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Older adults' experiences regarding discharge from hospital following orthopaedic intervention: a metasynthesis |
Perry MA, Hudson HS, Meys S, Norrie O, Ralph T, Warner S |
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CRD summary The authors concluded that mental outlook, loss of independence, limitations in function and activities, and coping with pain were important concepts during the hospital discharge process following orthopaedic intervention in older adults. Most included studies evaluated experience following surgery, and not directly relating to discharge. With this limitation in mind, the review was well-conducted and conclusions are reliably derived. Authors' objectives To explore the experience of discharge from hospital following orthopaedic surgery from the perspective of older adults. Searching Eight databases (including MEDLINE, CINAHL and PsycINFO) were searched from 1950 up to 2010 for published studies written in English. Search terms were reported. Dissertations and theses were excluded. Study selection Eligible for inclusion were studies that provided qualitative data on the experience of hospital discharge following orthopaedic surgery from the perspective of older adults (aged over 60 years). The hospital discharge period was defined as days leading up to departure from hospital, immediately following hospital departure, and for up to one year post-discharge. Studies that exclusively examined the early discharge process (for example, pre-admission perspectives of discharge) were excluded. The included studies were conducted worldwide, with two located in the UK. Intervention type included hip and/or knee surgery, with most procedures conducted electively. Most included studies did not specifically aim to evaluate the hospital discharge process; many focused on experience of the recovery process following surgical intervention. The mean age of participants ranged from 62.6 to 80.6 years; most were women (where reported). The ethnicity of participants was unclear in most studies. The method of data collection was largely by interview. Two reviewers independently selected the studies for inclusion. Disagreements were resolved by consensus, or with the involvement of a third reviewer. Assessment of study quality The quality of included studies was assessed using criteria provided by Fingfeld, and by applying the Critical Appraisal Skills Programme (CASP) checklist. CASP checklist appraised quality within 10 categories. Four independent reviewers (working in pairs) carried out the quality assessment; disagreements were resolved by discussion. Data extraction Four reviewers were involved in the coding of raw data. Emerging themes and categories were recorded and discussed across several iterations; these were subsequently examined to ensure that the meaning, context, and interpretation of the original data were retained. Diagrams were used to explore relationships between themes, and a final framework was agreed between the reviewers. Methods of synthesis A thematic analysis was presented. Results of the review Fourteen studies (285 participants) were included in the review. The quality of included studies appeared to be satisfactory. Most studies provided sufficient information across most of the 10 CASP appraisal categories, although reflexivity was discussed in only three studies. Four themes were identified for experiences following orthopaedic surgery from the perspective of older adults. These were: mental outlook, loss of independence, functional and activity limitations, and coping with pain. The synthesis revealed that positive mental outlook was a key influence in successful transition from hospital to home. Pain, functional and activity limitations, and loss of independence were negative influences on mental outlook. Participants described the relative impacts on mental outlook of faith and confidence, fear of falling, feelings of appreciation and thankfulness post-intervention, and motivation to overcome functional and activity limitations. Authors' conclusions Mental outlook, loss of independence, limitations in function and activities, and coping with pain were important concepts and problems encountered by older adults during the early and later stages of the process of discharge from hospital. CRD commentary The review question was broad but clear, inclusion criteria were adequately specified, and the review context was discussed. A number of relevant databases were searched. Language restrictions were applied and unpublished material was excluded, which meant that relevant studies could have been missed. The review process was conducted with attempts to maximise consistency, and reporting was detailed and clear throughout. Appropriate quality assessment criteria were applied to the included studies; the results were clearly reported and discussed. Study details were presented. The development of interpretations was reported, raw data were used to illuminate the discussion, and data inconsistencies were considered in the thematic synthesis. The limitation of this review was that most included studies evaluated patient experience following orthopaedic surgery, and not specifically in relation to the process of discharge from hospital. With this in mind, the remainder of the review was well-conducted and the conclusions seem reliably derived. Implications of the review for practice and research Practice: The authors stated that health professionals involved in in-patient and community care should be aware that perceived loss of independence, function and activity limitations, and that the ability to cope with pain could influence mental outlook and consequently rehabilitation. A pre-discharge discussion may be beneficial to encourage positive mental outlook, and more information may be needed to help participants make functional and activity choices. Pain management may need to be adapted according to reason for hospital admission and type of orthopaedic intervention. Research: The authors stated that further research should focus on how the process of hospital discharge was experienced by culturally diverse populations, those with cognitive impairment, with patients following upper limb orthopaedic surgery, and by gender. Additionally, future research should evaluate the effects of different pain management advice. Bibliographic details Perry MA, Hudson HS, Meys S, Norrie O, Ralph T, Warner S. Older adults' experiences regarding discharge from hospital following orthopaedic intervention: a metasynthesis. Disability and Rehabilitation 2012; 34(4): 267-278 Indexing Status Subject indexing assigned by NLM MeSH Activities of Daily Living; Adaptation, Psychological; Adult; Aged; Hospitals; Humans; Orthopedic Procedures /rehabilitation; Patient Discharge; Perception; Quality of Life AccessionNumber 12012011113 Date bibliographic record published 07/11/2012 Date abstract record published 25/11/2013 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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