Older patients’ perspectives on participating in multimodal rehabilitation including anabolic steroids following hip fracture: a qualitative study embedded within a pilot RCT

Abstract

Purpose

To explore patient perspectives of participating in a pilot RCT evaluating feasibility and effect of anabolic steroid, physiotherapy and nutritional supplement following hip fracture.

Methods

Semi-structured telephone-based interviews of 16 women and three men (average age 73 years) were conducted at baseline and after a 12-week intervention. Qualitative content analysis was performed.

Results

Two main categories were identified: (1) Trust and hope for a positive change with three sub-categories; reflections on anabolic steroids, anticipation of extra attention, lack of energy. (2) Curiosity, care, and commitment with four sub-categories; a sense of anabolic steroids, feeling of exclusivity and privileges, challenges and sense of obligation, and perspectives on personal gain.

Conclusions

Findings suggest high acceptability of the intervention. Participants motivated their participation on a trust that the intervention would “do more good than harm”. They found the randomization and possibility of receiving anabolic steroids intriguing, and especially valued trial participation because of their experience of getting extra care and “deluxe” rehabilitation including close contact and support by health professionals. Our findings may help inform future research recruiting older patients and generally considered relevant for health professionals in rehabilitation, emphasizing the impact of professional guidance and social support to encourage self-efficacy.

Implications for rehabilitation

• With muscle enhancing medicine being suggested as a supplement in rehabilitation following hip fracture, exploring patients’ perspectives is warranted and may help inform future trials in this area.

• Factors reported as important by older adults for engaging in rehabilitation trials are: simple but thorough information, friendly and trustful relation with study staff and opportunities of extra care and attention.

• Older patients with hip fracture highly valued professional guidance and support by health professionals during the rehabilitation intervention. High acceptability was identified for the supervised outpatient rehabilitation, where especially the individually structured progressive strength training was highlighted as the “active ingredient” accelerating recovery and potentially promoted self-efficacy.

Keywords:

• Hip fracture
• anabolic steroids
• rehabilitation
• strength training
• motivation
• acceptability
• older patients
• physiotherapy

Acknowledgements

We would like to thank the participants and physiotherapist Tina Krüger-Jankins, Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre for her help translating patient quotes.

Disclosure statement

The authors state no conflicts of interest.

Additional information

Funding

This work is supported by the Capital Regions Research Fund for Health Research (2017-188), The Capital Regions Cross-continuum Fund (P-2018-2-01), and Copenhagen University Hospital Amager-Hvidovre (2019, 2019-839).