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

Abstract

ObjectivesTo develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture.DesignComplex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys and focus groups of patients and rehabilitation teams.SettingNorth Wales.ParticipantsSurveys 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).ResultsThe 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.ConclusionsA 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 numberISRCTN22464643, Pre-results.

Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England

“…It is evident from the current study, and others, that resources and funding is a key barrier to effective provision following hip fracture, particularly matching demand with physiotherapy staff capacity ( environmental context and resources ) [ 8–10 , 43 ]. Furthermore, challenges regarding recruitment and retention in community physiotherapy services is recognised as a further barrier to effective provision.…”

“…This leads to variation in provision [ 5–7 ] often attributed to differences in access to structural resources (e.g. bed-based rehabilitation), staffing resources and different local caseload priorities [ 8–10 ]. Such variation affects quality of care, functional recovery and one-year mortality rates for patients following hip fracture [ 9 ].…”

What Works Where and How for Uptake and Impact of Artificial Intelligence in Pathology: Review of Theories for a Realist Evaluation (Preprint)

“…Realist evaluation is a theory-driven approach to understanding for whom and in what circumstances complex interventions work [16] and has been used for studying a number of complex interventions, including health information technology [17]. Realist approaches can be used both to evaluate complex interventions and inform intervention design [18]. For these reasons, a realist approach is highly appropriate for the conduct of this review.…”

Evidence-based rehabilitation medicine: definition, foundation, practice and development

“…In the field of EBMRM, the main research focuses on osteoarthritis, osteoporosis and musculoskeletal pain, and also focuses on other conditions such as hip and knee replacements [ 30 ], hip fractures [ 31 ], [ 32 ], [ 33 ], pinal deformities [ 34 ], [ 35 ], [ 36 ], and muscular diseases [ 37 , 38 ].…”