Integrating research into clinical practice for hip fracture rehabilitation: Implementation of a pragmatic RCT

被引:4
作者
Ashe, Maureen C. [1 ,2 ]
Merali, Khalil [1 ]
Edwards, Nicola [1 ]
Schiller, Claire [1 ]
Hanson, Heather M. [3 ]
Fleig, Lena [4 ]
Khan, Karim M. [1 ,2 ]
Cook, Wendy L. [5 ,6 ]
Mckay, Heather A. [1 ,2 ]
机构
[1] Ctr Hip Hlth & Mobil, 7F-2635 Laurel St, Vancouver, BC V5Z 1M9, Canada
[2] Univ British Columbia, Dept Family Practice, 320-5950 Univ Blvd, Vancouver, BC V6T 1Z3, Canada
[3] Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, TRW Bldg,Room 3D10,3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada
[4] MSB Med Sch Berlin, Fac Nat Sci, Dept Psychol, Hlth Psychol, Calandrellistr 1-9, D-12247 Berlin, Germany
[5] Univ British Columbia, Dept Med, Div Geriatr Med, 7th Floor 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
[6] St Pauls Hosp, Providence Healthcare, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
来源
AIMS MEDICAL SCIENCE | 2018年 / 5卷 / 02期
基金
加拿大健康研究院;
关键词
process evaluation; older adults; hip fracture; implementation;
D O I
10.3934/medsci.2018.2.102
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Objective: Testing clinical interventions integrated within health care delivery systems provides advantages, but it is important to make the distinction between the design of the intervention and the operational elements required for effective implementation. Thus, the objective of this study was to describe contextual factors for an outpatient follow-up clinic for older adults with hip fracture. Design: Implementation evaluation of a parallel-group 1:1 single-blinded two-arm pragmatic randomized controlled trial. Setting: Hospital-based multi-disciplinary outpatient clinic in Vancouver, Canada. Participants: Community-dwelling older adults (>= 65 years) with hip fracture in the previous year. Interventions: Usual care vs. usual care and a comprehensive geriatric clinic for older adults after hip fracture. The primary outcome for the main study was mobility as measured by the Short Physical Performance Battery. Outcome measures: A description of central tenets of implementation that include recruitment, participant characteristics (reach) and aspects of the innovation (e.g., delivery system, fidelity to the intervention, and exercise dose delivered and enacted. Results: We identified the reach for the intervention and delivered the intervention as intended. There were 53 older adults who enrolled in the study; more than 90% of participants returned for the final assessment. We provide a comprehensive description of the intervention and report on dose delivered to participants, and participants' 12-month maintenance for balance and strength exercises. Conclusions: It is important to move beyond solely assessing outcomes of an intervention and describe factors that influence effective implementation. This is essential if we are to replicate interventions across setting or populations or deliver interventions at broad scale to affect the health of patients, in future.
引用
收藏
页码:102 / 121
页数:20
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