Driving change in access to- and delivery of- evidence based rehabilitation for the benefit of patients with fragility fracture

Why are we doing this work? In the UK around half a million older people break a bone each year. These people often need surgery and rehabilitation to get better. We have been working to improve the rehabilitation that older people get after surgery to fix a broken bone. We will take two steps to further improve this rehabilitation. Project 1: We will measure what older people do during rehabilitation in hospital after a broken bone. Therapists write sentences to describe everything older people do during rehabilitation. This helps all members of the team know how best to help the older person get better. It is difficult to use these notes for research as what one therapist writes can be quite different to another. New technology allows us to look for key words or phrases in the sentences written by therapists for thousands of patients at once. This will help us to understand how much rehabilitation support differs from one older person to the next after surgery to fix a broken bone, and whether this influences their chance of getting better. Project 2: We will take the first steps to improve how older people access rehabilitation once they go home. When people leave the hospital, how long they wait for rehabilitation depends on how community teams decide who should be seen first. We don't really understand how these decisions differ across teams and what this means for people who are waiting. In this work, we will gain an understanding of how community rehabilitation teams decide who should be seen first, and whether this makes it harder for some older people to access rehabilitation than others after they break a bone. We will then create a 'toolkit' to help these teams decide who should be seen first in a way that is consistent and fair for all people seeking support. What will we do? Project 1: Patients, carers, therapists, and researchers will help us to create a list of rehabilitation treatments that people often receive in hospital after surgery to fix a broken bone. We will then use technology called 'natural language processing' to try to identify these treatments in the sentences that therapists wrote for over 3,000 patients admitted to a London hospital for surgery to fit their broken hip, leg, or ankle. We will seek to identify how often and for how long patients have these treatments. We will then see how well the technology does at identifying these treatments by comparing the results directly with the notes that therapists wrote for 400 patients. We will then describe how much treatment differs for patients with these broken bones, and whether there have been any changes over time. Project 2: We will gather initial information from the evidence and discussions with patients, carers, therapists, service managers, policy makers, and researchers on how decisions are made on who should be seen first by community rehabilitation teams. This will help us to create a theory, or idea, on what might be important to look for in further evidence searches and discussions with these groups. We will complete this additional work and bring all the information together into a 'toolkit' to help these teams make more consistent and fair decisions about the order in which patients should be seen. Who will be involved? The work will be supported by patients and carers at each step, to ensure that it is relevant to their needs. Patients and carers will help us to share the findings of the work at meetings with healthcare professionals from around the world. The work will also be supported by a research team who will have opportunities to learn new skills to support them to take the next step in their career. What will happen next? The work will allow us to create initial evidence for new approaches to using data and use existing evidence to improve rehabilitation for older people with broken bones. We will continue to work with patients and carers while growing a supported research team.