Community physiotherapy for people with dementia following hip fracture: Fact or fiction? A qualitative study

AJ Hall; J Fullam; IA Lang; R Endacott; VA Goodwin

doi:10.1177/1471301219857027

Community physiotherapy for people with dementia following hip fracture: Fact or fiction? A qualitative study

AJ Hall, J Fullam, IA Lang, R Endacott, VA Goodwin

School of Nursing and Midwifery

Research output: Contribution to journal › Article › peer-review

Abstract

Background Physiotherapy is a core component of rehabilitation following a hip fracture. Approximately 40% of people sustaining a hip fracture will have dementia, but there is little evidence to guide physiotherapy interventions in this population. Objective This study forms part of a process evaluation seeking to explore reasons why people with dementia were not referred for physiotherapy following a hip fracture and challenges that are faced treating these people in the community. Methods We undertook a series of structured focus groups and interviews with physiotherapists based in community-rehabilitation services in the South West of England. Qualitative data sought to explain reasons why people with dementia were not being referred for onward physiotherapy following discharge from the acute setting after hip fracture. Framework analysis was used to make sense of the data. Results Four focus groups and interviews were undertaken with physiotherapists and assistants working in community settings. Three main themes were determined – beliefs, the importance of pathways of care and the effect of resources on decision making. Discussion Out data suggest that people with dementia were often labelled as having ‘no rehabilitation potential’ in the acute setting and this excluded them from receiving ongoing therapy in the community setting. It was also suggested that physiotherapists were judging this potential using biomedical measures of outcome which fails to recognise the importance of person centred care for this population. Conclusion There was suggestion of therapeutic nihilism when considering rehabilitation for this population, whereby it is assumed that people with dementia cannot be rehabilitated, so they are not given the opportunity. It is unsurprising that outcomes for this population are poor considering the reluctance to provide physiotherapy to people with dementia following hip fracture.

Original language	English
Pages (from-to)	2750-2760
Number of pages	0
Journal	Dementia
Volume	19
Issue number	8
Early online date	20 Jun 2019
DOIs	https://doi.org/10.1177/1471301219857027
Publication status	Published - Nov 2020

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10.1177/1471301219857027

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@article{75687686326a48d996bb0342535dc6e7,

title = "Community physiotherapy for people with dementia following hip fracture: Fact or fiction? A qualitative study",

abstract = "Background Physiotherapy is a core component of rehabilitation following a hip fracture. Approximately 40% of people sustaining a hip fracture will have dementia, but there is little evidence to guide physiotherapy interventions in this population. Objective This study forms part of a process evaluation seeking to explore reasons why people with dementia were not referred for physiotherapy following a hip fracture and challenges that are faced treating these people in the community. Methods We undertook a series of structured focus groups and interviews with physiotherapists based in community-rehabilitation services in the South West of England. Qualitative data sought to explain reasons why people with dementia were not being referred for onward physiotherapy following discharge from the acute setting after hip fracture. Framework analysis was used to make sense of the data. Results Four focus groups and interviews were undertaken with physiotherapists and assistants working in community settings. Three main themes were determined – beliefs, the importance of pathways of care and the effect of resources on decision making. Discussion Out data suggest that people with dementia were often labelled as having {\textquoteleft}no rehabilitation potential{\textquoteright} in the acute setting and this excluded them from receiving ongoing therapy in the community setting. It was also suggested that physiotherapists were judging this potential using biomedical measures of outcome which fails to recognise the importance of person centred care for this population. Conclusion There was suggestion of therapeutic nihilism when considering rehabilitation for this population, whereby it is assumed that people with dementia cannot be rehabilitated, so they are not given the opportunity. It is unsurprising that outcomes for this population are poor considering the reluctance to provide physiotherapy to people with dementia following hip fracture. ",

author = "AJ Hall and J Fullam and IA Lang and R Endacott and VA Goodwin",

year = "2020",

month = nov,

doi = "10.1177/1471301219857027",

language = "English",

volume = "19",

pages = "2750--2760",

journal = "Dementia",

issn = "1471-3012",

publisher = "SAGE Publications Ltd",

number = "8",

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T1 - Community physiotherapy for people with dementia following hip fracture: Fact or fiction? A qualitative study

AU - Hall, AJ

AU - Fullam, J

AU - Lang, IA

AU - Endacott, R

AU - Goodwin, VA

PY - 2020/11

Y1 - 2020/11

N2 - Background Physiotherapy is a core component of rehabilitation following a hip fracture. Approximately 40% of people sustaining a hip fracture will have dementia, but there is little evidence to guide physiotherapy interventions in this population. Objective This study forms part of a process evaluation seeking to explore reasons why people with dementia were not referred for physiotherapy following a hip fracture and challenges that are faced treating these people in the community. Methods We undertook a series of structured focus groups and interviews with physiotherapists based in community-rehabilitation services in the South West of England. Qualitative data sought to explain reasons why people with dementia were not being referred for onward physiotherapy following discharge from the acute setting after hip fracture. Framework analysis was used to make sense of the data. Results Four focus groups and interviews were undertaken with physiotherapists and assistants working in community settings. Three main themes were determined – beliefs, the importance of pathways of care and the effect of resources on decision making. Discussion Out data suggest that people with dementia were often labelled as having ‘no rehabilitation potential’ in the acute setting and this excluded them from receiving ongoing therapy in the community setting. It was also suggested that physiotherapists were judging this potential using biomedical measures of outcome which fails to recognise the importance of person centred care for this population. Conclusion There was suggestion of therapeutic nihilism when considering rehabilitation for this population, whereby it is assumed that people with dementia cannot be rehabilitated, so they are not given the opportunity. It is unsurprising that outcomes for this population are poor considering the reluctance to provide physiotherapy to people with dementia following hip fracture.

AB - Background Physiotherapy is a core component of rehabilitation following a hip fracture. Approximately 40% of people sustaining a hip fracture will have dementia, but there is little evidence to guide physiotherapy interventions in this population. Objective This study forms part of a process evaluation seeking to explore reasons why people with dementia were not referred for physiotherapy following a hip fracture and challenges that are faced treating these people in the community. Methods We undertook a series of structured focus groups and interviews with physiotherapists based in community-rehabilitation services in the South West of England. Qualitative data sought to explain reasons why people with dementia were not being referred for onward physiotherapy following discharge from the acute setting after hip fracture. Framework analysis was used to make sense of the data. Results Four focus groups and interviews were undertaken with physiotherapists and assistants working in community settings. Three main themes were determined – beliefs, the importance of pathways of care and the effect of resources on decision making. Discussion Out data suggest that people with dementia were often labelled as having ‘no rehabilitation potential’ in the acute setting and this excluded them from receiving ongoing therapy in the community setting. It was also suggested that physiotherapists were judging this potential using biomedical measures of outcome which fails to recognise the importance of person centred care for this population. Conclusion There was suggestion of therapeutic nihilism when considering rehabilitation for this population, whereby it is assumed that people with dementia cannot be rehabilitated, so they are not given the opportunity. It is unsurprising that outcomes for this population are poor considering the reluctance to provide physiotherapy to people with dementia following hip fracture.

U2 - 10.1177/1471301219857027

DO - 10.1177/1471301219857027

M3 - Article

SN - 1471-3012

VL - 19

SP - 2750

EP - 2760

JO - Dementia

JF - Dementia

IS - 8

ER -

Community physiotherapy for people with dementia following hip fracture: Fact or fiction? A qualitative study

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