Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups
Research output: Contribution to journal › Article › peer-review
Electronic versions
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.
Keywords
- Journal Article
Original language | English |
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Article number | e014362 |
Journal | BMJ Open |
Volume | 7 |
Issue number | 10 |
DOIs | |
Publication status | Published - 11 Oct 2017 |
Research outputs (2)
- Published
Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)
Research output: Contribution to specialist publication › Article
- Published
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 ]
Research output: Contribution to journal › Article › peer-review
Projects (1)
FEMuR (Fracture in the Elderly Multidisciplinary Rehabilitation)
Project: Research