Intervention development and treatment success in UK health technology assessment funded trials of physical rehabilitation: a mixed methods analysis

Abstract

ObjectivesPhysical rehabilitation is a complex process, and trials of rehabilitation interventions are increasing in number but often report null results. This study aimed to establish treatment success rates in physical rehabilitation trials funded by the National Institute of Health Research Health Technology Assessment (NIHR HTA) programme and examine any relationship between treatment success and the quality of intervention development work undertaken.DesignThis is a mixed methods study.SettingThis study was conducted in the UK.MethodsThe NIHR HTA portfolio was searched for all completed definitive randomised controlled trials of physical rehabilitation interventions from inception to July 2016. Treatment success was categorised according to criteria developed by Djulbegovic and colleagues. Detailed textual data regarding any intervention development work were extracted from trial reports and supporting publications and informed the development of quality ratings. Mixed methods integrative analysis was undertaken to explore the relationship between quantitative and qualitative data using joint displays.ResultsFifteen trials were included in the review. Five reported a definitive finding, four of which were in favour of the ‘new’ intervention. Eight trials reported a true negative (no difference) outcome. Integrative analysis indicated those with lower quality intervention development work were less likely to report treatment success.ConclusionsDespite much effort and funding, most physical rehabilitation trials report equivocal findings. Greater focus on high quality intervention development may reduce the likelihood of a null result in the definitive trial, alongside high quality trial methods and conduct.

Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review

“…Therefore, collaboratives may bring unique challenges as well as benefits. This may mean that different organisations at different developmental levels deduce different outcomes from the same QI programmes [ 102 , 146 ]. Research developments here will be valuable to improve understanding of QI-ROI, for example how and why collaboratives work (or not) [ 51 , 185 ].…”

“…These include aspects of organisations' structures, systems, behaviours, cultures, and leadership [143,144]. The collection of benefits referred to in this review as QI-ROI largely contribute towards these QI effectiveness determinants [145][146][147]. Thus, improvement in these aspects must be of value for organisations.…”