Process evaluation results of FEMuR III randomised controlled trial (RCT), a community-based rehabilitation following hip fracture surgery.

In 30 seconds

This mixed-methods process evaluation examined implementation of FEMuR, a community-based rehabilitation programme after hip fracture surgery, delivered across 13 sites within a randomised controlled trial. Interviews with patients, carers, therapists and recruiting staff, alongside therapy records and other materials, explored how the intervention was delivered and experienced. Patients and staff valued additional, tailored support, but delivery varied and COVID-19 restrictions prompted remote sessions that affected feedback and risk assessment. The parent trial found no improvement in quantitatively measured outcomes versus usual rehabilitation, despite patient-reported benefits.

Key findings

• Patients and staff valued additional therapy, including tailored, person-centred support and time for therapists to address broader needs.
• Intervention delivery varied across sites, and implementation and fidelity were compromised.
• COVID-19-related remote delivery affected therapist feedback and risk assessment, while restrictions limited patients’ activities.
• Patient motivation, therapist expertise, variable usual care and poor service integration shaped how the intervention worked.

Why it matters

The evaluation shows why measured outcomes alone may not capture how rehabilitation is experienced or delivered. Patient-centred support was valued, but variation in implementation and contextual barriers complicate interpretation of the trial’s lack of improvement in quantitative outcomes. Considering acceptability, fidelity and contextual influences can help future rehabilitation research assess both outcomes and the processes that may contribute to them.

What to keep in mind

The evaluation identified disparities in intervention delivery and compromised fidelity; COVID-19 restrictions also altered delivery and limited activities.