AIMS Medical Science, 2018, 5(2): 102-121. doi: 10.3934/medsci.2018.2.102 Research article

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

Maureen C. Ashe, Khalil Merali, Nicola Edwards, Claire Schiller, Heather M. Hanson, Lena Fleig, Karim M. Khan, Wendy L. Cook, Heather A. McKay

1 Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1M9, Canada
2 Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
3 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building, Room 3D10, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6, Canada
4 MSB Medical School Berlin, Faculty of Natural Sciences, Department of Psychology, Health Psychology, Calandrellistraße 1-9, 12247 Berlin, Germany
5 Division of Geriatric Medicine, Department of Medicine, University of British Columbia, 7th Floor-2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
6 Providence Healthcare, St. Paul’s Hospital, 1081 Burrard Street Vancouver, BC V6Z 1Y6, Canada

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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. Trial registration: This trial was registered on ClinicalTrials.gov (NCT01254942).

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