PURPOSE:To explore patient and clinician perspectives of telephone-based, behaviour change counselling to support recovery after hip fracture. MATERIALS AND METHODS:In-depth interviews of 20 patients an average of 2.5 years after hip fracture and 6 clinicians were analysed within an interpretive description framework. Patient participants had taken part in a trial during their recovery from hip fracture. They received 10 sessions of telephone-based counselling in one of two forms: motivational interviewing focused on physical activity or advice-based support on nutrition. Clinician participants were involved in usual-care rehabilitation and trial recruitment. RESULTS:Patients reported excellent physical recovery after hip fracture but had lingering psychosocial impacts. Telephone-based counselling, whether motivational interviewing or dietary advice, was perceived by most patients to provide psychosocial support through establishing a strong therapeutic connection. Patients also said they received support from family and caring health professionals; however, not everyone had access to this type of support. Patients and clinicians suggested integrating a personalised approach such as telephone-based counselling into routine rehabilitation to address psychosocial needs after hip fracture. CONCLUSION:Telephone-based counselling was perceived as beneficial during hip fracture recovery by patients and clinicians and could be a feasible means to provide psychosocial support after hip fracture.

QUESTIONS:What is the effect of group exercise-based telerehabilitation compared with a single session of in-person assessment and advice on health-related quality of life in cancer survivors? What are the effects on activity, function, safety and cost-effectiveness? DESIGN:An assessor-blinded, pragmatic randomised controlled trial with embedded cost analysis, concealed allocation and intention-to-treat analysis. PARTICIPANTS:Adult cancer survivors with any cancer diagnosis who were receiving treatment or within 12 months of treatment completion. INTERVENTION:The experimental group received an 8-week, twice-weekly, physiotherapist-led exercise group via videoconferencing, supplemented with support resources and a single in-person session of assessment and advice (TeleCaRe). The control group received a single in-person session of exercise assessment and advice. OUTCOME MEASURES:Assessments were completed at baseline, after the intervention (week 9) and at follow-up (week 26). The primary outcome was health-related quality of life, measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, at week 9. Secondary measures were walking capacity (6-minute walk test), physical activity (accelerometer), self-efficacy (Health Action Process Approach Questionnaire), adverse events, and health service and cost data. RESULTS:In total, 117 participants were recruited. Their mean age was 59 years, 82 (70%) were female, and 47 (40%) had breast cancer. Participants attended an average of seven out of 16 sessions (SD 6). There were no major adverse events. Intention-to-treat analysis found that TeleCaRe was not superior for improving quality of life (MD -5.3 units, 95% CI -13.3 to 2.6) or any secondary outcomes. TeleCaRe cost AU$363 per participant. CONCLUSION:Group exercise-based cancer telerehabilitation was safe but attendance was poor. The addition of telerehabilitation to assessment and advice was not superior to a single in-person physiotherapy session alone for improving quality of life. REGISTRATION:ACTRN12621001417875.

INTRODUCTION:Patients frequently face excessive waiting times for specialist medical outpatient clinics, negatively impacting health outcomes. Previous research has demonstrated that translation of demand-driven strategies incorporated within the evidence-based Specific Timely Assessment and Triage (STAT) model effectively reduces wait times in a range of healthcare settings. We outline the study protocol for a hybrid type II implementation effectiveness study, using a stepped wedge cluster randomised controlled trial design, to evaluate whether the STAT model can be implemented in specialist medical clinics and reduce waiting times. METHODS:The Waiting List Evidence to Support Specialist clinics (WaitLESS) trial will implement STAT in eight clinical specialties (clusters) offering outpatient medical care at a metropolitan health network in Melbourne, Australia. After a 6 month pre-implementation period, clusters will be randomised to implement the STAT model, two clusters at a time at 3-month intervals, with a minimum 6-month follow-up period, following the STAT model's five-step implementation process: (i) analyse historical clinic demand data, (ii) model supply/demand, (iii) implement target interventions to address existing backlogs, (iv) protect capacity for new patients to align with demand and (v) implement tailored strategies to enhance patient flow. Strategies will be implemented collaboratively by researchers and clinical teams. The trial will measure both effectiveness (reductions in waiting time and patients on the waiting list) and implementation (fidelity, adoption, acceptability, feasibility, appropriateness and cost) outcomes, using quantitative healthcare data and qualitative data from staff and patients. ANALYSIS:Linear mixed-effects models will be used for analysis of the primary effectiveness outcome of waiting time from referral to first appointment, with time point and time since intervention as factor variables. Implementation outcomes will be analysed descriptively, with qualitative data mapped deductively to the Consolidated Framework for Implementation Research. A cost of implementation and cost-effectiveness analysis will be completed from the health service perspective. TRIAL REGISTRATION NUMBER:ISRCTN15820171.

Although telerehabilitation can improve access to exercise programs for cancer survivors, it is not known if these programs lead to ongoing change in exercise habits. This study explored participant experiences of exercise 4 months after finishing specialized cancer exercise-based telerehabilitation. A qualitative study embedded in a randomized controlled trial evaluated exercise-based cancer telerehabilitation delivered in groups. Data were collected via semistructured interviews that were audio-recorded and transcribed verbatim. Seventeen adult cancer survivors (age 21 to 80) were purposively sampled 4 months after completing exercise-based cancer telerehabilitation. Data were coded independently by two researchers and analyzed inductively within an interpretive description framework. The overarching theme was telerehabilitation was perceived to facilitate positive exercise intentions. Participants said they were empowered to exercise through knowledge, opportunity, and connection gained through telerehabilitation. They described acting on their positive intentions to exercise to varying degrees following telerehabilitation, depending on their context. A subtheme was that exercise was challenging in their new reality created by cancer. Comorbidities, ongoing side effects, previous exercise experience, and personal factors were considered by some to influence their ability to exercise. Telerehabilitation may facilitate positive intent to maintain exercise. Cancer survivors may need ongoing support after telerehabilitation to act on positive exercise intentions due to health-related difficulties. Participation in telerehabilitation may be a positive first step to initiate exercise, but ongoing support to maintain positive behavior changes is likely to be needed for people without previous exercise experience.

OBJECTIVE:To determine the effect of earlier vs. later initiation of exercise rehabilitation on patient and health service outcomes in individuals with cancer. DATA SOURCES:CINAHL, Embase, MEDLINE and PubMed were searched until October 2025. STUDY SELECTION/ELIGIBILITY CRITERIA:Randomised controlled trials including adults and/or children with cancer that compared exercise rehabilitation initiated at different times were eligible. The primary outcome was physical activity. Secondary outcomes included cardiorespiratory fitness, walking capacity, fatigue and quality of life; and health service outcomes such as hospital length of stay. DATA EXTRACTION AND DATA SYNTHESIS:Outcome data were extracted, and the methodological quality assessed using PEDro. Clinically homogenous data were combined in meta-analyses; overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach. RESULTS:Fifteen trials involving 1270 participants most commonly with breast (n = 6), colorectal (n = 3) and haematological (n = 3) cancers were included. There was low to moderate certainty evidence demonstrating similar improvements in physical activity (SMD -0.03, 95% CI -0.60 to 0.54), fitness (SMD 0.17, 95% CI -0.14 to 0.48), walking capacity (SMD 0.78, 95% CI -0.6 to 0.54), fatigue (SMD -0.11, 95% CI -0.55 to 0.33) and quality of life (SMD 0.17, 95% CI -0.17 to 0.50) when comparing earlier to later initiation. No differences were found in hospital length of stay (MD 0 days, 95% CI -0.9 to 0.9). CONCLUSION:People with cancer can achieve comparable health benefits, regardless of when exercise rehabilitation is initiated. SYSTEMATIC REVIEW REGISTRATION NUMBER:PROSPERO Registration Number CRD42024518878. CONTRIBUTION OF PAPER.

ObjectivesMany different approaches are used to manage demand and reduce waiting lists in outpatient and community health settings. This systematic review aimed to synthesise evidence for models of care which are based on the principle of protecting capacity for new patients.MethodsWe conducted a systematic search of Medline (Ovid), Embase, PyscINFO and CINAHL from inception until April 2024. Eligible studies included use of a protected appointment model in an outpatient and community health service and compared data on measures of waiting. Two reviewers independently extracted data and assessed risk of bias. Methodological quality was assessed using the Downs and Black checklist. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to evaluate evidence certainty for meta-analyses.ResultsA total of 26 studies were included in the review. Most studies described a specific, named model incorporating protected appointments, such as Open Access (n = 7), Advanced Access (n = 6), the Specific Timely Assessment and Triage Model (n = 6), and the Choice and Partnership Approach (n = 4). A single stepped wedge randomised controlled trial (n = 3,113) provided moderate certainty evidence of a large reduction in time from referral to first appointment (IRR -0.66, 95% CI -0.85 to -0.52), with a median reduction of 34%. Eight non-randomised studies of intervention (n = 43,655) provided moderate certainty evidence of a moderate to large reduction in waiting time (SMD = -0.66, 95% CI -0.95 to -0.36) with a weighted mean reduction of 81%. Studies that could not be included in the meta-analyses supported these findings. Five studies measured waiting list size and all reported reductions ranging from 44% to 98%. Other findings associated with interventions included increased service productivity and improved patient satisfaction.ConclusionsWaiting list reduction strategies incorporating protected appointments are associated with moderate to large reductions in waiting time in outpatient and community health services.

Introduction:This study evaluated a novel strategy to improve accessibility of implementation science to clinicians in a large health network. The strategy, called Accelerating Research Translation (ART), was based on an adaptation of the A3 problem-solving method developed for use in healthcare quality improvement. Method:An observational pre-post design was used to conduct a 'proof-of-concept' trial of the ART strategy. Clinicians who identified a gap between a clinical practice guideline and usual care were recruited as Project Leads to conduct research translation projects over a 6-month period, supported by a training programme involving a workshop series and mentor. The proportion of patients receiving guideline-consistent care for each project was measured pre- and post-intervention, and results across projects were combined in a planned pooled meta-analysis. Secondary outcomes included changes in confidence in research translation for Project Leads and the degree of evidence of implementation, mapped against Meyer and Goes' stages of healthcare implementation. Results:Ten projects were completed by 13 Project Leads, involving a diverse range of professional disciplines, clinical specialties, and healthcare settings. Pooled analysis of data from 768 patients suggests the ART programme increased the odds of receiving evidence-based care (logOR 2.52, 95% CI: 0.93-4.11, p < 0.01). Effects were stronger for evidence-practice gaps that could be addressed with changes to local policies and processes than those dependent on changing behaviour or complex systems. Confidence of Project Leads improved, and all reported increases in the level of implementation of evidence. Conclusion:This novel approach empowered clinicians to tackle evidence-practice gaps within a familiar structure already well-accepted and understood by health service providers. This concept provides a promising mechanism to demystify implementation science and address local evidence-practice gaps at scale.

BACKGROUND AND PURPOSE:Hip fracture is a serious and common injury affecting older adults with significant psychosocial impacts. However, there is little information available on the assessment and treatment of psychosocial impacts of hip fracture during rehabilitation. Our aim was to determine the extent to which psychosocial factors are: (1) incorporated into goal setting; and (2) assessment and treatment during rehabilitation after hip fracture. METHODS:A retrospective data audit of patients admitted to a community rehabilitation program with a primary diagnosis of hip fracture from 30 June 2022 to 30 June 2023 in Melbourne, Australia. Data were extracted from the assessment and treatment notes of physiotherapists and occupational therapists. RESULTS:One-hundred included patients (59% female, mean age 81 (SD 7) years) were admitted to the community rehabilitation program an average of 41 days (SD 29) after hip fracture. All patients consulted a physiotherapist, 23 an occupational therapist, 6 a dietitian and 3 a social worker. Overall, 3 of 100 patients had a goal that focused on psychosocial functioning and 21 had a goal with a psychosocial element. A total of 96 patients had a mental health screening, but of 17 who were assessed as being 'at risk', 9 (53%) patients did not receive any documented psychosocial management, including 5 (29%) who declined referrals for mental health services. Apart from those patients screened as 'at risk' a number of patients with clinical notes indicating psychosocial concerns were recorded as receiving education (n = 16) and encouragement (n = 9). DISCUSSION:Psychosocial aspects of goals, assessment and treatment are rarely the focus of management in rehabilitation after hip fracture. More attention is needed to assess and treat psychosocial factors as part of a multidisciplinary, holistic approach to rehabilitation after hip fracture.

Aim The primary aim of this systematic review of the literature was to determine whether interventions to reduce waiting time in outpatient and community health services can be sustained. The secondary aim was to describe associations between sustainability and features of waiting time interventions and the settings in which they have been implemented.Methods CINAHL, Medline, Embase and Psych Info databases were searched, combining the search concepts ‘waiting time or waiting lists’, ‘outpatient or community care’ and ‘sustainability’. Studies were included if they tested a service-level intervention that aimed to reduce waiting in an outpatient or community setting and reported data with a minimum 12-month follow-up period. Data were extracted and analysed using a descriptive synthesis. Methodological quality was evaluated using the mixed-methods appraisal tool (MMAT). Waiting interventions were rated as sustained, partially sustained or not sustained using predetermined criteria. The Grading of Recommendation, Assessment, Development and Evaluation was used to describe certainty of evidence for different intervention approaches.Results Screening of 7770 studies yielded 22 papers investigating the sustainability of waiting interventions for approximately 150 000 clients. Many were of lesser quality, with 14 not meeting more than 3 of 5 criteria on the MMAT checklist. Intervention types were categorised as referral entry, open access and substitution, used either alone or in combination. There was low certainty evidence that all interventions were associated with sustained reductions in waiting time, often with large effect sizes, but the findings are limited by low methodological quality of many studies and the risk of publication bias.Conclusion Reductions in wait times and waiting lists for health services can be achieved and sustained following interventions, but further high-quality research would better inform service providers about what interventions are most effective and provide the greatest return on investment.

OBJECTIVES:This trial aimed to provide estimates of effect and feasibility of a physical activity intervention for hospitalized cancer survivors using smartwatches for goal-setting and feedback. DESIGN:A feasibility, single-blinded, randomized trial. SETTING:Acute cancer unit in a tertiary hospital. PARTICIPANTS:Adult hospitalized cancer survivors undergoing cancer treatment (n = 24). INTERVENTIONS:Participants were randomized to usual care or 2 sessions of a behavioural intervention using goal setting and feedback. MAIN OUTCOME MEASURES:Blinded assessments occurred at admission (T0), discharge (T1) and 4-weeks post-discharge (T2). The primary outcome was accelerometer-measured daily step count and sedentary time. Secondary measures evaluated feasibility (demand, implementation, acceptability, practicality), mobility, self-efficacy, and health service outcomes. RESULTS:The trial was hampered by low recruitment rate (n = 24, 29% of target). There were moderate estimates of effect favouring the experimental group for mobility at T1 (mean difference [MD] 11 points, 95% CI -1 to 22). No other effects favored the experimental group. Estimates of step counts (T1 MD -284, 95% CI -1491 to +943; T2 -2249, 95% CI -6062 to +1565) and sedentary time (T1 MD +0.9 hours, 95% CI +0.1 to +2; T2 +2.8 hours, 95% CI -0.3 to +5.2) favored the usual care group. There was no difference in health service outcomes. The intervention was well accepted and no adverse events occurred. CONCLUSION:A physical activity intervention for cancer survivors admitted to hospital was safe and acceptable but slow recruitment and uncertainty surrounding its efficacy hampered trial feasibility. Future trials should consider whole-of-ward interventions using novel trial designs. TRIAL REGISTRATION:ACTRN12622001007729. CONTRIBUTION OF THE PAPER.

BACKGROUND:Sexual assault is a pervasive social issue worldwide, with significant harmful impacts on survivors' mental health and well-being. Sexual assault services that provide specialist crisis and therapeutic programs are contending with long waiting lists. Brief interventions are emerging as a potential strategy to provide timely care, but it is important to know whether these approaches remain effective in improving patient outcomes. AIM:To synthesize evidence informing the effectiveness of brief interventions on person-centered outcomes for people who have experienced sexual assault. METHODS:Four databases were systematically searched for trials testing the effectiveness of brief interventions (≤6 sessions) for sexual assault survivors. Studies were appraised, and data was extracted. Results from trials with homogenous data were combined in meta-analyses, and evidence certainty was assessed using GRADE. Remaining studies were synthesized descriptively. RESULTS:Eighteen studies were included. Meta-analyses of randomized trials (n = 7) provide moderate certainty evidence that brief interventions improve symptoms of posttraumatic stress disorder (6 studies), depression (4 studies), and anxiety (2 studies). Results across other controlled and single-group pre-post studies further supported these findings. DISCUSSION:Brief interventions can have a significant impact on reducing mental health symptoms for survivors who have experienced a sexual assault, providing support for the use of these models of care to broaden the reach and accessibility of sexual assault support services. There is limited evidence about other person-centered outcomes, such as quality of life measures, when considering brief interventions.

BACKGROUND:Falls are a serious risk for people who use health services. We aimed to evaluate the implementation of fall prevention guidelines in health services. METHODS:Databases and grey literature were searched for studies of the implementation of fall prevention guidelines in health services. Implementation outcomes were aligned with the reach, effectiveness, adoption, implementation and maintenance framework. The methodological quality of included papers was assessed using an internal validity checklist. Results were synthesised using narrative synthesis and meta-analysis. The certainty of evidence of each meta-analysis was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS:Fifty-five studies of over 115 000 patients implemented recommendations from 14 fall prevention guidelines. Methodological quality was generally poor (median of 5 of 13 internal validity criteria). Median reach of guideline implementation was 64% (range 38%-96%, five studies). Meta-analysis provided low certainty evidence that implementing guidelines did not prevent falls [falls risk ratio 1.01, 95% confidence interval (CI) = 0.81-1.26; falls rate ratio 1.06, 95% CI = 0.77-1.46]. Adoption of fall prevention recommendations by health professionals improved in 87% of recorded outcomes across 43 studies and was maintained 50% of the time. Adherence of patients to recommendations, however, varied from 7% to 73%. Two studies assessed maintenance of reduced falls percentage or rates and found that changes were sustained. CONCLUSION:Implementation of fall prevention guidelines in health services can change and sometimes sustain fall prevention behaviour of health professionals. It is uncertain whether implementation leads to reduced falls or changes in patient behaviour.

BACKGROUND:Hip fracture has profound psychosocial effects but there is little guidance about how to incorporate management of psychosocial factors into rehabilitation. We aimed to assess the effect of telephone-based motivational interviewing on physical activity in community-dwelling older adults after hip fracture. METHODS:We conducted a 12-month, assessor-masked, open-label, multisite, randomised controlled trial in three health networks (Eastern Health, Peninsula Health, and Alfred Health) in Melbourne, VIC, Australia. Each health network included acute hospitals, sub-acute (rehabilitation) hospitals, and community rehabilitation programmes from which eligible participants were recruited. Community-dwelling adults with hip fracture, aged 65 years and older, were randomly assigned (1:1) by an external provider with a random number generator to an experimental group receiving ten 30-min sessions of motivational interviewing over 16 weeks from one of 13 trained health professionals or to an attention-control group receiving an equivalent dosage of dietary advice from one of nine accredited dietitians. Assessors were masked to group allocation. The primary outcome, assessed in the intention-to-treat population, was physical activity expressed as accelerometer-measured daily walking time at week 52. All available data were used in the linear mixed effects models. To account for missing data, multiple imputation was completed as a sensitivity analysis. The study was registered prospectively (ACTRN12619000936123). FINDINGS:From Sept 29, 2019, to June 27, 2022, 1246 potentially eligible patients were screened, 1046 were excluded (611 were deemed ineligible, 359 declined to participate, and 76 were unable to be contacted) and the resulting 200 were randomly assigned to an intervention (98 assigned to the motivational interviewing group and 102 assigned to the nutritional education control group). 146 (73%) participants were female, 54 (27%) were male, the average age of participants was 79 years (SD 7), and participants were a mean of 89 days (SD 40) days post-surgery at baseline. Daily walking time at week 52 was a median of 53·1 min (IQR 28·8 to 73·8) in the motivational interviewing group and 63·7 min (42·6 to 89·2) in the control group, with no significant between-group differences (mean difference 4·1% [95% CI -16·6 to 21·1). There were no serious harms related to the intervention. There were seven deaths during the period from baseline to week 52, three in the motivational interviewing group and four in the control group. There were a small number of non-serious adverse events related to the intervention with a total of seven (1%) short-term skin reactions out of 668 assessments in response to the activity monitor being held in place on the thigh with dressing. INTERPRETATION:Motivational interviewing was no more effective than dietary advice in increasing physical activity in the form of daily walking for community-dwelling older adults after hip fracture. The most effective way of addressing psychosocial challenges during hip fracture rehabilitation remains uncertain. FUNDING:National Health and Medical Research Council, Australia.

Objective To investigate cost-effectiveness of pre-discharge home assessment visits for patients recovering after hip fracture. Design Cost-effectiveness analysis completed alongside a randomised controlled trial. Setting Hospital wards and the community. Participants Adults 50 years and over with hip fractures planning to return home. Intervention Participants were randomised to either usual-care hospital-based discharge planning or usual-care hospital-based discharge planning with a pre-discharge home assessment visit by an occupational therapist. Main measures Functional Independence Measure, EQ-5D-3L, and number of falls. Incremental cost-effectiveness ratios were calculated for changes at 30 days and 6 months. Results Seventy-seven patients participated. Compared to usual care, the home assessment group likely had fewer falls at 30 days (incidence rate ratio = 0.41, 95% confidence interval (CI) 0.15 to 1.11) and increased functional independence at 6 months (11.2 units, 95% CI 4.2 to 18.2) but no difference in quality of life (0.0 units, 95% CI −0.1 to 0.1). The mean cost to provide a home assessment visit was A$135.70. A mean cost saving of A$6182 (95% CI −$6414 to $18,777) favoured the home assessment group. The incremental cost-effectiveness ratio found a saving of A$71,337 (95% CI −$998,930 to $411,409) in achieving clinically important changes in functional independence for the home assessment group at 6 months and a saving of A$34,832 (95% CI −$331,344 to $213,900) per fall avoided in favour of the home assessment group at 30 days. Conclusion From a health service perspective, pre-discharge home assessments for patients after hip fracture are likely to be cost-effective in restoring functional independence and reducing falls.

Background Motivational interviewing (MI) promotes health-related behaviour change and improves patient health outcomes, but the effect of physical therapist-delivered MI is unclear. Objective To evaluate the effect of physical therapist-delivered MI on health-related behaviour change in adults attending physical therapy or rehabilitation. Methods CINAHL, Medline, PubMed, PEDro, Embase, and Cochrane databases were searched in August 2023. Randomised controlled trials evaluating physical therapist-delivered MI and health-related behaviour change were included. Internal validity was evaluated using the PEDro scale. GRADE approach was used for each meta-analysis. Results Ten publications from nine randomised controlled trials involving 909 participants were included. Physical therapist-delivered MI likely increased physical activity slightly (SMD 0.21, 95 % CI -0.05, 0.47) when compared to minimal intervention; however the evidence is very uncertain in relation to self-efficacy (SMD 0.51, 95 % CI -0.35, 1.38) and health-related quality of life (SMD 0.73, 95 % CI -0.64, 2.11). When physical therapist-delivered MI was combined with and compared to rehabilitation, there were no additional effects on physical activity (SMD 0.02, 95 % CI -0.37, 0.41), health-related quality of life (SMD 0.18, 95 % CI -0.27, 0.63), or endurance (SMD 0.15, 95 % CI -0.21, 0.52) and a likely small effect on self-efficacy (SMD 0.23, 95 % CI -0.1, 0.55). Conclusion Physical therapist-delivered MI is likely to produce a small improvement in physical activity, but only in the absence of other comprehensive rehabilitation. The most beneficial application of MI may be for patients who are not receiving rehabilitation or who have low levels of motivation and self-efficacy.

PURPOSE:Difficulty with communicating basic needs and attracting the attention of health professionals may contribute to falls for patients with communication disability after stroke. The aim of this study was to explore the views of hospital-based health professionals on: (a) the effect of communication disability on falls in patients with stroke; (b) falls prevention strategies for patients with communication disability following stroke; and (c) the roles of speech pathologists in the assessment, management, and prevention of falls in this population. MATERIALS AND METHODS:Online focus groups were conducted and analysed using content thematic analysis. RESULTS:In total, 11 health professionals participated in four focus groups. Clinicians viewed that: (a) the effects of falls in patients with communication disability are far-reaching; (b) communication disability complicates falls risk assessment and falls management; (c) current falls prevention strategies do not meet the needs of patients with communication disability; and (d) strong relationships have a central role in decreasing falls in this population. CONCLUSIONS:Health professionals articulate concerning gaps in falls prevention strategies for patients with communication disability. Further research should investigate strategies enabling falls prevention and management to be more inclusive of patients with communication disability following stroke and consider ways in which speech pathologists could contribute to this field.

BACKGROUND:Hip fracture is a common and serious traumatic injury for older adults characterised by poor outcomes. OBJECTIVE:This systematic review aimed to synthesise qualitative evidence about the psychosocial impact of hip fracture on the people who sustain these injuries. METHODS:Five databases were searched for qualitative studies reporting on the psychosocial impact of hip fracture, supplemented by reference list checking and citation tracking. Data were synthesised inductively and confidence in findings reported using the Confidence in the Evidence from Reviews of Qualitative research approach, taking account of methodological quality, coherence, relevance and adequacy. RESULTS:Fifty-seven studies were included. Data were collected during the peri-operative period to >12 months post fracture from 919 participants with hip fracture (median age > 70 years in all but 3 studies), 130 carers and 297 clinicians. Hip fracture is a life altering event characterised by a sense of loss, prolonged negative emotions and fear of the future, exacerbated by negative attitudes of family, friends and clinicians. For some people after hip fracture there is, with time, acceptance of a new reality of not being able to do all the things they used to do. There was moderate to high confidence in these findings. CONCLUSIONS:Hip fracture is a life altering event. Many people experience profound and prolonged psychosocial distress following a hip fracture, within a context of negative societal attitudes. Assessment and management of psychosocial distress during rehabilitation may improve outcomes for people after hip fracture.