Saturday, June 22, 2024

Evaluating Intensive Physiotherapy for Hip Fracture Recovery: The HIPSTER Trial

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Following hip fracture surgery, patients often endure poor functional outcomes and increased healthcare costs, presenting a significant challenge for healthcare providers. Intensive in-hospital physiotherapy may offer a solution to enhance recovery and reduce expenses. The HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER) trial seeks to determine the efficacy of intensive physiotherapy compared to standard care. This study will identify barriers and facilitators to implementation and delve into the experiences of patients, carers, and clinicians involved in the process.

The HIPSTER trial, set within eight Australian hospitals, will involve 620 participants who have undergone surgery due to low-trauma hip fractures. A process evaluation embedded within this randomized, controlled, assessor-blinded trial will use a mixed method approach guided by theory to assess the intervention.

Study Design and Methodology

Patient and carer experiences will be captured through semi-structured interviews conducted six weeks post-surgery. Clinician perspectives will be gathered via online surveys administered before and after the implementation of intensive therapy. These insights will be mapped to the Theoretical Domains Framework (TDF) to understand the behavioral aspects influencing therapy outcomes.

The Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) framework will evaluate the success of translation and behavior change. A combination of qualitative and quantitative data will inform the development of an Implementation Toolkit, aimed at facilitating the adoption of intensive physiotherapy practices in broader clinical settings.

Anticipated Outcomes and Practical Implications

The process evaluation aims to uncover how contextual factors within hospital environments affect the effectiveness of intensive physiotherapy. By understanding these dynamics, the study hopes to support the scalability and integration of successful interventions into diverse healthcare contexts.

This trial could lead to significant improvements in patient recovery times and functional outcomes, while potentially reducing costs associated with prolonged hospital stays and rehabilitation.

Key Insights for Implementation

– Enhanced in-hospital therapy can potentially improve patient outcomes post-hip fracture surgery.
– Identifying barriers and facilitators is crucial for the successful implementation of intensive physiotherapy.
– The development of an Implementation Toolkit may assist in translating effective interventions into routine practice.

The embedded process evaluation of the HIPSTER trial will provide valuable insights into the relationship between the implementation context and the effectiveness of intensive therapy for low-trauma hip fractures. These findings could aid in transferring successful interventions to other clinical settings, promoting wider adoption and improved patient care.

Original Article: Trials. 2024 May 24;25(1):344. doi: 10.1186/s13063-024-08143-4.

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