School of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.
Disabil Rehabil. 2010;32(15):1281-90. doi: 10.3109/09638280903483869.
This qualitative study explored mobility levels around the home and in the community before and after hip fracture.
Twenty-four people receiving rehabilitation after hip fracture were interviewed using an in-depth semi-structured format: 12 who were receiving rehabilitation as inpatients, and 12 who had been discharged home from inpatient rehabilitation and were continuing therapy as outpatients. The recorded interviews were transcribed and coded independently by two researchers. From these codes themes were developed.
Before their fracture, participants were independent about their houses, but their level of community ambulation had been reducing over recent months or years, often associated with another health problem. Participants who had returned home after inpatient rehabilitation for hip fracture reported much reduced levels of mobility both in their house and in the community compared with their pre-fracture performance. This reduced level of mobility was associated with psychological factors (fear, lack of confidence, frustration), physical factors (pain, the presence of another health problem) and social/environmental factors (reliance on daughter, and car). The level of optimism expressed by people receiving inpatient rehabilitation contrasted with the pessimism of those receiving outpatient rehabilitation.
Patients living back in the community after hip fracture described a reduced level of functioning and a pessimism that contrasted with the optimism expressed by people who were still in the inpatient phase of rehabilitation. These findings, and the importance of psychological factors and social support, may be considered when designing rehabilitation strategies to support the successful transition of people to their community after hip fracture.
本定性研究探讨了髋部骨折前后患者在家中和社区中的活动水平。
采用深入的半结构式访谈方式，对 24 名髋部骨折接受康复治疗的患者进行了访谈：12 名接受住院康复治疗的患者，12 名从住院康复治疗出院并继续作为门诊患者进行治疗的患者。记录的访谈由两名研究人员独立转录和编码。从这些代码中开发出主题。
在骨折之前，参与者在自己的家中是独立的，但他们的社区活动水平在最近几个月或几年中一直在下降，通常与另一个健康问题有关。髋部骨折住院康复治疗后返回家中的患者报告说，他们在室内和社区中的活动能力与骨折前相比大大降低。这种活动能力的降低与心理因素（恐惧、缺乏信心、沮丧）、身体因素（疼痛、存在其他健康问题）和社会/环境因素（依赖女儿和汽车）有关。接受住院康复治疗的患者表达的乐观态度与接受门诊康复治疗的患者的悲观态度形成了鲜明对比。
髋部骨折后返回社区生活的患者描述了功能水平的降低，以及与仍处于康复住院阶段的患者所表达的乐观态度形成鲜明对比的悲观态度。在设计康复策略以支持髋部骨折患者成功过渡到社区生活时，这些发现以及心理因素和社会支持的重要性可能需要加以考虑。
