Developing an individualised cross-sectoral programme based on activities of daily living to support rehabilitation of older adults with hip fracture: a qualitative study

OBJECTIVES: To develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently. DESIGN: Qualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles. SETTINGS: University Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities. PARTICIPANTS: One research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists). RESULTS: Three generic categories were identified: (1) ‘Challenge older adults with goal-oriented ADL tasks’, (2) ‘Implement strategies to enhance independent and safe performance of ADL tasks’, and (3) ‘Communicate the important information to the target group and across sectors’. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call. CONCLUSIONS: Engaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme. TRIAL REGISTRATION NUMBER: This article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID: NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID: NCT04207788; Pre-results.