Development of a physiotherapy/occupational therapy intervention to support patients with depressive symptoms during community-based rehabilitation after lower limb fragility fracture surgery

Background Optimising recovery after lower limb fragility fracture for older adults with concurrent depressive symptoms could significantly improve quality of life and enable patients to maintain the functional ability that enables well-being in older age. However, there is limited evidence on how physiotherapists/occupational therapists can best support these older adults. Aim To develop a physiotherapy/occupational therapy intervention to facilitate engagement of patients with concurrent depressive symptoms in their community-based rehabilitation after lower limb fragility fracture surgery. Objectives Evidence synthesis of non-pharmacological, non-surgical interventions among patients who undergo surgery for a fragility fracture to: determine the effectiveness of interventions on depressive symptoms. identify potential intervention ingredients using the Rehabilitation Treatment Specification System. Qualitative interview study exploring: patient and carers understanding and experiences of rehabilitation after fragility fracture surgery while experiencing depressive symptoms. community-based physiotherapist and occupational therapists understanding and experiences of current and optimal support for these patients. Nominal Group Technique consensus process (patients, carers, healthcare professionals, community service managers, researchers) on which ingredients should be included in an intervention to support patients with depressive symptoms during community rehabilitation after lower limb fragility fracture surgery. Methods Workstream 1 - systematic review and meta-analysis of studies assessing effectiveness of non-pharmacological, non-surgical interventions on depressive symptoms in adults undergoing surgery for a lower limb fragility fracture. Intervention ingredients will be extracted using the Rehabilitation Treatment Specification System for consideration in workstream 3. Workstream 2 - qualitative interviews of 1) 20 patients with lower limb fragility fracture and depressive symptoms and/or their carers, and 2) physiotherapists and occupational therapists who support these patients in the community. Workstream 3 – Nominal Group Technique consensus process with 15-20 representatives from healthcare professional, patient and researcher groups (two workshops and a survey). PPI Patient and public involvement informs this work from idea conception. Their continued involvement will be ensured throughout the project, through regular group meetings and a named PPI representative on the research team. Inclusion INCLUDE principles have been prioritised throughout the design of this work. Strategies to assess and increase the representation of underserved groups have been considered and measures to optimise accessibility have been implemented. Impact and Dissemination The immediate impact of this project will be a rehabilitation intervention to optimise outcomes of rehabilitation following lower limb fragility fractures for older adults with coexisting depressive symptoms. The project outputs will include intervention programme theories and prototype, and a logic model. This will form the foundation of a subsequent funding application to support feasibility testing in the National Health Service. We will disseminate findings to direct to study participants, as well as patients and the public via social media, TROOP website, and through the Royal Osteoporosis Society. We will also disseminate findings to UK clinicians to identify teams that may support the future feasibility study. We will also share results internationally in open-access journal articles and presentations.