Barriers and facilitators of weight bearing after hip fracture surgery among older adults.  A scoping review

Ruqayyah Turabi; David Wyatt; Stefanny Guerra; Matthew O'Connell; Toslima Khatun; Saibin Ahmad Sageer; Adel Alhazmi; Katie Sheehan

doi:10.1007/s00198-023-06735-5

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

Ruqayyah Turabi, David Wyatt, Stefanny Guerra, Matthew O'Connell, Toslima Khatun, Saibin Ahmad Sageer, Adel Alhazmi, Katie Sheehan

Population Health Sciences

Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.

Research output: Contribution to journal › Review article › peer-review

4 Citations (Scopus)

106 Downloads (Pure)

Abstract

Purpose: This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults. Methods: Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov, OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach. Results: In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses’ notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year. Conclusion: Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes.

Original language	English
Pages (from-to)	1193-1205
Number of pages	13
Journal	Osteoporosis International
Volume	34
Issue number	7
Early online date	4 Apr 2023
DOIs	https://doi.org/10.1007/s00198-023-06735-5
Publication status	E-pub ahead of print - 4 Apr 2023

Keywords

Hip fractures
Surgery
Weight-bearing
orthogeriatric
barriers and facilitators
factors

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10.1007/s00198-023-06735-5

Barriers and facilitators of weight_TURABI_Published4April2023_GREEN AAMAccepted author manuscript, 559 KB

Cite this

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title = "Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review",

abstract = "Purpose: This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults. Methods: Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov, OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach. Results: In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses{\textquoteright} notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year. Conclusion: Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes.",

keywords = "Hip fractures, Surgery, Weight-bearing, orthogeriatric, barriers and facilitators, factors",

author = "Ruqayyah Turabi and David Wyatt and Stefanny Guerra and Matthew O'Connell and Toslima Khatun and Sageer, {Saibin Ahmad} and Adel Alhazmi and Katie Sheehan",

note = "Funding Information: This study is part of a PhD programme funded by the Ministry of Education in Saudi Arabia. Publisher Copyright: {\textcopyright} 2023, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.",

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doi = "10.1007/s00198-023-06735-5",

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T1 - Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

AU - Turabi, Ruqayyah

AU - Wyatt, David

AU - Guerra, Stefanny

AU - O'Connell, Matthew

AU - Khatun, Toslima

AU - Sageer, Saibin Ahmad

AU - Alhazmi, Adel

AU - Sheehan, Katie

N1 - Funding Information: This study is part of a PhD programme funded by the Ministry of Education in Saudi Arabia. Publisher Copyright: © 2023, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.

PY - 2023/4/4

Y1 - 2023/4/4

N2 - Purpose: This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults. Methods: Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov, OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach. Results: In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses’ notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year. Conclusion: Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes.

AB - Purpose: This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults. Methods: Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov, OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach. Results: In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses’ notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year. Conclusion: Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes.

KW - Hip fractures

KW - Surgery

KW - Weight-bearing

KW - orthogeriatric

KW - barriers and facilitators

KW - factors

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DO - 10.1007/s00198-023-06735-5

M3 - Review article

SN - 0937-941X

VL - 34

SP - 1193

EP - 1205

JO - Osteoporosis International

JF - Osteoporosis International

IS - 7

ER -

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

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