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 '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.

Keywords: community; dementia; hip fracture; physiotherapy; qualitative; rehabilitation.