What are frail older people prepared to endure to achieve improved mobility following hip fracture? A Discrete Choice Experiment
Rachel Milte, Julie Ratcliffe, Michelle Miller, Craig Whitehead, Ian D. Cameron, Maria Crotty
Flinders Clinical Effectiveness, Flinders University, GPO Box 2100, Adelaide 5001, Australia
Objective: To investigate the preferences of frail older people for individualised multidisciplinary rehabilitation to promote recovery from a hip fracture.
Design: Discrete Choice Experiment.
Setting: Acute and Rehabilitation Hospitals in Adelaide, South Australia.
Subjects: Eighty-seven patients with recent hip fracture (16 living in residential care facilities prior to fracture).
Methods: Patients providing informed consent (or consenting family carer proxies in cases where patients were unable to provide informed consent (n = 10)) participated in a face to face interview following surgery to repair a fractured hip to assess their preferences for different configurations of rehabilitation programs.
Results: Overall, participants expressed a strong preference for improvements in mobility and a willingness to participate in rehabilitation programs involving moderate pain and effort. However, negative preferences were observed for extremely painful interventions involving high levels of effort (2 h per day for 2 months). Subgroup analysis revealed consistently similar preferences according to place of residence (residential care vs community).
Conclusions: Improvements in mobility are highly valued by frail older people recovering from hip fracture, including those living in residential care. Further research should be directed towards achieving greater equity in access to rehabilitation services for the wide spectrum of patients attending hospital with hip fractures.
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