Conceptual Framework for an Episode of Rehabilitative Care After Surgical Repair of Hip Fracture

Abstract

Researchers face a challenge when evaluating the effectiveness of rehabilitation after a surgical procedure for hip fracture. Reported outcomes of rehabilitation will vary depending on the end point of the episode of care. Evaluation at an inappropriate end point might suggest a lack of effectiveness leading to the underuse of rehabilitation that could improve outcomes. The purpose of this article is to describe a conceptual framework for a continuum-care episode of rehabilitation after a surgical procedure for hip fracture. Definitions are proposed for the index event, end point, and service scope of the episode. Challenges in defining the episode of care and operationalizing the episode, and next steps for researchers are discussed. The episode described is intended to apply to all patients eligible for entry to rehabilitation after hip fracture and includes most functional recovery end points. This framework will provide a guide for rehabilitation researchers when designing and interpreting evaluations of the effectiveness of rehabilitation after hip fracture. Evaluation of all potential care episodes facilitates transparency in reporting of outcomes, enabling researchers to determine the true effectiveness of rehabilitation after a surgical procedure for hip fracture.

Figure 1.

Conceptual framework for rehabilitation continuum-care episode after a surgical procedure for hip fracture. The asterisk (*) indicates readmission for complications, readmission for revision surgery, or the start of a new unrelated episode of care.

Figure 2.

Defining “back to baseline” from the perspective of the patient and caregiver, and of the therapist.

Figure 3.

Expanded service scope of conceptual framework for continuum-care episode of rehabilitation after a surgical procedure for hip fracture.