Mandy M Archibald1,2,3, Michael Lawless4,5, Tiffany K Gill6, Mellick J Chehade4,7. 1. for the Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia. mandy.archibald@umanitoba.ca. 2. University of Manitoba, College of Nursing, 99 Curry Pl, Winnipeg, MB, R3T 2M6, Canada. mandy.archibald@umanitoba.ca. 3. Flinders University, College of Nursing and Health Sciences, Bedford Park, SA, 5042, Australia. mandy.archibald@umanitoba.ca. 4. for the Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia. 5. Flinders University, College of Nursing and Health Sciences, Bedford Park, SA, 5042, Australia. 6. Adelaide Medical School, South Australian Health and Medical Research Institute, Level 7, North Tce, Adelaide, SA, 5000, Australia. 7. Discipline of Orthopaedics & Trauma, Royal Adelaide Hospital, The University of Adelaide, Level 4 Bice Building, Adelaide, SA, 5005, Australia.
Abstract
BACKGROUND: Over the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts. METHODS: We used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior Consultants, and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation. RESULTS: Orthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used. CONCLUSIONS: There is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.
BACKGROUND: Over the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts. METHODS: We used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior Consultants, and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation. RESULTS: Orthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used. CONCLUSIONS: There is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.
Authors: Daniel R Evans; Eliana B Saltzman; Albert T Anastasio; Ndeye F Guisse; Elshaday S Belay; Tyler S Pidgeon; Marc J Richard; David S Ruch; Oke A Anakwenze; Mark J Gage; Christopher S Klifto Journal: JSES Int Date: 2020-12-16
Authors: Mandy M Archibald; Kristy Wittmeier; Matthew Gale; Florencia Ricci; Kelly Russell; Roberta L Woodgate Journal: BMJ Open Date: 2021-05-04 Impact factor: 2.692
Authors: Eliana B Saltzman; Daniel R Evans; Albert Anastasio; Ndeye Guisse; Elshaday S Belay; Oke A Anakwenze; Mark J Gage; Tyler S Pidgeon; Marc J Richard; David S Ruch; Christopher S Klifto Journal: JSES Int Date: 2021-09-17
Authors: Maximilian Peter Forssten; Yang Cao; Dhanisha Jayesh Trivedi; Lovisa Ekestubbe; Tomas Borg; Gary Alan Bass; Ahmad Mohammad Ismail; Shahin Mohseni Journal: Trauma Surg Acute Care Open Date: 2022-09-13