Volkmer, Brittannia, Sadler, Euan, Lambe, Kate, Martin, Finbarr C., Ayis, Salma, Beaupre, Lauren, Cameron, Ian D., Gregson, Celia L., Johansen, Antony, Kristensen, Morten Tange, Magaziner, Jay, Sackley, Catherine, Smith, Toby O., Sobolev, Boris and Sheehan, Katie J.
(2021)
Orthopaedic physiotherapists’ perceptions of mechanisms for observed variation in the implementation of physiotherapy practices in the early postoperative phase after hip fracture. A UK qualitative study.
Age and Ageing, 50 (6), .
(doi:10.1093/ageing/afab131).
Abstract
OBJECTIVE: to explore physiotherapists' perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit. METHODS: a qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at seven hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings. RESULTS: four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting 'postoperative physiotherapy' as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services. CONCLUSION: physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care and allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice, which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles.
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Volkmer2021_Accepted (3)
- Accepted Manuscript
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Accepted/In Press date: 12 May 2021
Published date: 10 November 2021
Additional Information:
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© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Keywords:
acute care, audit, fracture neck of femur, normalisation process theory, older people, rehabilitation
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Local EPrints ID: 449312
URI: http://eprints.soton.ac.uk/id/eprint/449312
ISSN: 0002-0729
PURE UUID: 0f08aade-8dea-4c13-8761-8e25a8d05e9e
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Date deposited: 24 May 2021 16:31
Last modified: 17 Mar 2024 06:36
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Contributors
Author:
Brittannia Volkmer
Author:
Kate Lambe
Author:
Finbarr C. Martin
Author:
Salma Ayis
Author:
Lauren Beaupre
Author:
Ian D. Cameron
Author:
Celia L. Gregson
Author:
Antony Johansen
Author:
Morten Tange Kristensen
Author:
Jay Magaziner
Author:
Catherine Sackley
Author:
Toby O. Smith
Author:
Boris Sobolev
Author:
Katie J. Sheehan
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