Anxiety in patients post fractured neck of femur (NOF). Is there a place for basic psychological techniques?

Purpose

Psychological well-being of patients post traumatic injury is often not fully addressed. Yet our ability to progress patients and engage them in rehabilitation can be hugely influenced by psychological factors such as anxiety. Patients post fractured NOF often experience complications affecting multi-systems including delirium, chest infection, acute kidney injury and postural hypotension, all of which can delay mobilisation and impact on psychological well-being. The aim of this Quality Improvement project was to identify factors that caused most anxiety in patients post fractured NOF and to review physiotherapists’ experience and skills when treating anxious patients.

36% of patients
reported new feelings of anxiety since their injury

Approach

14 patients admitted following a fractured NOF completed a face-to-face questionnaire about factors that caused anxiety in hospital and what worried them in the longer term i.e. once home. They were also asked what mattered most to them about their recovery. All qualified physiotherapists and physiotherapy assistants within the physiotherapy department at St. Richard’s Hospital were surveyed. Questions were asked about the frequency they treated anxious patients, techniques used and whether they felt a knowledge of basic psychological techniques (motivational interviewing, cognitive behavioural therapy and mindfulness) was within their scope of practice.

Outcomes

Results: 36% of patients reported new feelings of anxiety since their injury. Patients were most anxious about getting out of bed for the first time (64%), standing up for the first time (43%) and transferring into a chair (36%). Main worries about home included falling indoors and outdoors, getting up at night-time, not feeling in control of the situation and having to depend on others for help. 100% of the orthopaedic physiotherapy team (14 members) reported treating patients with anxiety of moving at least 2-3 times a week and 93% treated patients with fear of falling at least 2-3 times a week. 79% felt that a basic knowledge of psychological techniques sat within our scope and 93% agreed that further training would benefit their practice.

Conclusion(s): Patients post fractured NOF worried about a range of factors individual to them. Some also had previously unconsidered worries not related to movement, such as recent bereavement or being a carer themselves which also impacted on their recovery. Physiotherapists wanted increased training to support these needs. The next stage of the project is to ask the same questions to patients on our general trauma ward who have a different demographic to ensure any interventions trialled are relevant and individually tailored.

Cost and savings

No cost other than time.

Implications

Developing a training programme to enhance the psychological support skills of and confidence of physiotherapists treating patients following traumatic injury which could help improve patients' engagement with rehabilitation. This could be replicated across the wider hospital setting.

Top three learning points

No further data 

Funding acknowledgements

Clinical Academic Scholarship funded by Western Sussex Hospitals NHS Trust Research Department