TY  - JOUR
PY  - 2017//
TI  - Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups
JO  - BMJ open
A1  - Roberts, Jessica Louise
A1  - Din, Nafees Ud
A1  - Williams, Michelle
A1  - Hawkes, Claire A.
A1  - Charles, Joanna M.
A1  - Hoare, Zoë
A1  - Morrison, Val
A1  - Alexander, Swapna
A1  - Lemmey, Andrew
A1  - Sackley, Catherine
A1  - Logan, Phillipa
A1  - Wilkinson, Clare
A1  - Rycroft-Malone, Jo
A1  - Williams, Nefyn H.
SP  - e014362
EP  - e014362
VL  - 7
IS  - 10
N2  - OBJECTIVES: To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture. <br><br>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). <br><br>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. <br><br>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.<br><br>© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.<p />  <p>Language: en</p>
LA  - en
SN  - 2044-6055
UR  - http://dx.doi.org/10.1136/bmjopen-2016-014362
ID  - ref1
ER  -