Telerehabilitation Outcomes for Frail Aged Patients Following Fracture and Technology Uptake by Patients and Clinicians

Author: Claire Morris

Morris, Claire, 2018 Telerehabilitation Outcomes for Frail Aged Patients Following Fracture and Technology Uptake by Patients and Clinicians, Flinders University, College of Nursing and Health Sciences

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Background and Aims

Despite growing evidence of the effectiveness of telerehabilitation (TR) for patients with a wide range of conditions, and the need for improved access by frail aged patients to rehabilitation following hip and pelvic fractures, there is limited evidence of the provision of TR to this demographic. There are also acknowledged challenges to the uptake and use of technology by health professionals and their patients. The aim of this study was to evaluate the delivery of TR to frail aged adults following hip or pelvic fracture and identify factors that may influence uptake.


Community dwelling patients admitted to a home rehabilitation service (HRS) in Southern Adelaide following femoral or pelvic fracture were offered TR. Using iPad technology, multidisciplinary rehabilitation was delivered via videoconferencing and therapeutic apps, as an alternative or in addition to usual care.

The study compared functional levels at admission and discharge between those who received TR (TR group) with a matched historical group (HC group) who received HRS prior to the introduction of TR.

Outcomes measures included Functional Independence Measure (FIM), Timed Up and Go (TUG) and length of stay (LOS). The number of therapy sessions and adverse events were also reported.

Focus groups to explore clinicians’ perceptions of acceptability and usefulness of a scheduling app and their attitudes towards TR in general were conducted. Clinicians also completed self-assessed technology proficiency, perceived usefulness, and perceived ease of use scales.


Patients who did not receive TR (nTR group) were older (p=0.014) and frailer (p=0.008) than patients who received TR (TR group). There was no significant difference in function at discharge as measured by FIM and TUG scores for the patients in the TR group, when compared to a historical comparison (HC) group, despite a shorter LOS. There was no significant difference between the two groups in the number of therapy sessions per day when adjusted for LOS (TR group 1 1.43 ± 0.55 vs HC group 1.26 ± 0.60). There were no falls in the TR group.

Clinicians described time constraints in rehabilitation practice and welcomed technology that could assist with the reliable scheduling of therapy sessions. The more experienced clinicians found the scheduling app more difficult to use than their less experienced colleagues, and did not see the app as useful nor adding value to the delivery of care. There did not appear to be a relationship between self-assessed level of technology proficiency and either perceived usefulness or perceived ease of use.


Frail elderly with a fractured hip or pelvis admitted to HRS and receiving TR achieved equivalent functional outcomes to the historical group receiving usual care. Although clinicians appreciated the concept of an avatar-directed scheduling and memory app, they did not see it as a useful tool in the provision of scheduling assistance in short-term rehabilitation services.

Keywords: telerehabilitation, frail aged, hip fracture, clinician perspectives

Subject: Rehabilitation thesis

Thesis type: Masters
Completed: 2018
School: College of Nursing and Health Sciences
Supervisor: A/Prof Chris Barr