Effectiveness of digital health interventions in the recovery of older adults with hip fracture and their family caregivers

Resumo

Hip fracture is a major public health problem which has a traumatic impact on older adults and their caregivers, usually family members. Older adults suffer severe physical and psychological consequences, and their family caregivers take on a new role of responsibility for which they are often unprepared. The resources available for the care of older adults with hip fracture are often limited, and this leads to the consideration of alternative options to conventional rehabilitation and care, such as digital health. This option is a promising alternative for providing rehabilitation and health education to both older adults with hip fracture and their family caregivers. The present doctoral thesis has aimed to provide options for digital health interventions to improve the quality of care for older adults with hip fracture and their family caregivers. Three studies were carried out for this purpose. Through study I, we aimed to make it easier for healthcare professionals to follow up on older adults with hip fracture by employing easy-to-use tools. In study II, we tried to observe the effects of a hip fracture telerehabilitation intervention called @ctivehip, and delivered through a website, in older adults with hip fracture. Across study III, we proposed the protocol of a mobile Health (mHealth) intervention called ActiveHip+ for older adults with hip fracture and their family caregivers and we observed the effects of the intervention. Our study I, a reliability study, with a sample of 60 participants, showed how the Spanish version of the Cumulated Ambulation Score is a reliable and easy tool to measure basic mobility in older adults with hip fracture during the acute phase of recovery. Study II, a non-randomized clinical trial, with a sample of 71 participants, showed the effect of @ctivehip intervention on the improvement of quality of life, psychological factors, and fitness level of older adults with hip fracture. Lastly, through our study III, which consisted of the protocol of a ActiveHip+ mHealth intervention, and the subsequent randomized clinical trial of a sample of 105 participants, we observed the positive effect of this intervention on physical and psychological outcomes in older adults with hip fracture and their family caregivers. At the same time, we observed that these effects were not maintained in the long term, at one year follow-up. Surely, the knowledge gained in the present doctoral thesis improves the understanding of the potential and limitations of digital health for the recovery of older adults with fracture and their family caregivers. At the same time, this doctoral thesis also outlines some aspects, identifying barriers and facilitators to achieve better outcomes in terms of recovery.