Discussion
fracture, dementia, cognitive impairment
RECRUITMENT
The findings from this feasibility study indicate that the HIP HELPER intervention was acceptable to patients, informal caregivers and health professionals but the trial design requires further development to ensure feasibility. Modifications should be made on promoting intervention adherence, prioritising outcome measures to test future effectiveness of data completeness and exploring strategies to support the recruitment of patients with cognitive impairment.The completion of data from the outcomes at 4 months was lower than anticipated. This was particularly for participants with cognitive impairment. The qualitative study indicated that participants found the number of outcome measures challenging to complete and future study could better discern what outcome measures are important to people following hip fracture and their caregivers.A written, information guide about rehabilitation, recovery goals and caregiver responsibilities in the home has been previously reported as valuable to other populations.Approximately 40% of people who sustain a hip fracture present with dementia.Previous evidence suggests that health professionals have been inflexible about people with hip fracture and their caregivers to discuss care plans, when these do happen.This study presented with strengths and limitations. A notable strength was the ability to recruit over 100 participants from five NHS organisations during the 2020 COVID-19 pandemic. While a short-fall of 10 participant dyads, given the challenges in managing site opening and research conduct during the COVID-19 pandemic, the ability to undertake this was considered a success. In the absence of COVID-19 (or such like) restrictions on visiting, patient flow and research activity in NHS settings, we would anticipate that this impact would be negated in future trials of this population. Second, although we planned to assess whether caregivers adopted their caregiving knowledge from the intervention into the home environment, only two participants returned these data. This was a major limitation and resulted in an inability to answer an a prior progression criterion. The findings from the qualitative study and acceptability questionnaires may suggest carryover of the intervention into practice. However, we acknowledge that this does not offer the granularity of detail which the original caregiver log would have conveyed. Finally, the follow-up rates and data competition for clinical outcomes were low. Accordingly, it was not possible to confidently assess for a signal of efficacy in the experimental intervention. Further modifications in what and how clinical outcome data are collected should be considered as part of the following work to improve the feasibility of this trial design.