Physical rehabilitation for people with advanced dementia who fracture their hip – expert consensus process

Hip fracture is common in older people – with prevalence even higher for people with dementia. Research often excludes people with dementia – especially those in the more advanced stages. Therefore, the most appropriate interventions remain unknown. The main aim of this study was to gain consensus about the core considerations needed to deliver a physical intervention for people with advanced dementia who fracture their hip. Materials and Methods: An expert consensus process was undertaken, using Nominal Group Technique, to explore the key considerations when delivering rehabilitation. Data collection was undertaken in January 2023 and involved an online group discussion followed by voting and off-line rating. Qualitative content analysis and quantitative analysis of consensus scoring was undertaken. An international group of seven highly specialised physiotherapists took part. 59 statements were agreed following the process. Content analysis was used to categorise these statements according to the International Classification of Functioning, Disability and Health. Although consensus levels were high, there was disagreement in several areas. The statements provide an overarching understanding of the multidisciplinary expertise that is needed to effectively deliver rehabilitation interventions to this population. People with dementia require highly skilled and trained professionals, providing holistic and person-centred approaches to deliver rehabilitation interventions.IMPLICATIONS FOR REHABILITATION The expert consensus provides an overarching understanding of the multidisciplinary expertise that is needed to effectively deliver rehabilitation interventions to this population. Physiotherapy - or other interventions - cannot be used in isolation. People with dementia require highly skilled and trained professionals, providing holistic and person-centred approaches to deliver rehabilitation interventions. While our focus was on hip fracture, we suggest these statements can be used for people with advanced dementia with a variety of other conditions. The expert consensus provides an overarching understanding of the multidisciplinary expertise that is needed to effectively deliver rehabilitation interventions to this population. Physiotherapy - or other interventions - cannot be used in isolation. People with dementia require highly skilled and trained professionals, providing holistic and person-centred approaches to deliver rehabilitation interventions. While our focus was on hip fracture, we suggest these statements can be used for people with advanced dementia with a variety of other conditions.髋部骨折在老年人群中高发，痴呆患者的患病率甚至更高。既往研究常将痴呆患者，尤其是晚期痴呆患者排除在研究之外，因此针对该人群的最优干预方案仍不明确。本研究的核心目标是，就为晚期痴呆合并髋部骨折患者开展躯体干预所需的核心考量要素达成共识。 材料与方法：本研究采用名义小组技术（Nominal Group Technique）开展专家共识研讨，以探索康复干预实施过程中的关键考量要点。数据采集于2023年1月完成，流程包括线上小组讨论、投票及线下评分环节。研究采用质性内容分析法与共识评分量化分析法对数据进行处理。共有7名具备高度专业水平的国际物理治疗师参与本研究。 本次共识研讨最终形成59条达成共识的条目。研究采用《国际功能、残疾和健康分类》（International Classification of Functioning, Disability and Health）对这些条目进行分类。尽管整体共识度较高，但部分领域仍存在分歧。 这些条目全面阐明了为该人群有效实施康复干预所需的多学科专业团队构成。痴呆患者需要具备高水平专业技能与培训背景的从业人员，采用整体化、以患者为中心的方案开展康复干预。 【康复实践启示】 本次专家共识全面阐明了为该人群有效实施康复干预所需的多学科专业支撑体系。物理治疗或其他干预手段不可单独使用。痴呆患者需要具备高水平专业技能与培训背景的从业人员，采用整体化、以患者为中心的方案开展康复干预。尽管本研究聚焦于髋部骨折场景，但我们认为上述共识条目同样可应用于合并各类其他疾病的晚期痴呆患者。