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



Roberts, Jessica L, Din, Nafees Ud, Williams, Michelle, Hawkes, Claire A, Charles, Joanna M, Hoare, Zoe, Morrison, Val, Alexander, Swapna, Lemmey, Andrew, Sackley, Catherine
et al (show 4 more authors) (2017) Development of an evidence-based complex intervention for community rehabilitation of hip fracture patients using realist review, survey and focus group. BMJ Open. 1 - 11.

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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 realworld 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).

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 14 Feb 2018 15:09
Last Modified: 19 Nov 2020 21:10
DOI: 10.1136/bmjopen-2016-014362
Open Access URL: http://bmjopen.bmj.com/content/7/10/e014362
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URI: http://livrepository.liverpool.ac.uk/id/eprint/3018147