Table 3.
Narrative synthesis.
| 3A Targeted Patient Communication * | ||||
| SR No | Author/Year Methodological Quality (H, M, L) *** | Intervention | Outcome | Results |
| 1 | Allegrante et al. (2007) [23] L | Motivational videotape and a corresponding booklet around falls prevention self-efficacy, in addition an in-hospital peer support visit and 8-weeks out-patient physical therapy consisting of tailored exercises and progressive muscle strengthening training. | Functional status was assessed using 36-item short form health survey (SF-36) as the study’s primary outcome at 6-months follow-up | All the intervention patients were exposed to at least one of the three intervention components, i.e., videotape, strength training and peer counselling. However, only 34% of all the participants were able to complete full 6-months follow-up assessments (Intervention 32 vs. control 27). Patients within the intervention group had a significant positive change in the role-physical scale as compared to the control group (mean score, −11 ± 33 Vs −37 ± 41, p = 0.03). No significant post intervention differences were observed in the change on the physical functioning and social functioning scales and other domains like bodily pain, general health, vitality, role-emotional and mental health |
| 2 | Tappen et al. (2003) [36] M | Consisted of two parts; videotaping the study participants during their physical therapy sessions and showing one of the two generic educational videos that were produced for this study, depending upon the type of surgical repair, i.e., total hip replacement or arthroplasty, using plates or screws. Generic educational videos depict all aspects of physical recovery through the use of demonstrations and interviews with actual patients. The major focus of these generic tapes was the need to increase activity daily and intended to reinforce instructions that were given during rehabilitation and applied while moving in home or the respective community setting. Symptoms of anxiety and depression after hip surgery were also addressed using psychosocial adjustments. On the other hand, individual videos consisted of intervention participants being videotaped during their respective physical therapy sessions at regular intervals throughout their stay to record their progress. These videos show the therapist instructing the individual participants in the use of assistive devices, ambulance techniques and procedures for transferring. The tapes also document individualised instructions on exercises and show the therapist helping the participant do the prescribed exercises correctly. Participants were given both videotapes to take home for review | Physical activity performance measured through the distance walked in feet and time in seconds at three months post-discharge. | At three months post-discharge, time walked in seconds was significant, intervention [314.79 (SD-139.59)] Vs control [204.77 (179.70)]. |
| Though analysis comparing the two groups did not differ significantly on self-care, functional ability, coping and performance of independent ADLs; results for coping approached statistical significance. | ||||
| 3 | Cook et al. (2007) [34] H | “Scriptassist” telephonic counselling program, intervention delivered telephonically by one of the four registered nurses at the scriptassist call centre. This communication was based upon the principles of motivational interviewing, focused on patient’s motivation for treatment, problem solving to resolve barriers to adherence, improve self-efficacy and helping patient practice skills to self-manage their own chronic conditions. Calls focused on relationship building and answering questions to encourage participant’s motivation for treatment. | Adherence to osteoporosis medication at 6 months based on pharmacy and clinical interview data | Among the high risk participants for fragility fractures, up to five telephonic contacts (median) were made with average call duration of 15 min. The participants were followed up for an average of 4.1 months after the start of the treatment (range 0–14 months). In terms of 6-months follow-up, 188 patients completed pharmacy data whereas, 255 patients with interview data. Adherence to treatment was reported at 6 months around 70% in this study, by both methods, compared to 46% in the representative population group reported through a national survey. |
| 4 | Monaco et al. (2015) [26] M | The intervention included at least 3 h during the stay of the patients, an occupational therapist to assess home hazards of falling based upon a standard checklist to determine future risk of falling and subsequent recommendations were provided. The patients also received a brochure describing falls prevention strategies. Further, geriatric evaluation was conducted for health optimisation and possibility of withdrawing medications in use which may increase the risk of falls and oral supplements of vitamin D and calcium were prescribed to continue after discharge from the hospital. Single telephonic call by an occupational therapist after discharge to check for environmental hazards, behaviour in ADL, use of assistive devices and reinforced targeted modifications to prevent falls. | Proportion of falls between two groups at 6 months | As an outcome measure, no differences were found in the proportion of fallers between the two groups (RR 1.06, CI 0.48–2.34) |
| 5 | O’Halloran et al. (2016) [30] M | Telephonic-based motivational interviewing eight times during the study participation period, lasting about 30 min per session and one call per week. The intervention was delivered by a trained physiotherapist in motivational interviewing. The intervention was designed to address issues associated with ambivalence about change in activity, such as beliefs about physical activity, low confidence and fear of falling which may prevent people after hip fracture from being more active. | Participants were asked to wear an accelerometer fitted to the thigh for a seven-day period at baseline and then again after the intervention phase, to measure the amount of physical activity they completed (ActivPal). Physical activity was recorded as the number of steps taken per day, the time spent walking per day and the time spent sitting or lying each day (sedentary behaviour). Secondary outcomes were health-related quality of life assessed through AQOL 8-D | Physical activity seemed to be improved in the intervention group compared with the control group, measured by daily steps and time spent walking; 26% and 22% respectively. Intervention group improved in mobility-related confidence but no difference observed with respect to mobility-related function. Further, the intervention group also demonstrated improvements in health-related quality of life (5.8, CI 1.2 to 10.4, p = 0.015), anxiety (−1.8, CI −3.0 to −0.6, p = 0.004) and depression scores (−3.7 CI −6.3 to −1.1, p = 0.010). |
| 6 | Suwanpasu et al. (2014) [32] L | Physical activity enhancing program (PEP) which composed of four phases, covered five sessions of implementation within seven weeks post-hip fracture surgery, but combined both phone calls and face-to-face interactions. Phase-1 assess existing self-efficacy, outcome expectations for physical activity and being ready to change physical activity. Phase-2 involved preparation for strengthening self-efficacy and outcome expectations offered through individual education and training in structural exercise and daily life physical activity and the benefits of regular behaviour, verbal encouragement by credible sources, seeing others experience and visual cueing (physical activity after hip fracture booklet, poster and flipbook), and short and long-term goal setting. Phase-3 included practice for strengthening self-efficacy and outcome expectations, involved everyday workouts of structural exercises and daily life physical activity, re-evaluating goal setting, self-monitoring and re-interpretation and control of unpleasant sensations associated with physical activity. Phase-4 involved evaluation of physical activity behaviour, including the energy expenditure of physical activity. | Information on physical activity was collected at 6-weeks after discharge. | At 6-weeks post-discharge, there was a significant increase in physical activity in the intervention group compared with the control group after controlling for pre-fracture physical activity with an effect size of 0.18 (<0.01). The amount of overall physical activity of the intervention group significantly increased by 961.37 MET/min/week over the control group. Physical activity was effective in 65% of the PEP (intervention) group. The ratio of efficiency (markedly effective and effective) induced by the PEP was higher than that induced by usual care (65% vs. 48%) and similarly ratio of markedly effective induced by the PEP was significantly higher than that induced by usual care 30% vs. 8%). |
| 7 | Langford et al. (2015) [27] M | The intervention included one hour in-hospital educational session with a trained health professional, using the hip fracture recovery manual and four educational videos. The content of this education program followed a standard format as guided by the manual but was individualised for each participant, including a description of the type of fracture sustained, how it was surgically fixated, red flags to watch out for during the recovery phase, an exercise program (home-based reducing both the rate and risk of future falls), practical information about future falls prevention, review of home safety and environmental hazards and mobility and recovery goal setting. The videos were viewed at the bedside using a tablet and headphone. Teach-back method was used which intends to clarify and check participants’ understanding of materials and ensured that the participants were able to provide a verbal summary of the education provided to them. After discharge, the trained health professional telephoned participants up to five times in the first 4 months following hip fracture to provide further encouragement, falls prevention information, coaching to remain active, problem solving skills, mobility goal setting, and advise to help participants maintain and increase their prescribed home exercises. The content of the sessions classified according to the CALO-RE (Coventry, Aberdeen and London-Redefined) taxonomy of behaviour change. | This study was a pilot study and the primary outcome of the trial was feasibility measured by recruitment rate and participant retention | The recruitment and retention rate of participants in the study was 42% and 90% respectively |
| 3B Telemedicine, personal health tracking and healthcare provider decision support ** | ||||
| SR No | Author/Year | Intervention | Outcome | Results |
| 1 | Bedra et al. (2015) [33] L | Home automated telemanagement (HAT) system to support individualised exercise program which consisted of a home unit, HAT server and a clinician unit. Home unit guides patients at home in routinely following their exercise program in a safe and effective way. The unit sends this information through a landline or wireless connection to the HAT information system. This system is able to monitor progress in terms of patient adherence and compare the results with the prescribed level of activities by the respective clinician. On the other hand, clinician unit can be any web-enabled devise. This system provides tailored feedback to the patients motivates them based on the behavioural profile and notifies clinicians. The system can further empower patients with self-paced interactive multimedia education on the major aspects of hip fracture rehabilitation program. This education module can be individualised to each patient’s specific needs and is based on the concepts of social cognitive theory. | Exercise self-efficacy, physical functioning, role limitations due to physical health problems, social functioning, health transition and client satisfaction at 30-day | Overall, 14 patients were recruited to test the telerehabilitation system at their homes. Mean age was around 77 (±9), More than 50% never had any computer experience in their lifetime. The telerehabilitation system was successfully used by the hip fracture patients at their home regardless of their socioeconomic or computer literacy background. At the end of 30-day telerehabilitation program, exercise self-efficacy (9 ± 1 vs. 6 ± 3, p = 0.01), physical functioning (71 ± 31 vs. 38 ± 27, p = 0.009), role-limitations due to physical health problems (17 ± 12 vs. 6 ± 10, p = 0.05), social functioning (85 ± 28 vs. 54 ± 31, p = 0.01), health transition (22 ± 18 vs 47 ± 40, p = 0.05) and client satisfaction (31 ± 0.46 vs. 27 ± 4, p = 0.04) apparently seems to have improved. Also, physical activity in terms of hours per week demonstrated a significant increase (31 ± 14 vs. 24 ± 14, p = 0.04). Adherence to the telerehabilitation over a 30-day program was reported to be 90% and above in most domains. |
| 2 | Dickson et al. (2007) [35] L | Involved setting up of network studio within the osteoporosis research department at a Women’s college hospital. The technology included a set-top videoconferencing system with a 27 inch television. Space was allocated for two desks; one for telehealth coordinator and one for health professionals to allow for them to move and demonstrate various exercises/activities to the patients during the consultation. Each healthcare professional individually consulted the patient via a telehealth, providing them with the same information they would receive in an in-person consult. | Knowledge about osteoporosis, confidentiality, and client satisfaction | The mean age was 56.5 years and the average length of telehealth consultation was around two hours and the length of follow-up was 15-min. The response rate to satisfaction survey questionnaire was 67%. Out of which, 58% rated telehealth consultation as excellent in comparison to in-person specialist consultation and 33% rated as a good experience. Almost all the participants expressed their intent to be using it again and recommend to their friends and family members. Prior to consultation, 73% described their knowledge about osteoporosis as fair and 27% as good but after consultation, only 10% described as fair, 30% good and 60% rated as excellent. When rating confidentiality, 83% patients felt completely comfortable discussing their health problems during their telehealth consultation |
| 3 | Tousignant et al. (2014) [37] M | The intervention based on a modular design, a generic platform was built, consisting of a videoconferencing unit to provide telerehabilitation program over eight consecutive weeks. The treatment program was delivered twice a day, every day, either supervised by a physiotherapist through telerehabilitation or unsupervised. Patients had two telerehab sessions in week 1, 3 and 5 and only one on weeks 2, 4, 6, 7 and 8. | Three outcome measures were evaluated; pain, shoulder ROM and upper limb function and additional satisfaction with health services received. | Each session lasted for about 30–45 min and divided into three parts; warm-up, treatment program and question period. The treatment program was adjusted for each patient according to the number of weeks, post fracture. Every exercise program involved four exercise types based on the orthopaedic physician’s specifications; stretching, pain control, active/active assisted ROM and muscle building. The physiotherapist also adjusted the progression of exercises according to the patient’s progress. Pain decreased significantly between pre and post intervention as indicated by the SF-MPQ score (difference of 10.6 ± 12.4, p = 0.003) and VAS (difference 26.3 ± 21.8, p = 0.001) which was greater than minimal clinically important difference (difference over 5/45 for total descriptors). The shoulder ROM difference was greater than the interrater minimal clinical difference (more than 5–10 degrees) for all. A difference of 42.1 ± 11.4 (p < 0) in the upper limb function was observed, greater than the minimal clinical difference (change over 15/100). Further, around 82% was the overall satisfaction, considered to be very good. |
* A unidirectional or bidirectional communication initiated by health system customised according to an individual’s specific needs, results in “tailored or targeted client or patient communication” whereby message content is matched according to the needs and preferences of an individual. This consists of transmitting targeted health information to patients or client based on health status or demographics, which can include health education, behaviour change communication, client-centred messaging. In this theme, the delivery channels mainly consisted of voice telephone or calls by healthcare providers and educational videos. ** Telemedicine is defined as the provision of health-care services at a distance where patients and providers are separated. This could include consultation between remote client and healthcare providers, real-time telemedicine or interactive telemedicine, remote monitoring of client health or virtual monitoring or telemonitoring. Whereas, personal health tracking involves use of mobile application by clients, phone-based sensors, health records, wearables, web tools and other applications that allow to review and track their health status in terms of self-monitoring of health status and active data capture. Further, healthcare provider (HCP) decision support is defined as digitised job aids that combine an individual’s health information with the health-care provider’s knowledge and clinical protocols in order to assist HCPs in making diagnosis and treatment decisions. This involves supporting service delivery according to care plans, guidelines and protocols [33] *** Methodological quality; H-High > 85%, M-Moderate 50–80%, L-Low < 50%.