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Milton-Cole R, Goubar A, Ayis S, O’Connell MDL, Kristensen MT, Schuch FB, Sheehan KJ. The role of depression in the association between mobilisation timing and live discharge after hip fracture surgery: Secondary analysis of the UK National Hip Fracture Database. PLoS One 2024; 19:e0298804. [PMID: 38574013 PMCID: PMC10994389 DOI: 10.1371/journal.pone.0298804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE The aim was to compare the probability of discharge after hip fracture surgery conditional on being alive and in hospital between patients mobilised within and beyond 36-hours of surgery across groups defined by depression. METHODS Data were taken from the National Hip Fracture Database and included patients 60 years of age or older who underwent hip fracture surgery in England and Wales between 2014 and 2016. The conditional probability of postsurgical live discharge was estimated for patients mobilised early and for patients mobilised late across groups with and without depression. The association between mobilisation timing and the conditional probability of live discharge were also estimated separately through adjusted generalized linear models. RESULTS Data were analysed for 116,274 patients. A diagnosis of depression was present in 8.31% patients. In those with depression, 7,412 (76.7%) patients mobilised early. In those without depression, 84,085 (78.9%) patients mobilised early. By day 30 after surgery, the adjusted odds ratio of discharge among those who mobilised early compared to late was 1.79 (95% CI: 1.56-2.05, p<0.001) and 1.92 (95% CI: 1.84-2.00, p<0.001) for those with and without depression, respectively. CONCLUSION A similar proportion of patients with depression mobilised early after hip fracture surgery when compared to those without a diagnosis of depression. The association between mobilisation timing and time to live discharge was observed for patients with and without depression.
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Affiliation(s)
- R. Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - A. Goubar
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - S. Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - M. D. L. O’Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - M. T. Kristensen
- Department of Physical- and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F. B. Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - K. J. Sheehan
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
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Guerra S, Ellmers T, Turabi R, Law M, Chauhan A, Milton-Cole R, Godfrey E, Sheehan KJ. Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review. Eur Geriatr Med 2024; 15:305-332. [PMID: 38418713 PMCID: PMC10997732 DOI: 10.1007/s41999-024-00936-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. METHODS A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. RESULTS We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. CONCLUSION These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.
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Affiliation(s)
- Stefanny Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK.
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
| | - Toby Ellmers
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Ruqayyah Turabi
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Magda Law
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Aishwarya Chauhan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Emma Godfrey
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
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Wijekoon A, Jayawardana S, Milton-Cole R, Chandrathilake K, Jones A, Cook S, Morrison E, Sheehan KJ. Response to Letter to the Editor on "Effectiveness and Equity in Community-based Rehabilitation on Pain, Physical Function, and Quality of Life Following Unilateral Lower Limb Amputation: A Systematic Review". Arch Phys Med Rehabil 2024:S0003-9993(24)00814-1. [PMID: 38521497 DOI: 10.1016/j.apmr.2024.02.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Ashan Wijekoon
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK; Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
| | - Subashini Jayawardana
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rhian Milton-Cole
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK
| | - Krm Chandrathilake
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Amy Jones
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, Bowley Close, Farquhar Road, London SE19 SZ, UK
| | - Sophie Cook
- Amputee Rehabilitation Unit, Lambeth Community Care Centre, Guys and St Thomas' NHS Foundation Trust, Monkton Street, Kennington, London SE11 4TX, UK
| | - Ed Morrison
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, Bowley Close, Farquhar Road, London SE19 SZ, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK
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Milton-Cole R, Kazeem K, Gibson A, Guerra S, Sheehan KJ. Effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults post hip fracture: a systematic review and meta-analysis. Osteoporos Int 2024; 35:227-242. [PMID: 37831102 DOI: 10.1007/s00198-023-06923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
This study determines the effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults after hip fracture. Ovid MEDLINE, Embase, Global Health, APAPsych, CENTRAL, CIHAHL, PEDro and Open Grey were searched from database inception to June 10, 2022 for definitive, pilot or feasibility randomised controlled trials of rehabilitation interventions (versus any comparator) which reported depressive symptoms among older adults post hip fracture. Nonrandomised trials and those not published in English were excluded. Selection, quality appraisal (Cochrane Risk of Bias 2) and extraction in duplicate. Results were synthesised narratively and with meta-analysis (Hedge's g for intervention effect, I2 for heterogeneity). Eight trials (1146 participants) were included. Interventions were predominantly face-to-face exercise rehabilitation (range three to 56 sessions) at home versus usual care. Three trials were assigned overall low risk of bias, three some concerns and two high risk. The pooled effect of rehabilitation on depressive symptoms at intervention end favoured the intervention group (Hedges's g -0.43; 95% CI: -0.87, 0.01; four trials). Three trials demonstrated no between group difference following adjustment for baseline depressive symptoms. One trial found lower odds of depression when the intervention additionally included falls prevention, nutrition consultation and depression management. There is a potential benefit of exercise rehabilitation interventions on depressive symptoms after hip fracture. A mechanism for benefit may relate to baseline symptom severity, exercise frequency, frequency of health professional contacts, addition of a psychological component or of the quality of the underlying trials. To appropriately inform clinical guidelines, further appropriately powered trials with follow-up are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CRD42022342099.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kareema Kazeem
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Alexander Gibson
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK.
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Milton-Cole R, O'Connell MDL, Sheehan KJ, Ayis S. The role of depression in the association between physiotherapy frequency and duration and outcomes after hip fracture surgery: secondary analysis of the physiotherapy hip fracture sprint audit. Eur Geriatr Med 2023; 14:999-1010. [PMID: 37329488 PMCID: PMC10587201 DOI: 10.1007/s41999-023-00808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE It is not known whether the association between the frequency and duration of physiotherapy and patient outcomes varies for those with and without depression. This study aims to evaluate whether the associations between the frequency and duration of physiotherapy after hip fracture surgery and discharge home, surviving at 30 days post-admission, and being readmitted 30 days post discharge vary by depression diagnosis. METHODS Data were from 5005 adults aged 60 and over included in the UK Physiotherapy Hip Fracture Sprint Audit who had undergone surgery for a nonpathological first hip fracture. Logistic regression models were used to estimate the unadjusted and adjusted odds ratios and their 95% confidence intervals for the associations between physiotherapy frequency and duration and outcomes. RESULTS Physiotherapy frequency and duration were comparable between patients with and without depression (42.1% and 44.6%). The average adjusted odds for a 30-min increase in physiotherapy duration for those with and without depression for discharge home were 1.05 (95% CI 0.85-1.29) vs 1.16 (95% CI 1.05-1.28, interaction p = 0.36), for 30-day survival were 1.26 (95% CI 1.06-1.50) vs 1.11 (95% CI 1.05-1.17, interaction p = 0.45) and for readmission were 0.89 (95% CI 0.81-0.98) vs 0.97 (95% CI 0.93-1.00, interaction p = 0.09). None of the interaction tests reached formal significance, but the readmission models were close (p = 0.09). CONCLUSION Results suggest physiotherapy duration may be negatively associated with readmission in those with depression but not those without depression, while no clear difference in the other outcomes was noted.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
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Wijekoon A, Jayawardana S, Milton-Cole R, Chandrathilaka M, Jones A, Cook S, Morrison E, Sheehan KJ. Effectiveness and Equity in Community-Based Rehabilitation on Pain, Physical Function, and Quality of Life After Unilateral Lower Limb Amputation: A Systematic Review. Arch Phys Med Rehabil 2023; 104:1484-1497. [PMID: 36893877 DOI: 10.1016/j.apmr.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To synthesize evidence for (1) the effectiveness of exercise-based rehabilitation interventions in the community and/or at home after transfemoral and transtibial amputation on pain, physical function, and quality of life and (2) the extent of inequities (unfair, avoidable differences in health) in access to identified interventions. DATA SOURCES Embase, MEDLINE, PEDro, Cinahl, Global Health, PsycINFO, OpenGrey, and ClinicalTrials.gov were systematically searched from inception to August 12, 2021, for published, unpublished, and registered ongoing randomized controlled trials. STUDY SELECTION Three review authors completed screening and quality appraisal in Covidence using the Cochrane Risk of Bias Tool. Included were randomized controlled trials of exercise-based rehabilitation interventions based in the community or at home for adults with transfemoral or transtibial amputation that assessed effectiveness on pain, physical function, or quality of life. DATA EXTRACTION Effectiveness data were extracted to templates defined a priori and the PROGRESS-Plus framework was used for equity factors. DATA SYNTHESIS Eight completed trials of low to moderate quality, 2 trial protocols, and 3 registered ongoing trials (351 participants across trials) were identified. Interventions included cognitive behavioral therapy, education, and video games, combined with exercise. There was heterogeneity in the mode of exercise as well as outcome measures employed. Intervention effects on pain, physical function, and quality of life were inconsistent. Intervention intensity, time of delivery, and degree of supervision influenced reported effectiveness. Overall, 423 potential participants were inequitably excluded from identified trials (65%), limiting the generalizability of interventions to the underlying population. CONCLUSIONS Interventions that were tailored, supervised, of higher intensity, and not in the immediate postacute phase showed greater promise for improving specific physical function outcomes. Future trials should explore these effects further and employ more inclusive eligibility to optimize any future implementation.
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Affiliation(s)
- Ashan Wijekoon
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
| | - Subashini Jayawardana
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rhian Milton-Cole
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Amy Jones
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Sophie Cook
- Amputee Rehabilitation Unit, Lambeth Community Care Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Ed Morrison
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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7
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Almilaji O, Ayis S, Goubar A, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ. Frequency, duration, and type of physiotherapy in the week after hip fracture surgery - analysis of implications for discharge home, readmission, survival, and recovery of mobility. Physiotherapy 2023; 120:47-59. [PMID: 37369161 DOI: 10.1016/j.physio.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery. METHODS A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence. RESULTS Overall, 73% were female and 40% had high frailty risk. Patients who received ≥2 hours of physiotherapy (versus less) had 3% (95% Confidence Interval: 0-6%), 4% (2-6%), and 6% (1-11%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 3% (0-6%) lower adjusted probability of readmission. Recipients of exercise (versus mobilisation alone) had 6% (1-12%), 3% (0-7%), and 11% (3-18%) higher adjusted probabilities of discharge home, survival, and outdoor mobility recovery, and 6% (2-10%) lower adjusted probability of readmission. Recipients of 6-7 days physiotherapy (versus 0-2 days) had 8% (5-11%) higher adjusted probability of survival. For patients with dementia, improved probability of survival, discharge home, readmission and indoor mobility recovery were observed with greater physiotherapy access. CONCLUSION Greater access to physiotherapy was associated with a higher probability of positive outcomes. For every 100 patients, greater access could equate to an additional eight patients surviving to 30-days and six avoiding 30-day readmission. The findings suggest a potential benefit in terms of home discharge and outdoor mobility recovery. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Orouba Almilaji
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK; Department of Health Service Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - Aicha Goubar
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine University of Alberta,Canada
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health,University of Sydney, Australia
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Antony Johansen
- Cardiff Trauma Unit, University Hospital of Wales, Cardiff, UK
| | - Morten Tange Kristensen
- Department of Physical & Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Finbarr C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK; Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, UK & Southern Health NHS Foundation Trust, UK
| | - Euan Sadler
- Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK.
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Myers-Ingram R, Sampford J, Milton-Cole R, Jones GD. Effectiveness of eHealth weight management interventions in overweight and obese adults from low socioeconomic groups: a systematic review. Syst Rev 2023; 12:59. [PMID: 36998094 PMCID: PMC10061957 DOI: 10.1186/s13643-023-02207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 03/01/2023] [Indexed: 03/31/2023] Open
Abstract
Background Low socioeconomic status (SES) is associated with increased rates of overweight and obesity. Proponents of electronic health (eHealth) hypothesise that its inclusion in weight management interventions can improve efficacy by mitigating typical barriers associated with low SES. Objectives To establish the scope of eHealth weight management interventions for people with overweight and obesity from a low SES. Secondary objectives were to determine the efficacy of eHealth interventions in facilitating weight loss, physical activity and fitness improvements. Methods Four databases and grey literature were systematically searched to identify eligible studies published in English from inception to May 2021. Studies examining an eHealth intervention with low SES participants were included. Outcomes included temporal change in weight and BMI, anthropometry, physiological measures and physical activity levels. The number and heterogeneity of studies precluded any meta-analyses; thus, a narrative review was undertaken. Results Four experimental studies with low risk of bias were reviewed. There was variance in how SES was defined. Study aims and eHealth media also varied and included reducing/maintaining weight or increasing physical activity using interactive websites or voice responses, periodic communication and discourse via telephone, social media, text messaging or eNewsletters. Irrespectively, all studies reported short-term weight loss. eHealth interventions also increased short-term physical activity levels where it was assessed, but did not change anthropometry or physiological measures. None reported any effect on physical fitness. Conclusions This review revealed short-term effects of eHealth interventions on weight loss and increased physical activity levels for low SES participants. Evidence was limited to a small number of studies, with small to moderate sample sizes. Inter-study comparison is challenging because of considerable variability. Future work should prioritise how to utilise eHealth in the longer term either as a supportive public health measure or by determining its long-term efficacy in engendering volitional health behaviour changes. Systematic review registration PROSPERO CRD42021243973 Supplementary Information The online version contains supplementary material available at 10.1186/s13643-023-02207-3.
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Affiliation(s)
- Richard Myers-Ingram
- grid.420545.20000 0004 0489 3985Department of Physiotherapy, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Jade Sampford
- grid.420545.20000 0004 0489 3985Department of Physiotherapy, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Rhian Milton-Cole
- grid.420545.20000 0004 0489 3985Department of Physiotherapy, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK
- grid.13097.3c0000 0001 2322 6764Department of Population and Health Sciences, King’s College London, London, UK
| | - Gareth David Jones
- grid.420545.20000 0004 0489 3985Department of Physiotherapy, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London, UK
- grid.13097.3c0000 0001 2322 6764Faculty of Life Sciences & Medicine, Centre for Human & Applied Physiological Sciences (CHAPS), King’s College London, London, UK
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Milton-Cole R, Ayis S, O'Connell MDL, Smith T, Sheehan K. 1174 THE ROLE OF HIP FRACTURE IN TRAJECTORIES OF DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS: ANALYSIS FROM THE ENGLISH LONGITUDINAL STUDY. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Older adults experience ‘Late life depression’. Hip fractures may negatively influence trajectories of depressive symptoms in older adults. This study aimed to determine trajectories of depressive symptoms among older adults in England, overall and for those after hip fracture, and identify characteristics defining trajectory membership.
Methods
Analysis of adults aged 60 years or more (n=7,050), including a hip fracture subgroup (n = 384), from the English Longitudinal Study of Ageing. Latent class growth mixture modelling was completed. Depressive symptom prevalence was estimated at baseline. Chi-squared tests were completed to compare baseline characteristics across trajectories.
Results
Three trajectory groups were identified overall and for those with hip fracture: no-, mild-, and moderate-severe- symptoms. The moderate-severe group comprised 13.7% and 7% of participants for overall and hip fracture populations respectively. Overall, the proportion of participants with depressive symptoms were 0.4%, 12.4% and 65.4% for no-, mild-, and moderate-severe- symptom groups, respectively. For the hip fracture subgroup, these proportions were 0.7%, 28.8%, and 85.2%. Depressive symptoms were stable over time, with a weak trend towards increasing severity for the moderate-severe group. Individuals with moderate-severe trajectories were older, more likely to be female, live alone and had worse health outcomes (p < 0.001).
Conclusions
Older adults, and those after hip fracture, follow one of three trajectories of depressive symptoms which are broadly stable over time. The prevalence of depressive symptoms was lower for those with hip fracture however, when present, the symptoms were more severe than the overall population. Results suggest a role of factors including age, gender, and marital status in depressive symptoms trajectories.
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Milton-Cole R, Ayis S, O'Connell MDL, Smith T, Sheehan KJ. Trajectories of Depressive Symptoms Among Older Adults and in Adults With Hip Fracture: Analysis From the English Longitudinal Study of Ageing. J Gerontol A Biol Sci Med Sci 2022; 77:2453-2458. [PMID: 36073633 PMCID: PMC9799186 DOI: 10.1093/gerona/glac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This study aimed to determine trajectories of depressive symptoms among older adults in England, overall and for those with hip fracture. The study aimed to explore the differential characteristics of each trajectory identified. METHODS Analysis of adults aged 60 years or more (n = 7 050), including a hip fracture subgroup (n = 384), from the English Longitudinal Study of Ageing. Latent class growth mixture modeling was completed. Depressive symptom prevalence was estimated at baseline. Chi-square tests were completed to compare baseline characteristics across trajectories. RESULTS Three trajectories of depressive symptoms (no, mild, and moderate-severe) were identified overall and for those with hip fracture. The moderate-severe trajectory comprised 13.7% and 7% of participants for overall and hip fracture populations, respectively. The proportion of participants with depressive symptoms in the moderate-severe trajectory was 65.4% and 85.2% for overall and hip fracture populations, respectively. Depressive symptoms were stable over time, with a weak trend toward increasing severity for the moderate-severe symptom trajectory. Participants in the moderate-severe symptom trajectory were older, more likely to be female, live alone, and had worse health measures than other trajectories (p < .001). CONCLUSIONS Older adults, and those with hip fracture, follow one of the 3 trajectories of depressive symptoms that are broadly stable over time. Depressive symptoms' prevalence was higher for those with hip fracture and, when present, the symptoms were more severe than the overall population. Results suggest a role of factors including age, gender, and marital status in depressive symptom trajectories.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Toby Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
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11
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Geohagen O, Hamer L, Lowton A, Guerra S, Milton-Cole R, Ellery P, Martin FC, Lamb SE, Sackley C, Sheehan KJ. The effectiveness of rehabilitation interventions including outdoor mobility on older adults' physical activity, endurance, outdoor mobility and falls-related self-efficacy: systematic review and meta-analysis. Age Ageing 2022; 51:6612691. [PMID: 35737601 PMCID: PMC9220027 DOI: 10.1093/ageing/afac120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the effectiveness of community-based rehabilitation interventions which incorporate outdoor mobility on physical activity, endurance, outdoor mobility and falls-related self-efficacy in older adults. Design MEDLINE, Embase, CINAHL, PEDro and OpenGrey were searched systematically from inception to June 2021 for randomised controlled trials (RCTs) of community-based rehabilitation incorporating outdoor mobility on physical activity, endurance, outdoor mobility and/or falls-related self-efficacy in older adults. Duplicate screening, selection, extraction and appraisal were completed. Results were reported descriptively and with random-effects meta-analyses stratified by population (proactive [community-dwelling], reactive [illness/injury]). Results A total of 29 RCTs with 7,076 participants were identified (66% high bias for at least one domain). The outdoor mobility component was predominantly a walking programme with behaviour change. Rehabilitation for reactive populations increased physical activity (seven RCTs, 587 participants. Hedge’s g 1.32, 95% CI: 0.31, 2.32), endurance (four RCTs, 392 participants. Hedges g 0.24; 95% CI: 0.04, 0.44) and outdoor mobility (two RCTs with 663 participants. Go out as much as wanted, likelihood of a journey) at intervention end versus usual care. Where reported, effects were preserved at follow-up. One RCT indicated a benefit of rehabilitation for proactive populations on moderate-to-vigorous activity and outdoor mobility. No effect was noted for falls-related self-efficacy, or other outcomes following rehabilitation for proactive populations. Conclusion Reactive rehabilitation for older adults may include walking programmes with behaviour change techniques. Future research should address the potential benefit of a walking programme for proactive populations and address mobility-related anxiety as a barrier to outdoor mobility for both proactive and reactive populations.
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Affiliation(s)
- Olyvia Geohagen
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Lydia Hamer
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Alexandra Lowton
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | | | - Finbarr C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Sallie E Lamb
- Institute of Health Research, University of Exeter, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK.,Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
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12
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Goubar A, Ayis S, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ. The impact of the frequency, duration and type of physiotherapy on discharge after hip fracture surgery: a secondary analysis of UK national linked audit data. Osteoporos Int 2022; 33:839-850. [PMID: 34748023 PMCID: PMC8930962 DOI: 10.1007/s00198-021-06195-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Additional physiotherapy in the first postoperative week was associated with fewer days to discharge after hip fracture surgery. A 7-day physiotherapy service in the first postoperative week should be considered as a new key performance indicator in evaluating the quality of care for patients admitted with a hip fracture. INTRODUCTION To examine the association between physiotherapy in the first week after hip fracture surgery and discharge from acute hospital. METHODS We linked data from the UK Physiotherapy Hip Fracture Sprint Audit to hospital records for 5395 patients with hip fracture in May and June 2017. We estimated the association between the number of days patients received physiotherapy in the first postoperative week; its overall duration (< 2 h, ≥ 2 h; 30-min increment) and type (mobilisation alone, mobilisation and exercise) and the cumulative probability of discharge from acute hospital over 30 days, using proportional odds regression adjusted for confounders and the competing risk of death. RESULTS The crude and adjusted odds ratios of discharge were 1.24 (95% CI 1.19-1.30) and 1.26 (95% CI 1.19-1.33) for an additional day of physiotherapy, 1.34 (95% CI 1.18-1.52) and 1.33 (95% CI 1.12-1.57) for ≥ 2 versus < 2 h physiotherapy, and 1.11 (95% CI 1.08-1.15) and 1.10 (95% CI 1.05-1.15) for an additional 30-min of physiotherapy. Physiotherapy type was not associated with discharge. CONCLUSION We report an association between physiotherapy and discharge after hip fracture. An average UK hospital admitting 375 patients annually may save 456 bed-days if current provision increased so all patients with hip fracture received physiotherapy on 6-7 days in the first postoperative week. A 7-day physiotherapy service totalling at least 2 h in the first postoperative week may be considered a key performance indicator of acute care quality after hip fracture.
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Affiliation(s)
- A Goubar
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - L Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - R Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Johansen
- Cardiff Trauma Unit, University Hospital of Wales, Cardiff, UK
| | - M T Kristensen
- Department of Physical & Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
- Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - E Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - T O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - K J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK.
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13
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Milton-Cole R, Ayis S, Lambe K, O’Connell MDL, Sackley C, Sheehan KJ. 661 PROGNOSTIC FACTORS OF DEPRESSION AFTER HIP FRACTURE SURGERY: SYSTEMATIC REVIEW. Age Ageing 2022. [DOI: 10.1093/ageing/afac035.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Patients with hip fracture and depression are less likely to recover. This review aimed to identify prognostic factors of depression up to one year after hip fracture surgery in adults. Secondary aims were to determine whether identified factors are modifiable or non-modifiable and describe proposed underlying mechanisms for their association with depression.
Methods
We searched MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection databases for published studies as well as grey literature. We did not impose any date, geographical, or language limitations. Two reviewers independently screened studies against predefined eligibility criteria to identify relevant papers. We included observational studies investigating prognostic factors of depression up to one year after surgery in adults surgically managed for non-pathological hip fracture. Two reviewers independently extracted data (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist) and completed quality appraisal (using Quality in Prognosis Studies tool).
Results
3,402 studies were identified; 2,915 studies were excluded leaving 13 studies included in this review. 3,769 patients were included across all studies with a mean age ranging from 76.21–81.82 years. A total of 39 prognostic factors were investigated and most studies failed to identify a primary prognostic factor of interest. Most of these factors were patient factors with only a few being process or structure factors.
Conclusion
Various potential prognostic factors of depression after hip fracture were identified however, Methodological quality and heterogeneity between studies limited the certainty of which prognostic factors were the strongest. High-quality research investigating prognostic factors using the same study design, Methodology and measurements is warranted to allow for comparisons of the predictive power of factors. As well as future research into the underlying mechanisms of prognostic factors.
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Affiliation(s)
- R Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - K Lambe
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - M D L O’Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - K J Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
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14
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Myers-Ingram R, Sampford J, Milton-Cole R, Jones GD. Outcomes Following eHealth Weight Management Interventions in Adults With Overweight and Obesity From Low Socioeconomic Groups: Protocol for a Systematic Review. JMIR Res Protoc 2022; 11:e34546. [PMID: 35049506 PMCID: PMC8814919 DOI: 10.2196/34546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obesity is a complex health condition with multiple associated comorbidities and increased economic costs. People from low socioeconomic status (SES) backgrounds are more likely to be overweight and obese and are less successful in traditional weight management programs. It is possible that eHealth interventions may be more successful in reaching people from low SES groups than traditional face-to-face models, by overcoming certain barriers associated with traditional interventions. It is not yet known, however, if eHealth weight management interventions are effective in people living with overweight and obesity from a low SES background. OBJECTIVE The primary aim of this study is to evaluate the efficacy of eHealth weight management interventions for people with overweight and obesity from low SES groups. METHODS A systematic review on relevant electronic databases (MEDLINE, Embase, Emcare, and CINAHL) will be undertaken to identify eligible studies published in English up until May 2021. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to guide the systematic review, two reviewers will independently screen, select, and extract data and complete a risk of bias assessment of search results according to predefined criteria. Studies that have investigated an eHealth weight management intervention within a low SES population will be included. Primary outcomes include weight, BMI, and percentage weight change compared at baseline and at least one other time point. Secondary outcomes may include a range of anthropometric and physical fitness and activity measures. If sufficient studies are homogeneous, then we will pool results of individual outcomes using meta-analysis. RESULTS Searches have been completed, resulting in 2256 studies identified. Once duplicates were removed, 1545 studies remained for title and abstract review. CONCLUSIONS The use of eHealth in weight management programs has increased significantly in recent years and will continue to do so; however, it is uncertain if eHealth weight management programs are effective in a low SES population. The results of this systematic review will therefore provide a summary of the evidence for interventions using eHealth for people living with overweight and obesity and from a low SES background. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021243973; https://tinyurl.com/2p8fxtnw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34546.
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Affiliation(s)
- Richard Myers-Ingram
- Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jade Sampford
- Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rhian Milton-Cole
- Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Population and Health Sciences, King's College London, London, United Kingdom
| | - Gareth David Jones
- Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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15
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Milton-Cole R, Ayis S, Lambe K, O'Connell MDL, Sackley C, Sheehan KJ. Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review. BMC Geriatr 2021; 21:537. [PMID: 34627160 PMCID: PMC8502369 DOI: 10.1186/s12877-021-02514-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. Methods We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. Results In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. Conclusion Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. Trial registration Prospero registration: CRD42019138690. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02514-1.
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Affiliation(s)
- R Milton-Cole
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK.
| | - S Ayis
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - K Lambe
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - M D L O'Connell
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - C Sackley
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK.,Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - K J Sheehan
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
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16
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Connolly B, Milton-Cole R, Adams C, Battle C, McPeake J, Quasim T, Silversides J, Slack A, Waldmann C, Wilson E, Meyer J. Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report. BMJ Open 2021; 11:e052214. [PMID: 34607869 PMCID: PMC8491421 DOI: 10.1136/bmjopen-2021-052214] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/31/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To comprehensively update and survey the current provision of recovery, rehabilitation and follow-up services for adult critical care patients across the UK. DESIGN Cross-sectional, self-administered, predominantly closed-question, electronic, online survey. SETTING Institutions providing adult critical care services identified from national databases. PARTICIPANTS Multiprofessional critical care clinicians delivering services at each site. RESULTS Responses from 176 UK hospital sites were included (176/242, 72.7%). Inpatient recovery and follow-up services were present at 127/176 (72.2%) sites, adopting multiple formats of delivery and primarily delivered by nurses (n=115/127, 90.6%). Outpatient services ran at 130 sites (73.9%), predominantly as outpatient clinics. Most services (n=108/130, 83.1%) were co-delivered by two or more healthcare professionals, typically nurse/intensive care unit (ICU) physician (n=29/130, 22.3%) or nurse/ICU physician/physiotherapist (n=19/130, 14.6%) teams. Clinical psychology was most frequently lacking from inpatient or outpatient services. Lack of funding was consistently the primary barrier to service provision, with other barriers including logistical and service prioritisation factors indicating that infrastructure and profile for services remain inadequate. Posthospital discharge physical rehabilitation programmes were relatively few (n=31/176, 17.6%), but peer support services were available in nearly half of responding institutions (n=85/176, 48.3%). The effects of the COVID-19 pandemic resulted in either increasing, decreasing or reformatting service provision. Future plans for long-term service transformation focus on expansion of current, and establishment of new, outpatient services. CONCLUSION Overall, these data demonstrate a proliferation of recovery, follow-up and rehabilitation services for critically ill adults in the past decade across the UK, although service gaps remain suggesting further work is required for guideline implementation. Findings can be used to enhance survivorship for critically ill adults, inform policymakers and commissioners, and provide comparative data and experiential insights for clinicians designing models of care in international healthcare jurisdictions.
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Affiliation(s)
- Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rhian Milton-Cole
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Claire Adams
- Department of Anaesthesia & Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ceri Battle
- Ed Major Critical Care Unit, Morriston Hospital, Swansea, UK
| | - Joanne McPeake
- NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Tara Quasim
- NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Jon Silversides
- Department of Critical Care, Belfast Health and Social Care Trust, Belfast, UK
| | - Andrew Slack
- Department of Critical Care, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Carl Waldmann
- Department of Intensive Care and Anaesthetics, Royal Berkshire Hospital, Reading, UK
| | - Elizabeth Wilson
- Department of Critical Care Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Joel Meyer
- Department of Critical Care, Guy's and St.Thomas' NHS Foundation Trust, London, UK
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17
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Sheehan KJ, Guerrero EM, Tainter D, Dial B, Milton-Cole R, Blair JA, Alexander J, Swamy P, Kuramoto L, Guy P, Bettger JP, Sobolev B. Prognostic factors of in-hospital complications after hip fracture surgery: a scoping review. Osteoporos Int 2019; 30:1339-1351. [PMID: 31037362 DOI: 10.1007/s00198-019-04976-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/14/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To examine prognostic factors that influence complications after hip fracture surgery. To summarize proposed underlying mechanisms for their influence. METHODS We reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. We searched MEDLINE, Embase, CINAHL, AgeLine, Cochrane Library, and reference lists of retrieved studies for studies of prognostic factor/s of postoperative in-hospital medical complication/s among patients 50 years and older treated surgically for non-pathological closed hip fracture, published in English on January 2008-January 2018. We excluded studies of surgery type or in-hospital medications. Screening was duplicated by two independent reviewers. One reviewer completed the extraction with accuracy checks by the second reviewer. We summarized the extent, nature, and proposed underlying mechanisms for the prognostic factors of complications narratively and in a dependency graph. RESULTS We identified 44 prognostic factors of in-hospital complications after hip fracture surgery from 56 studies. Of these, we identified 7 patient factors-dehydration, anemia, hypotension, heart rate variability, pressure risk, nutrition, and indwelling catheter use; and 7 process factors-time to surgery, anesthetic type, transfusion strategy, orthopedic versus geriatric/co-managed care, multidisciplinary care pathway, and potentially modifiable during index hospitalization. We identified underlying mechanisms for 15 of 44 factors. The reported association between 12 prognostic factors and complications was inconsistent across studies. CONCLUSIONS Most factors were reported by one study with no proposed underlying mechanism for their influence. Where reported by more than one study, there was inconsistency in reported associations and the conceptualization of complications differed, limiting comparison across studies. It is therefore not possible to be certain whether intervening on these factors would reduce the rate of complications after hip fracture surgery.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK.
| | - E M Guerrero
- Department of Orthopaedic Surgery, Duke University Medical Centre, Durham, NC, USA
| | - D Tainter
- Department of Orthopaedic Surgery, Duke University Medical Centre, Durham, NC, USA
| | - B Dial
- Department of Orthopaedic Surgery, Duke University Medical Centre, Durham, NC, USA
| | - R Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - J A Blair
- Department of Orthopaedics and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, USA
| | - J Alexander
- Department of Rehabilitation Sciences, Kingston & St George's University of London, London, UK
| | - P Swamy
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - L Kuramoto
- Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - P Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
| | - J P Bettger
- Department of Orthopaedic Surgery, Duke University Medical Centre, Durham, NC, USA
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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18
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Sheehan KJ, Fitzgerald L, Hatherley S, Potter C, Ayis S, Martin FC, Gregson CL, Cameron ID, Beaupre LA, Wyatt D, Milton-Cole R, DiGiorgio S, Sackley C. Inequity in rehabilitation interventions after hip fracture: a systematic review. Age Ageing 2019; 48:489-497. [PMID: 31220202 DOI: 10.1093/ageing/afz031] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/18/2019] [Accepted: 03/13/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes. DESIGN systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE and ClinicalTrials.gov for randomised controlled trials of rehabilitation interventions after hip fracture published between 1 January 2008 and 30 May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool) and data extraction (Cochrane's PROGRESS-Plus framework). RESULTS twenty-three published, eight protocol, four registered ongoing randomised controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age and/or non-surgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions. CONCLUSION the generalisability of trial results to the underlying population of frail older adults is limited. Yet, this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated. PROSPERO CRD42018085930.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - L Fitzgerald
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - S Hatherley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C Potter
- Department of Physiotherapy, Guy’s and St. Thomas’s National Health Service Foundation Trust, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - F C Martin
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C L Gregson
- Translational Health Sciences, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK
| | - I D Cameron
- Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Australia
| | - L A Beaupre
- Department of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Canada
| | - D Wyatt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, NIHR Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, UK
| | - R Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - S DiGiorgio
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
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