Table 3.

Confidence in the evidence from reviews of qualitative research (CERQual) summary of qualitative findings.

Summary of review finding	Studies contributing to the review finding	CERQual assessment of confidence in the evidence	Explanation of CERQual assessment
Life-altering event: Hip fracture was seen as a major disruption that altered the course of participants’ lives, which required major physical and psychosocial adjustment. Many people had to reconfigure their environment, relationships, and perception of their identity and broader aspects of life.	[21, 23–25, 28–33, 35–40, 42, 43, 45, 46, 48–56, 59, 61, 63, 65–67, 70, 71, 73, 75–77]	Moderate confidence	41 studies with moderate concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy, and relevance.
Profound loss: Many people mourned the loss of their prior lives after a hip fracture. They spoke of ‘social death’ (where they no longer had a vibrant social life), loss of independence, and the ability to fully participate and take control of their own lives.	[21–23, 25, 29–32, 35, 36, 38, 40, 42–54, 56–63, 66–68, 70, 72, 73, 75–77]	High confidence	42 studies with minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy, and relevance.
Negative emotion: After a hip fracture, a pervasive cloud of negative emotions permeated every aspect of people’s lives. People reported feeling vulnerable, hopeless, helpless, losing courage and purpose, and a general sense of gloominess. The lack of visible progress in their recovery further reinforced these negative emotions, leading to the next theme.	[21–33, 35–37, 39, 40, 42–68, 70–73, 75–77]	Moderate confidence	52 studies with moderate concerns regarding methodological limitations. Minor concerns regarding relevance (findings may differ based on temporal context (acute, subacute, community or post-hip fracture)). No or very minor concerns regarding coherence and adequacy.
Worried about the future: People reported feeling worried about their future. Uncertainty about who they are now, where and how they will live the rest of their lives, and the unwillingness to be a burden to their families and friends became a constant thought process.	[21–24, 26, 27, 30–39, 41–59, 61, 62, 65–73, 75, 76]	Moderate confidence	48 studies with moderate concerns regarding methodological limitations. Minor concerns regarding relevance (findings may differ based on temporal context (acute, subacute, community or post-hip fracture)). No or very minor concerns regarding coherence and adequacy.
Negative societal attitude: People were perceived differently after a hip fracture; most of these new perceptions were negative and disempowering. Many people reported experiencing ageism, including people who had a hip fracture before 60 years of age. These perceptions, coming from friends, family, and even healthcare professionals, further compounded people’s negative emotions and worry about their ability to recover.	[22–25, 27, 30, 35–37, 39–48, 50–58, 60–63, 65, 66, 70, 73, 76]	Moderate confidence	37 studies with minor concern regarding coherence (some concerns about the fit between the data from primary studies and the review findings). Minor concerns regarding relevance (findings may differ based on cultural context). Studies included were mostly of developed nations, although diverse cultures were explored (Asian, European, American, and Australian). No or very minor concerns regarding adequacy.
New reality: Over time, some people managed to rebuild their lives by accepting and making sense of their new reality. However, not everyone successfully made this transition.	[21–24, 26, 28, 29, 31–34, 37, 38, 42, 46, 48, 49, 51, 54, 56–60, 64–66, 70, 71, 73–77]	Moderate confidence	34 studies with moderate concerns regarding methodological limitations. Minor concern regarding coherence (some concerns about the fit between the data from primary studies and the review findings). Minor concerns about relevance (findings may differ based on temporal context (acute, subacute, community or post-hip fracture)). No or very minor concerns regarding adequacy.