**1. Introduction**

Loss of functional independence [1], decreased social participation [1], and reduced quality of life [2] are some of the main consequences of hip fractures. Early hospital rehabilitation with follow-up post-discharge can support older adults' recovery of function [3]. Family caregivers play an essential role in helping older patients to complete activities of daily living (ADL) in the home setting [4,5]. The sudden and unexpected nature of hip fractures can impact both older adults and family caregivers, who as a result can experience increased stress and burden [6]. As a result, hip fracture is associated with worse overall health status in family caregivers [7]. These factors indicate a need for new post-discharge management strategies [8,9] to improve older adults ' function post-hip fracture and reduce caregiver stress [10].

**Citation:** Ariza-Vega, P.;

Prieto-Moreno, R.; Castillo-Pérez, H.; Martínez-Ruiz, V.; Romero-Ayuso, D.; Ashe, M.C. Family Caregivers' Experiences with Tele-Rehabilitation for Older Adults with Hip Fracture. *J. Clin. Med.* **2021**, *10*, 5850. https:// doi.org/10.3390/jcm10245850

Academic Editor: Gianluca Testa

Received: 13 October 2021 Accepted: 8 December 2021 Published: 13 December 2021

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There are barriers to delivering rehabilitation after hip fracture, such as limited access to health professionals after discharge to home. Telerehabilitation (telerehab) is a promising management strategy to support recovery after discharge, and may be especially important in rural and remote areas with limited access to in-person rehabilitation [11]. Of note, there has been an increase in remote delivery of health care because of the SARS-CoV-2 (COVID-19) pandemic [12]. Based on previous studies, telerehab for musculoskeletal injuries or conditions were effective for improving physical function, quality of life, and psychological factors [13–16]. However, there is limited evidence for: (i) the effect of telerehab for older adults after hip fracture [17], and (ii) the inclusion of family caregivers in telerehab for hip fracture [18]. We focus on family caregivers to support older people using information and communication technologies (ICT), and to provide support for the telerehab program. Involving family caregivers in telerehab also addresses their request for more information on the recovery process [19]. Thus, we aimed to address these knowledge gaps [17] by designing and testing a telerehab program called @ctivehip for older adults with hip fracture and their family caregivers.

We previously published results from the main trial [20]—a choice-based multiple methods clinical trial comparing @ctivehip telerehab with home-based in-person rehabilitation for functional recovery of older adults with hip fracture [21]. The @ctivehip intervention consisted of: (i) web-based information to increase family caregivers' knowledge and skill development; (ii) a supported exercise and ADL program for older adults (delivered by the family caregiver); (iii) a specific section on family caregivers' health; and (iv) an option for family caregivers to video conference with health professionals.

The aim of the present exploratory study was to describe family caregivers experience with the @ctivehip telerehab program. We anticipated that family caregivers' feedback could be used to refine the intervention by identifying implementation opportunities and challenges from a person-centered approach.

#### **2. Materials and Methods**
