Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups

Jessica Louise Roberts; Nafees Ud Din; Michelle Williams; Claire Hawkes; Joanna  Charles; Zoe Hoare; Val Morrison; Swapna Alexander; Andrew Lemmey; Catherine Sackley; Phillipa Logan; Clare Wilkinson; Jo Rycroft-Malone; Nefyn  Williams

doi:10.1136/bmjopen-2016-014362

Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups

Jessica Louise Roberts
, Nafees Ud Din
, Michelle Williams
, Claire Hawkes
, Joanna Charles
, Zoe Hoare
, Val Morrison
, Swapna Alexander
, Andrew Lemmey
, Catherine Sackley
, Phillipa Logan
, Clare Wilkinson
, Jo Rycroft-Malone
, Nefyn Williams

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVES: To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture.

DESIGN: Complex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys and focus groups of patients and rehabilitation teams.

SETTING: North Wales.

PARTICIPANTS: Surveys of therapy managers (n=13), community and hospital-based physiotherapists (n=129) and occupational therapists (n=68) throughout the UK. Focus groups with patients (n=13), their carers (n=4) and members of the multidisciplinary rehabilitation teams in North Wales (n=13).

RESULTS: The realist review provided understanding of how rehabilitation interventions work in the real-world context and three programme theories were developed: improving patient engagement by tailoring the intervention to individual needs; reducing fear of falling and improving self-efficacy to exercise and perform activities of daily living; and coordination of rehabilitation delivery. The survey provided context about usual rehabilitation practice; focus groups provided data on the experience, acceptability and feasibility of rehabilitation interventions. An intervention to enhance usual rehabilitation was developed to target these theory areas comprising: a physical component consisting of six additional therapy sessions; and a psychological component consisting of a workbook to enhance self-efficacy and a patient-held goal-setting diary for self-monitoring.

CONCLUSIONS: A realist approach may have advantages in the development of evidence-based interventions and can be used in conjunction with other established methods to contribute to the development of potentially more effective interventions. A rehabilitation intervention was developed which can be tested in a future randomised controlled trial (MRC framework phases II and III).

TRIAL REGISTRATION NUMBER: ISRCTN22464643, Pre-results.

Original language	English
Article number	e014362
Journal	BMJ Open
Volume	7
Issue number	10
DOIs	https://doi.org/10.1136/bmjopen-2016-014362
Publication status	Published - 11 Oct 2017

Keywords

Journal Article

Access to Document

10.1136/bmjopen-2016-014362

2017 FEMuR phase I develop interventionFinal published version, 991 KB

FEMuR (Fracture in the Elderly Multidisciplinary Rehabilitation)
1/11/12 → 15/08/18
Project: Research

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)
Williams, N., Roberts, J., Din, N., Charles, J., Totton, N., Williams, M., Mawdesley, K., Hawkes, C., Morrison, V., Lemmey, A., Edwards, R., Hoare, Z., Pritchard, A., Woods, R., Alexander, S., Sackley, C., Logan, P., Wilkinson, C. & Rycroft-Malone, J., Aug 2017, Health Technology Assessment, 21, 44.
Research output: Contribution to specialist publication › Article

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Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): study protocol for a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture [ ISRCTN22464643 ]
Williams, N. H., Hawkes, C. A., Din, N. U., Roberts, J. L., Charles, J. M., Morrison, V. L., Hoare, Z. S., Edwards, R. T., Alexander, S., Andrew, G., Lemmey, A. B., Woods, R. T., Sackley, C., Logan, P., Hunnisett, D. S., Mawdesley, K. J. & Wilkinson, C. E., 7 Apr 2015, In: Pilot and Feasibility Studies. 1, 13, p. 1-22
Research output: Contribution to journal › Article › peer-review

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Roberts, J. L., Din, N. U., Williams, M., Hawkes, C., Charles, J., Hoare, Z., Morrison, V., Alexander, S., Lemmey, A., Sackley, C., Logan, P., Wilkinson, C., Rycroft-Malone, J., & Williams, N. (2017). Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups. BMJ Open, 7(10), Article e014362. https://doi.org/10.1136/bmjopen-2016-014362

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abstract = "OBJECTIVES: To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture.DESIGN: Complex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys and focus groups of patients and rehabilitation teams.SETTING: North Wales.PARTICIPANTS: Surveys of therapy managers (n=13), community and hospital-based physiotherapists (n=129) and occupational therapists (n=68) throughout the UK. Focus groups with patients (n=13), their carers (n=4) and members of the multidisciplinary rehabilitation teams in North Wales (n=13).RESULTS: The realist review provided understanding of how rehabilitation interventions work in the real-world context and three programme theories were developed: improving patient engagement by tailoring the intervention to individual needs; reducing fear of falling and improving self-efficacy to exercise and perform activities of daily living; and coordination of rehabilitation delivery. The survey provided context about usual rehabilitation practice; focus groups provided data on the experience, acceptability and feasibility of rehabilitation interventions. An intervention to enhance usual rehabilitation was developed to target these theory areas comprising: a physical component consisting of six additional therapy sessions; and a psychological component consisting of a workbook to enhance self-efficacy and a patient-held goal-setting diary for self-monitoring.CONCLUSIONS: A realist approach may have advantages in the development of evidence-based interventions and can be used in conjunction with other established methods to contribute to the development of potentially more effective interventions. A rehabilitation intervention was developed which can be tested in a future randomised controlled trial (MRC framework phases II and III).TRIAL REGISTRATION NUMBER: ISRCTN22464643, Pre-results.",

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Roberts, JL, Din, NU, Williams, M, Hawkes, C, Charles, J, Hoare, Z, Morrison, V, Alexander, S, Lemmey, A, Sackley, C, Logan, P, Wilkinson, C, Rycroft-Malone, J & Williams, N 2017, 'Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups', BMJ Open, vol. 7, no. 10, e014362. https://doi.org/10.1136/bmjopen-2016-014362

TY - JOUR

T1 - Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups

AU - Roberts, Jessica Louise

AU - Din, Nafees Ud

AU - Williams, Michelle

AU - Hawkes, Claire

AU - Charles, Joanna

AU - Hoare, Zoe

AU - Morrison, Val

AU - Alexander, Swapna

AU - Lemmey, Andrew

AU - Sackley, Catherine

AU - Logan, Phillipa

AU - Wilkinson, Clare

AU - Rycroft-Malone, Jo

AU - Williams, Nefyn

PY - 2017/10/11

Y1 - 2017/10/11

N2 - OBJECTIVES: To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture.DESIGN: Complex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys and focus groups of patients and rehabilitation teams.SETTING: North Wales.PARTICIPANTS: Surveys of therapy managers (n=13), community and hospital-based physiotherapists (n=129) and occupational therapists (n=68) throughout the UK. Focus groups with patients (n=13), their carers (n=4) and members of the multidisciplinary rehabilitation teams in North Wales (n=13).RESULTS: The realist review provided understanding of how rehabilitation interventions work in the real-world context and three programme theories were developed: improving patient engagement by tailoring the intervention to individual needs; reducing fear of falling and improving self-efficacy to exercise and perform activities of daily living; and coordination of rehabilitation delivery. The survey provided context about usual rehabilitation practice; focus groups provided data on the experience, acceptability and feasibility of rehabilitation interventions. An intervention to enhance usual rehabilitation was developed to target these theory areas comprising: a physical component consisting of six additional therapy sessions; and a psychological component consisting of a workbook to enhance self-efficacy and a patient-held goal-setting diary for self-monitoring.CONCLUSIONS: A realist approach may have advantages in the development of evidence-based interventions and can be used in conjunction with other established methods to contribute to the development of potentially more effective interventions. A rehabilitation intervention was developed which can be tested in a future randomised controlled trial (MRC framework phases II and III).TRIAL REGISTRATION NUMBER: ISRCTN22464643, Pre-results.

AB - OBJECTIVES: To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture.DESIGN: Complex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys and focus groups of patients and rehabilitation teams.SETTING: North Wales.PARTICIPANTS: Surveys of therapy managers (n=13), community and hospital-based physiotherapists (n=129) and occupational therapists (n=68) throughout the UK. Focus groups with patients (n=13), their carers (n=4) and members of the multidisciplinary rehabilitation teams in North Wales (n=13).RESULTS: The realist review provided understanding of how rehabilitation interventions work in the real-world context and three programme theories were developed: improving patient engagement by tailoring the intervention to individual needs; reducing fear of falling and improving self-efficacy to exercise and perform activities of daily living; and coordination of rehabilitation delivery. The survey provided context about usual rehabilitation practice; focus groups provided data on the experience, acceptability and feasibility of rehabilitation interventions. An intervention to enhance usual rehabilitation was developed to target these theory areas comprising: a physical component consisting of six additional therapy sessions; and a psychological component consisting of a workbook to enhance self-efficacy and a patient-held goal-setting diary for self-monitoring.CONCLUSIONS: A realist approach may have advantages in the development of evidence-based interventions and can be used in conjunction with other established methods to contribute to the development of potentially more effective interventions. A rehabilitation intervention was developed which can be tested in a future randomised controlled trial (MRC framework phases II and III).TRIAL REGISTRATION NUMBER: ISRCTN22464643, Pre-results.

KW - Journal Article

U2 - 10.1136/bmjopen-2016-014362

DO - 10.1136/bmjopen-2016-014362

M3 - Article

C2 - 29025824

SN - 2044-6055

VL - 7

JO - BMJ Open

JF - BMJ Open

IS - 10

M1 - e014362

ER -

Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups

Abstract

Keywords

Access to Document

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Projects

FEMuR (Fracture in the Elderly Multidisciplinary Rehabilitation)

Research output

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): study protocol for a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture [ ISRCTN22464643 ]

Cite this