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Background and Purpose: Motivational interviewing, an evidence-based person-centered counseling style, may help to facilitate increased mobility and physical activity after hip fracture. We explored contextual factors influencing the outcome, mechanism, and implementation of motivational interviewing after hip fracture. Methods: A qualitative study was completed using an interpretive description framework. Data sources included verbatim transcriptions of interviews with purposively sampled patients (n = 18), clinicians (n = 6 including 3 physical therapists), and relevant physical therapy stakeholders (a trial coordinator, a manager, and physical therapists involved in trial recruitment; n = 4), and 128 randomly selected clinician diaries where clinicians recorded notes at the end of each motivational interviewing session. Data were independently coded by 2 researchers and mapped to the Medical Research Council process evaluation framework. Consensus discussions involving all researchers were completed to triangulate the data and develop an interpretive synthesis. Results: We found 3 main themes and 3 subthemes in the data. The main themes were: (a) It's about life, (b) Walking is not the goal, and (c) It's complicated. The last theme was further developed into a model depicting internal, external, and social factors influencing the outcome, mechanism, and implementation of motivational interviewing after hip fracture. Internal factors related to physical and psychological functioning. External factors included elements related to the environment and health services. Social factors included having a support system, receiving positive feedback, isolation, and feeling overwhelmed. Factors interplayed to create a multitiered model, with the person's life at the center. Traditional rehabilitation was perceived as addressing the physical factors of hip fracture, while motivational interviewing intervention was considered to address the whole person. Conclusion: Many contextual factors interplay to influence motivational interviewing intervention after hip fracture. For successful hip fracture rehabilitation, our results suggest physical therapists and other care providers address these factors in addition to physical rehabilitation and focus on the person at the center of the process. [ABSTRACT FROM AUTHOR]

Purpose: To explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture. Materials and Methods: Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis determined factors associated with meeting physical activity thresholds related to positive health outcomes: 4,400 and 7,100 daily steps. Explanatory variables were: walking self-confidence; falls self-efficacy; depression; anxiety; co-morbidities; previous gait aid use; nutritional status; age; and gender. Results: Forty-three participants (20%) met the lower threshold of ≥4,400 to <7,100 steps and thirty participants (14%) met the upper threshold of ≥7,100 steps. Walking self-confidence was positively associated with meeting higher physical activity thresholds (adjusted odds ratio [AOR] 1.32: 95% CI 1.11 to 1.57, p = 0.002). Age (AOR 0.93: 95% CI 0.89 to 0.98, p = 0.003), DASS-21 anxiety score (AOR 0.81: 95% CI 0.69 to 0.94, p = 0.008) and comorbidity index score (AOR 0.52: 95% CI 0.36 to 0.72, p < 0.001) were negatively associated with meeting higher physical activity thresholds. Conclusion: Walking self-confidence and anxiety are potentially modifiable factors associated with meeting physical activity thresholds related to positive health outcomes after hip fracture. IMPLICATIONS FOR REHABILITATION: Older people are often physically inactive after hip fracture, which can lead to negative health outcomes and increased risk of mortality. The potentially modifiable psychological factors of walking self-confidence and anxiety are associated with meeting recommended physical activity levels after hip fracture. Therapists should include assessment of psychological factors to help guide rehabilitation of patients after hip fracture. [ABSTRACT FROM AUTHOR]

Purpose: Communication difficulties are highly prevalent in the stroke population, with implications for patient experience, safety and outcomes. This study explores the experiences of people with aphasia and family members regarding healthcare communication in acute and subacute stroke settings. Methods and materials: A phenomenological approach was used to understand participants' experiences. Participants took part in a focus group and data were analysed using an inductive thematic approach. Results: For individuals with aphasia (n = 4) and family members (n = 2), five themes were generated: "aphasia makes it hard to communicate," "hospital staff focus on the patient's medical status only," "people with aphasia do not get the help they need to improve," "staff lack the skills to communicate with people with aphasia," and "staff are crucial to improving healthcare communication." Conclusions: The stroke team has expertise in the medical management of stroke but struggle to communicate with patients with aphasia. Patients' experience of healthcare communication is often one-way and limited to following instructions, with missed opportunities to discuss core topics such as prognosis, rehabilitation, and person-specific needs. Patients and families assert that all members of the stroke healthcare team should be able to adapt communication to accommodate patients. Implications for Rehabilitation: Person-centred care is not a reality for many patients with aphasia. Many healthcare conversations, including informal assessments and discussing prognosis, are not accessible for people with aphasia. Consequently, for people with aphasia, healthcare in hospital is characterised by confusion and exclusion. Staff are crucial to improving healthcare communication; when appropriate strategies were used, these were not only effective but very meaningful to patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of benign paroxysmal positional vertigo without dizziness, a treatable falls risk factor in people attending outpatient falls clinics. Methods: Over 6 years, 618 people at risk of falls attending 2 falls clinics were assessed for benign paroxysmal positional vertigo, whether dizzy or non dizzy. Data regarding demographics, canal location of positive tests and comorbidities were collected from medical records. Results: Thirty-nine percent (238) of people with falls risk tested positive for benign paroxysmal positional vertigo; 62 (26%) or 1 in 4 of those testing positive were not dizzy. Thirty-nine of 104 (38%) testing positive for single canal benign paroxysmal positional vertigo and twenty-four of 134 (18%) testing positive for multiple canal benign paroxysmal positional vertigo were not dizzy. Comorbidities were common for all with falls risk but did not differentiate for benign paroxysmal positional vertigo on testing. Conclusions: Benign paroxysmal positional vertigo is common in people attending falls clinics and contributes to falls risk. Dizziness is common in BPPV though 26% or 1 in 4 people testing positive were not dizzy and would be missed without mandatory testing. Testing should also include all semicircular canals as multiple-canal involvement was high. IMPLICATIONS FOR REHABILITATION: Benign paroxysmal positional vertigo is a common and treatable falls risk factor, however screening for benign paroxysmal positional vertigo in people who fall usually only occurs if they are dizzy. 1 in 4 people with falls risk who have benign paroxysmal positional vertigo do not report symptoms of dizziness Screening for benign paroxysmal positional vertigo in all people who fall whether dizzy or not, is required to comprehensively identify and treat benign paroxysmal positional vertigo All semicircular canals should be screened for benign paroxysmal positional vertigo as the incidence of multiple-canal involvement is high [ABSTRACT FROM AUTHOR]

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Exercise for people with Prader-Willi syndrome (PWS) is important for their health and wellbeing and can provide opportunities for community participation. However, they may find it difficult to participate in some contexts, such as community gyms because social and environmental barriers in these settings may compound difficulties caused by physical impairments or intellectual disability. This study aims to observe and understand the actions and interactions of people with PWS when they exercise in community gyms. A focussed ethnographic study will be conducted. Field notes will be taken in community gyms where people with PWS are participating in a structured exercise program for six months as part of a randomised control trial called PRESTO. Up to ten participants will be observed, with at least three observations planned per participation during the program. Gym sessions observed will be approximately 1 hour long. Within the framework of interpretive description, reflective thematic analysis will be used to interpret observational data. Our findings will inform how best to support people with PWS to exercise at a community gym. Trial Registration Number: ACTRN12620000416998; Australian and New Zealand Clinical Trial Registry. [ABSTRACT FROM AUTHOR]

Background: Hip osteoarthritis (OA) is a prevalent and burdensome condition that leads to impaired quality of life and a substantial economic burden. Encouraging physical activity, particularly walking, is crucial for OA management, but many individuals with hip OA fail to meet recommended activity levels. Prefabricated contoured foot orthoses have shown promise in improving hip muscle efficiency during walking in laboratory settings, but their real‐world feasibility and efficacy remain uncertain. Objective: The aim of this study was to assess the feasibility of conducting a fully powered randomised controlled trial (RCT) to evaluate the effectiveness of prefabricated contoured foot orthoses, prescribed via telehealth, in people with hip OA. Methods: This feasibility trial randomised 27 participants with hip OA into two groups: prefabricated contoured foot orthoses or flat shoe inserts. Feasibility outcomes were assessed, including recruitment rate, adherence, logbook completion, and dropout rate. Patient‐reported outcomes and accelerometer‐measured physical activity were collected as secondary outcomes. Results: While the recruitment rate was low (0.88 people/week), adherence to the intervention (59%), logbook completion (93%), and dropout rates (7%) met or exceeded our predefined feasibility parameters. Participants found the intervention acceptable, and practicality was demonstrated with minor adverse events. Preliminary efficacy testing indicated that prefabricated contoured foot orthoses positively affected physical activity (adjusted mean difference = 2590 [260 to 4920] steps/day), with comparable outcomes for hip‐related quality of life and pain. Conclusion: This trial supports proceeding to a fully powered RCT to assess the effect of teleheath prescribed prefabricated contoured foot orthoses on physical activity in people with hip OA. Study Registration Number: National Institutes of Health Trial Registry (NCT05138380). [ABSTRACT FROM AUTHOR]

Hospital discharge is a pivotal point in healthcare delivery, impacting patient outcomes and resource utilisation. Ineffective discharge processes contribute to unplanned hospital readmissions. This study explored hospital discharge process from the perspectives of patients, caregivers, and healthcare staff. Qualitative data were collected through semi-structured interviews with adult patients being discharged home from a medical ward, their caregivers, and healthcare staff at an Australian hospital. Thematic analysis followed established guidelines for qualitative research. A total of 65 interviews and 21 structured observations were completed. There were three themes: i) Communication, ii) System Pressure, and iii) Continuing Care. The theme 'Communication' highlighted challenges and inconsistencies in notifying patients, caregivers, and staff about discharge plans, leading to patient stress and frustration. Information overload during discharge hindered patient comprehension and satisfaction. Staff identified communication gaps between teams, resulting in uncertainty regarding discharge logistics. The theme 'System Pressure' referred to pressure to discharge patients quickly to free hospital capacity occasionally, even in the face of inadequate service provision on weekends and out-of-hours. The 'Continuing Care' theme drew attention to gaps in patient understanding of follow-up appointments, underscoring the need for clearer post-discharge instructions. The lack of structured systems for tracking referrals and post-discharge care coordination was also highlighted, potentially leading to fragmented care. The findings resonate with international literature and the current emphasis in Australia on improving communication during care transitions. Furthermore, the study highlights the tension between patient-centred care and health service pressure for bed availability, resulting in perceptions of premature discharges and unplanned readmissions. It underscores the need for strengthening community-based support and systems for tracking referrals to improve care continuity. These findings have implications for patient experience and safety and suggest the need for targeted interventions to optimise the discharge process. [ABSTRACT FROM AUTHOR]

Background Hip fracture is a common and serious traumatic injury for older adults characterised by poor outcomes. Objective This systematic review aimed to synthesise qualitative evidence about the psychosocial impact of hip fracture on the people who sustain these injuries. Methods Five databases were searched for qualitative studies reporting on the psychosocial impact of hip fracture, supplemented by reference list checking and citation tracking. Data were synthesised inductively and confidence in findings reported using the Confidence in the Evidence from Reviews of Qualitative research approach, taking account of methodological quality, coherence, relevance and adequacy. Results Fifty-seven studies were included. Data were collected during the peri-operative period to >12 months post fracture from 919 participants with hip fracture (median age > 70 years in all but 3 studies), 130 carers and 297 clinicians. Hip fracture is a life altering event characterised by a sense of loss, prolonged negative emotions and fear of the future, exacerbated by negative attitudes of family, friends and clinicians. For some people after hip fracture there is, with time, acceptance of a new reality of not being able to do all the things they used to do. There was moderate to high confidence in these findings. Conclusions Hip fracture is a life altering event. Many people experience profound and prolonged psychosocial distress following a hip fracture, within a context of negative societal attitudes. Assessment and management of psychosocial distress during rehabilitation may improve outcomes for people after hip fracture. [ABSTRACT FROM AUTHOR]