Tele-Rehabilitation and Health Education for Older Adults with Hip Fracture and their Family CaregiversFeasibility and Effectiveness of the AvtiveHip+ Program

Résumé

Hip fracture is a traumatic and life-disrupting event for the patient and their family caregivers. Both of them feel a sudden loss of control in their lives. The patient become dependent and their family caregiver often assumes an important responsibility. Despite the benefits of multidisciplinary approach and early in-person rehabilitation are well known in older adults with hip fracture, healthcare resources are not enough to offer such a care. In this context, digital health is a promising alternative to provide rehabilitation and health education both for older adults with hip fracture and their family caregivers. This Doctoral Thesis aimed to improve the quality of care in older adults with hip fracture and their caregivers through digital health tools. To do so, we conducted 2 qualitative studies to understand: (i) the needs of the key stakeholders in the recovery process (i.e., older adults with hip fracture, family caregivers and healthcare providers) during the development phase of the ActiveHip+ mHealth system (study IV) and (ii) the experience of caregivers after using the @ctivehip telerehabilitation program (study III). Additionally, we conducted 4 quantitative studies that aimed: to facilitate health providers' follow-up of older adults with hip fracture through easy-to-use validated scales (study I) and to test the feasibility (study V) and effectiveness (studies II and VI) of @ctivehip tele-rehabilitation program and ActiveHip+ mHealth system in the recovery of older adults with hip fracture and their family caregivers. Study I showed that the New Mobility Score Spanish version is a valid, reliable and easy-to-use scale to measure the functional status of older people with hip fracture. Furthermore, it can be integrated into the daily clinical practice of the health providers. Studies III and IV identified aspects that the stakeholders considered necessary to include in digital health tool for the recovery of older adults with hip fracture. Digital health tools have to be user-friendly, simple, contain information that is permanently accessible and address not only the recovery process but also the prevention of future fractures. In addition, they should provide information to both patients and caregivers because the latter' supportive role is important in the patients' recovery process. Moreover, these digital tools have to be a channel to facilitate the communication of patients and caregivers with health providers. Studies II, V and VI demonstrated the feasibility and effectiveness of @ctivehip and ActiveHip+ to increase the functional status and to reduce the pain in older adults with hip fracture. Collectively, the knowledge gained from the present doctoral thesis improve the understanding about the potential that digital health has for the recovery of older adults with fracture and their family caregivers. This thesis provides scientific evidence on the feasibility and effectiveness of digital health in hip fracture recovery. This thesis also outlines some aspects for further implementation in this field, identifying barriers and facilitators to achieve satisfactory results in terms of recovery.