Clinical and research implications
This study illustrates the ‘real-world’ challenges in planning, implementing and evaluating a TCI in an ever-changing setting, with a complex study population and a long study period. To address this, it is essential to plan the study thoroughly based on previous research findings and to conduct pilot tests prior to implementation to ensure feasibility. Designing an interdisciplinary intervention is also essential to achieve a greater impact. In addition, future research should register implementation fidelity to provide a clear picture of whether the effects are caused by implementation failure or success, the study design or are solely due to the intervention. Future research should also address the importance of the implementation context and consider conducting a process evaluation. Finally, we recommended to screen participants for frailty to assess the intervention effect in this patient group.