title: Rehabilitation for long-term care residents following hip fracture: a survey of reported rehabilitation practices and perceived barriers to delivery of care.
abstract: OBJECTIVE
  In Canada, residents of long-term care (LTC) facilities are frequently transferred back to their residential facilities to continue recovery 1 week following hip fractures. Limited evidence is available regarding rehabilitation services in LTC facilities following hip fracture or rehabilitation practices after hip fracture for persons with dementia. We previously performed a systematic review of the impact of rehabilitation after hip fractures on persons with dementia. The purpose of this project was to augment our systematic review findings and determine current reported rehabilitation practices of rehabilitation professionals working in LTC facilities with hip-fractured patients with dementia and examine perceived barriers to the delivery of rehabilitation.
  
  
  METHODS
  We performed a survey study of rehabilitation professionals working in LTC facilities in a Canadian province, using a modified Delphi Consensus approach and a Web-based survey format. The survey was constructed on the basis of our systematic literature review and through discussions with clinical experts. A 2-round modified Delphi consensus approach was used to attain consensus among respondents. Examination of agreement and disagreement among respondents in the areas of (1) current practice and (2) perceived barriers to care was undertaken.
  
  
  RESULTS
  A total of 42 respondents completed round 1 and 27 respondents completed round 2. Respondents were primarily female and working as physical therapists or occupational therapists. Most worked at facilities that employed at least 1 physical therapist and 1 occupational therapist. Treatment strategies for patients with hip fracture focused on return to independent ambulation and transfers. Although cognition was seen as a barrier to treatment, respondents implemented strategies to mitigate this barrier. Inadequate time and staffing were also seen as barriers to effective treatment.
  
  
  CONCLUSIONS
  Rehabilitation professionals working in LTC facilities reported that the residents with dementia can and should participate in rehabilitation following hip fractures; however, they identified time and staffing constraints in addition to cognitive impairment as barriers.
  
  
  CONCLUSIONS
  Current research in LTC facilities is very sparse and little is known about the rehabilitation care provided in these facilities. Further research is needed to determine the most effective rehabilitation interventions following hip fractures for residents of LTC facilities with dementia.
authors.affiliation: Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Buddingh
authors.forename: Jieyun
authors.initials: J
authors.lastname: Liang
authors.forename: Jennifer
authors.initials: J
authors.lastname: Allen
authors.forename: Adriana
authors.initials: A
authors.lastname: Koziak
authors.forename: Jeanette
authors.initials: J
authors.lastname: Buckingham
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beaupre
mesh_terms: D000328:Adult; D000368:Aged; D003697:Delphi Technique; D003704:Dementia / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000534:rehabilitation*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration*; D009788:Occupational Therapy / Q000458:organization & administration*; D026761:Physical Therapy Specialty / Q000458:organization & administration*; D004856:Postural Balance; D016138:Walking