{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:12:28Z","timestamp":1789542748042,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,10,6]],"date-time":"2016-10-06T00:00:00Z","timestamp":1475712000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>For older adults with osteoporosis, a fall resulting in hip fracture is a life\u2010changing event from which only one\u2010third fully recover. Current best evidence argues strongly for elderly patients to bear weight on their repaired hip fracture immediately after their surgery to maximize their chances of full or nearly full recovery. Patient stakeholders in Canada have argued that some surgeons fail to issue \u201cweight\u2010bearing\u2010as\u2010tolerated\u201d (WBAT) orders in all eligible cases, protecting their bony repair but contributing to increased mortality and long\u2010term disability rates. In collaboration with a national stakeholder organization, Bone and Joint Canada, we interviewed 20 orthopedic surgeons across Canada who perform hip fracture repair surgery, with the aim of understanding their attitudes and behavior toward patient management regarding weight bearing. Qualitative content analysis, in which themes are identified and agreed by multiple coders, suggested that both patient characteristics and surgeon factors influence surgeons' postoperative weight\u2010bearing orders. While almost all respondents agreed that weight bearing as tolerated is indeed therapeutic for most hip fracture repair or replacement patients, surgeons also described certain patient characteristics that would diminish the value of immediate weight bearing, including poor bone quality and certain types of fracture pattern. Surgeon factors that affect postoperative mobilization orders include choice of construct, previous experience of construct failure, and lack of local audit data regarding past weight\u2010bearing decisions and patient outcomes. Thus, although familiar with best practice guidelines, surgeons also have \u201crules to break the rules.\u201d In an era when \u201cgood\u201d medicine leans toward science rather than art, the role of individual experience in decision making with regard to hip fracture care continues to be important and would benefit from being discussed openly.<\/jats:p>","DOI":"10.1111\/jep.12645","type":"journal-article","created":{"date-parts":[[2016,10,12]],"date-time":"2016-10-12T22:06:49Z","timestamp":1476310009000},"page":"42-47","source":"Crossref","is-referenced-by-count":33,"title":["Exploring Canadian surgeons' decisions about postoperative weight bearing for their hip fracture patients"],"prefix":"10.1111","volume":"24","author":[{"given":"Leslie","family":"Carlin","sequence":"first","affiliation":[{"name":"Department of Physical Therapy University of Toronto Faculty of Medicine  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Sibley","sequence":"additional","affiliation":[{"name":"University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Jenkinson","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Kontos","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhona","family":"McGlasson","sequence":"additional","affiliation":[{"name":"Bone and Joint Canada  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans J.","family":"Kreder","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Jaglal","sequence":"additional","affiliation":[{"name":"University of Toronto Faculty of Medicine  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,10,6]]},"reference":[{"issue":"2","key":"e_1_2_7_2_1","first-page":"297","article-title":"Physical exercise after hip fracture: an evidence overview","volume":"47","author":"Sherrington C","year":"2011","journal-title":"Eur J Phys Rehabil Med"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.100771"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(91)90265-E"},{"key":"e_1_2_7_5_1","first-page":"53","article-title":"Hold on!: falling, embodiment and the materiality of old age","volume":"50","author":"Katz S","year":"2010","journal-title":"Gerontologist"},{"issue":"3","key":"e_1_2_7_6_1","first-page":"507","article-title":"Self blame and fears among peri\u2010operative hip fracture patients: a qualitative study","volume":"1","author":"Webster F","year":"2011","journal-title":"Int J Pers Cent Med"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102014\u2010005406"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2012.707747"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2006.03786.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurger.2012.10.003"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-201312000-00003"},{"key":"e_1_2_7_12_1","unstructured":"NICE (National Institute for Health and Care Excellence).NICE guidelines for hip fracture management. Available fromhttps:\/\/www.nice.org.uk\/guidance\/indevelopment\/gid\u2010qsd142."},{"key":"e_1_2_7_13_1","unstructured":"Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering Group.Australian and New Zealand guidelines for hip fracture care\u2014improving outcomes in hip fracture management of adults. In: Council NHaMR editor. Sydney: Available fromhttps:\/\/www.clinicalguidelines.gov.au\/portal\/2393\/australian\u2010and\u2010new\u2010zealand\u2010guideline\u2010hip\u2010fracture\u2010care\u2010improving\u2010outcomes\u2010hip\u2010fracture; 2014."},{"key":"e_1_2_7_14_1","unstructured":"SIGN (Scottish Intercollegiate Guidelines Network).Management of hip fracture in older people. Available fromhttp:\/\/www.sign.ac.uk\/guidelines\/fulltext\/111\/NHS National Health Service; 2009."},{"key":"e_1_2_7_15_1","unstructured":"WaddellJ.National hip fracture toolkit.Bone and Joint Canada;2011."},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2008.00943.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470750841.ch7"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/nur.1025"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u20109\u201052"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/nur.20362"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2010.07.007"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(84)90050-9"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000249296.55245.97"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2757-x"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.12058"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588407X232206"},{"issue":"5","key":"e_1_2_7_27_1","first-page":"215","article-title":"Orthopedic grand rounds can change resident practice","volume":"42","author":"Cantu RV","year":"2013","journal-title":"Am J Orthop (Belle Mead NJ)"},{"issue":"100","key":"e_1_2_7_28_1","first-page":"1","article-title":"Overcoming resistance to implementation of integrated care pathways in orthopaedics","volume":"95","author":"Manning BT","year":"2013","journal-title":"J Bone Joint Surg"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjep.12645","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjep.12645","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.12645","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.12645","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.12645","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T01:10:28Z","timestamp":1694394628000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.12645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,6]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["10.1111\/jep.12645"],"URL":"https:\/\/doi.org\/10.1111\/jep.12645","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,6]]}}}