Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England
Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England
Purpose: to investigate physiotherapists' perspectives of effective community provision following hip fracture. Methods: qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. Results: four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. Conclusion: physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.
allied health professional, femoral neck fractures, older people, process mapping, qualitative research, stratified care
Adams, J.
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Jones, G.D.
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Sadler, E.
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Guerra, S.
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Sobolev, B.
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Sackley, C.
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Sheehan, K.J.
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1 September 2023
Adams, J.
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Jones, G.D.
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Sadler, E.
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Guerra, S.
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Sobolev, B.
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Sackley, C.
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Sheehan, K.J.
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Adams, J., Jones, G.D., Sadler, E., Guerra, S., Sobolev, B., Sackley, C. and Sheehan, K.J.
(2023)
Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England.
Age and Ageing, 52 (9), [afad130].
(doi:10.1093/ageing/afad130).
Abstract
Purpose: to investigate physiotherapists' perspectives of effective community provision following hip fracture. Methods: qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. Results: four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. Conclusion: physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.
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350_Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture - A qualitative study in England
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Accepted/In Press date: 16 May 2023
Published date: 1 September 2023
Additional Information:
Funding Information:
This work was supported by the Chartered Society of Physiotherapy Charitable Trust (CSPCT) and the Private Physiotherapy Educational Foundation (PPEF) [grant number PRF-PPEF-21-PRE01].
Funding Information:
J.A. received funding from the Chartered Society of Physiotherapy Charitable Trust and The Private Physiotherapy Educational Foundation. K.J.S. received funding from UK Research & Innovation Future Leaders Fellowship, the National Institutes of Health Research (NIHR) and Chartered Society of Physiotherapy Charitable Trust for hip fracture health services research. K.J.S. is the Chair of the Scientific and Publications Committee of the Falls and Fragility Fracture Audit Programme, which managed the National Hip Fracture Database audit at the Royal College of Physicians. E.S. is supported by NIHR Applied Research Collaboration (ARC) Wessex. G.D.J. has no conflicts of interest to declare.
Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Keywords:
allied health professional, femoral neck fractures, older people, process mapping, qualitative research, stratified care
Identifiers
Local EPrints ID: 478569
URI: http://eprints.soton.ac.uk/id/eprint/478569
ISSN: 0002-0729
PURE UUID: c617c632-6eb3-4eaf-a56c-97b9761a7b28
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Date deposited: 05 Jul 2023 16:30
Last modified: 17 Mar 2024 03:56
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Contributors
Author:
J. Adams
Author:
G.D. Jones
Author:
S. Guerra
Author:
B. Sobolev
Author:
C. Sackley
Author:
K.J. Sheehan
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