Introduction to investigate physiotherapists’ perspectives of effective community provision following hip fracture. Methods qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. Results four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. Conclusion physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.

中文翻译：

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2191 物理治疗师对髋部骨折后有效社区服务的障碍和促进因素的看法


简介 调查物理治疗师对髋部骨折后有效社区服务的看法。方法 对英格兰各地的 17 名社区物理治疗师进行了定性半结构化访谈。利用理论领域框架进行主题分析，确定了实施有效提供的障碍和促进因素。访谈由伦敦一个行政区的流程映射社区提供补充，以确定建议干预措施已到位和/或可以实施的护理点。结果确定了四个主题：护理系统协调无效、患者分层无效、员工招聘和保留方法不足以及抑制性恐惧回避行为。为了加强护理协调，参与者建议改善获得社会服务和职业治疗师的机会，通过在线符号、扩展物理治疗角色、骨科特定角色和 7 天工作来最大化多学科交流。参与者建议根据收到转诊、评估和适当匹配的干预措施对患者进行分层的重要性。为了缓解员工招聘和留住不足的问题，参与者提出了重返实践流、学徒计划、大学参与、联合紧急社区轮换和改进职位描述广告。为了减少恐惧回避行为对康复的影响，参与者建议使用患者特定目标、患者和护理人员教育、心理策略员工教育或社区心理学家访问。 伦敦一个行政区的流程图确定了已经和/或可以实施克服障碍的建议干预措施的护理点。结论 物理治疗师提出，通过改进护理协调、利用分层技术、采用增强的招募和保留策略以及解决恐惧回避行为，可以提高髋部骨折后社区物理治疗的有效性。