ArticleBone & joint open2026
Protocol for the ACTIVE trial: a multicentre, open-label, cluster-randomized controlled trial of a quality improvement programme for older adults with hip fracture in resource-limited hospitals in China.
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Minghui YangDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Tingzhuo LiuSchool of Public Health, Harbin Medical University, Harbin, China.
Gang LiuDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Ning TangSchool of Public Health, Harbin Medical University, Harbin, China.
Xinyi ZhangSchool of Public Health, Harbin Medical University, Harbin, China.
Rebecca IversSchool of Population Health, Faculty of Medicine and Health, The University of New South Wales, Randwick, Australia.
Yongchen WangDepartment of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Maoyi TianSchool of Public Health, Harbin Medical University, Harbin, China.
ACTIVE trial Investigators
Zhenghua SunSchool of Public Health, Harbin Medical University, Harbin, China.
Jiarong ShenSchool of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China.
Boya NanSchool of Public Health, Harbin Medical University, Harbin, China.
Wei TianCenter for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.
Qiang LiThe George Institute for Global Health, Faculty of Medicine and Health, The University of New South Wales, Sydney, Australia.
Lei SiSchool of Health Sciences, Faculty of Health, Western Sydney University, Sydney, Australia.
Ronald Man Yeung WongDepartment of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
Jing ZhangSchool of Public Health, Harbin Medical University, Harbin, China.
Shangzhi XiongThe George Institute for Global Health, Faculty of Medicine and Health, The University of New South Wales, Sydney, Australia.
Pengpeng YeNational Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Lei YangDepartment of Orthopaedics and Traumatology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Liming LiDepartment of Orthopaedics, Changzhi Municipal Second People's Hospital, Changzhi, China.
Matthew CostaDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Jianyu LiuDepartment of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China.
Chenguang HaoDepartment of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Tingting ZhouHebei Key Laboratory of Integrated Traditional and Western Medicine for Osteoarthritis Research, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei, China.
Baorui XingPelvic and Hip Trauma Department, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Hebei, China.
Wenming LuoDepartment of Orthopaedic Trauma, Weifang People's Hospital, Shandong, China.
Xuecheng SunDepartment of Trauma Orthopedics, Weifang People's Hospital, Shandong Second Medical University, Weifang, China.
Haibin SunDepartment of Emergency Orthopaedics, Nanyang Hospital of Traditional Chinese Medicine, Henan, China.
Shuyuan WangDepartment of Emergency Orthopaedics, Nanyang Municipal Traditional Chinese Medicine Hospital, Henan, China.
Xuefei WuDepartment of Orthopaedics, Yancheng Third People's Hospital, Jiangsu, China.
Honghua DongDepartment of Orthopaedics and Traumatology, Yancheng Third People's Hospital, Jiangsu, China.
Fuhong ChengDepartment of Orthopaedics, Weinan Central Hospital, Shaanxi, China.
Dongsheng WuDepartment of Trauma Orthopaedics, Weinan Central Hospital, Shaanxi, China.
Bihui SongDepartment of Orthopaedics, The First Clinical Medical College of China Three Gorges University, Hubei, China.
Kangquan ShouDepartment of Orthopaedics, Yichang Central People's Hospital and The First College of Clinical Medical Science, China Three Gorges University, Hubei, China.
Yang LiMedical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China.
Zhengqiang LiuDepartment of Orthopaedics, Affiliated Hospital of Jiujiang University, Jiangxi, China.
Jun LiDepartment of Orthopaedics, Affiliated Hospital of Jiujiang University, Jiangxi, China.
Shangmin ChenSports Medicine Center, The First Affiliated Hospital of Shantou University Medical College, Guangdong, China.
Zhigang ZhongSports Medicine Center, The First Affiliated Hospital of Shantou University Medical College, Guangdong, China.
Zhichao ZhuDepartment of Orthopaedics, Acheng District People's Hospital, Heilongjiang, China.
Wenbo YangDepartment of Orthopaedics, Mishan People's Hospital, Heilongjiang, China.
Jianbang YanDepartment of Orthopaedics, Nenjiang People's Hospital, Heilongjiang, China.
Chunlei ShiDepartment of Orthopaedics, Qinggang County People's Hospital, Heilongjiang, China.
Zhuhui XiThird Surgery Department, Wangkui County Hospital of Traditional Chinese Medicine, Heilongjiang, China.
Baozhu WenDepartment of Orthopaedics and Traumatology, Wudalianchi Hospital of Traditional Chinese Medicine, Heilongjiang, China.
Jinbao GuoDepartment of Orthopaedics, Yi'an County People's Hospital, Heilongjiang, China.
Chengyu FengDepartment of Orthopaedics, Zhaodong People's Hospital, Heilongjiang, China.
Desheng WuDepartment of Orthopaedics and Traumatology, Dongguang County People's Hospital, Hebei, China.
Sheng GuoDepartment of Orthopaedics, Hejian People's Hospital, Hebei, China.
Xiaowei ZhangSecond Department of Orthopaedics, Hejian People's Hospital, Hebei, China.
Xingke ChiDepartment of Traumatic Orthopaedics, Nanpi County People's Hospital, Hebei, China.
Yongli PengDepartment of Orthopaedics, Renqiu People's Hospital, Hebei, China.
Tianliang LiDepartment of Orthopaedics and Traumatology, Suning County People's Hospital, Hebei, China.
Qingzheng FanSecond Department of Orthopaedics, Wuqiao County People's Hospital, Hebei, China.
Zhiwen AnFirst Department of Orthopaedics, Wuqiao County People's Hospital, Hebei, China.
Yue GuanDepartment of Orthopaedics, Wuqiao County People's Hospital, Hebei, China.
Zhichang LvDepartment of Orthopaedics, Xian County People's Hospital, Hebei, China.
Jianbing WangThird Department of Orthopaedics, Yanshan County People's Hospital, Hebei, China.
Yanguang YuanDepartment of Orthopaedics, Anqiu People's Hospital, Shandong, China.
Xuehao ChengDepartment of Orthopaedics III, Anqiu Hospital of Traditional Chinese Medicine, Shandong, China.
Haipeng LiuDepartment of Joint Surgery, Changyi People's Hospital, Shandong, China.
Fei DuDepartment of Orthopaedics and Traumatology, Fangzi District People's Hospital, Shandong, China.
Ruiyong TanDepartment of Orthopaedics and Traumatology, Fangzi District People's Hospital, Shandong, China.
Liangquan JiDepartment of Orthopaedics and Traumatology, Fangzi District People's Hospital, Shandong, China.
Zhaoyong LiuDepartment of Orthopaedics, Linqu County People's Hospital, Shandong, China.
Fengquan DouSecond Department of Orthopaedics, Linqu County Hospital of Traditional Chinese Medicine, Shandong, China.
Yuzhu GuoDepartment of Orthopaedics and Traumatology, Qingzhou People's Hospital, Shandong, China.
Qifu LiuDepartment of Orthopaedics and Traumatology, Qingzhou People's Hospital, Shandong, China.
Shuwei WangDepartment of Orthopaedics and Traumatology, Shouguang Hospital of Traditional Chinese Medicine, Shandong, China.
Fuwei ZhaoDepartment of Spine Trauma, Shouguang Hospital of Traditional Chinese Medicine, Shandong, China.
Hongchao SunDepartment of Orthopaedics, Fangcheng County People's Hospital, Henan, China.
Xingyan WangDepartment of Orthopaedics and Traumatology, Neixiang County People's Hospital, Henan, China.
Yu CaoDepartment of Orthopaedics, Sheqi County People's Hospital, Henan, China.
Yuhu ZhangDepartment of Orthopaedics, Tanghe County People's Hospital, Henan, China.
Hao WangDepartment of Orthopaedic Surgery, Tongbai County People's Hospital, Henan, China.
Dongfeng AnFirst Department of Orthopaedics, Xichuan County People's Hospital, Henan, China.
Wenfeng JiaDepartment of Orthopaedics, Xinye County People's Hospital, Henan, China.
Heng YangThird Ward, Department of Orthopaedics, Zhenping County People's Hospital, Henan, China.
Xiaohui NiDepartment of Orthopaedics, Dafeng People's Hospital, Jiangsu, China.
Shunbing WangDepartment of Orthopaedics and Traumatology, Dafeng Hospital of Traditional Chinese Medicine, Jiangsu, China.
Xiang ChenDepartment of Orthopaedics and Traumatology, Dongtai Hospital of Traditional Chinese Medicine, Jiangsu, China.
Cheng LiDepartment of Orthopaedics, Funing County People's Hospital, Jiangsu, China.
Yuehua ZhuDepartment of Orthopaedics, Sheyang County People's Hospital, Jiangsu, China.
Haitao ZhuDepartment of Orthopaedics, Sheyang County People's Hospital, Jiangsu, China.
Fuwen ZhaoDepartment of Orthopaedics, Sheyang County Hospital of Traditional Chinese Medicine, Jiangsu, China.
Tongwei NiDepartment of Orthopaedics, The Sixth People's Hospital of Yancheng City, Jiangsu, Yancheng, China.
Xia GuoDepartment of Orthopaedics, The Sixth People's Hospital of Yancheng City, Jiangsu, Yancheng, China.
Wanqing LuDepartment of Orthopaedics, Xiangshui County People's Hospital, Jiangsu, China.
Junping ShanDepartment of Orthopaedics, Dali County Hospital, Shaanxi, China.
Wenpeng JiaDepartment of Orthopaedics, Fuping County Hospital, Shaanxi, China.
Yongle BaiDepartment of Orthopaedics and Traumatology, Heyang County People's Hospital, Shaanxi, China.
Xiqing WangDepartment of Orthopaedics, Huayin People's Hospital, Shaanxi, China.
Pingzhou JiaoDepartment of Orthopaedics, Huayin People's Hospital, Shaanxi, China.
Guoliang ChenDepartment of Orthopaedics II, Pucheng County Hospital, Shaanxi, China.
Kai SunFirst Department of Orthopaedics and Traumatology, Pucheng County Hospital of Traditional Chinese Medicine, Shaanxi, China.
Junfeng ZhaoDepartment of Orthopaedics, Dali County Hospital of Traditional Chinese Medicine, Shaanxi, China.
Yupeng XieDepartment of Orthopaedic Trauma, The Second Hospital of Weinan, Shaanxi, China.
Minzhi TanDepartment of Orthopaedics and Traumatology, Badong County Hospital of Traditional Chinese Medicine, Hubei, China.
Shaoping LiuDepartment of Orthopaedics, Dangyang People's Hospital, Hubei, China.
Wei LuDepartment of Orthopaedic Surgery, Wufeng Tujia Autonomous County People's Hospital, Hubei, China.
Jianbo ZhouDepartment of Orthopaedics and Traumatology, Xingshan County People's Hospital, Hubei, China.
Quanchuan HuangDepartment of Orthopaedics, Yuan'an County People's Hospital, Hubei, China.
Jing TuDepartment of Orthopaedics and Traumatology, Changyang County Hospital of Traditional Chinese Medicine, Hubei, China.
Xingchun LongDepartment of Orthopaedics, Zhijiang People's Hospital, Hubei, China.
Yuanchun LiuDepartment of Orthopaedics, Zigui County People's Hospital, Hubei, China.
Yonghua ChenDepartment of Orthopaedics, Liangjiang New Area People's Hospital, Chongqing, China.
Demeng TanDepartment of Orthopaedics and Traumatology, Pengshui County Hospital of Traditional Chinese Medicine, Chongqing, China.
Qiqi PengDepartment of Orthopaedics and Traumatology, Wushan County People's Hospital, Chongqing, China.
Xiaolin ZhangDepartment of Orthopaedics, Wulong District People's Hospital, Chongqing, China.
Yiguang MouDepartment of Orthopaedics and Traumatology, Wulong District Hospital of Traditional Chinese Medicine, Chongqing, China.
Lunhua PengDepartment of Orthopaedics, Affiliated Hospital of Traditional Chinese Medicine, Chongqing Three Gorges Medical College, Chongqing, China.
Yinzhi TangWard III Department of Orthopaedics, Affiliated Hospital of Traditional Chinese Medicine, Chongqing Three Gorges Medical College, Chongqing, China.
Yanyang HouDepartment of Orthopaedics and Traumatology, Affiliated Hospital of Traditional Chinese Medicine, Chongqing Three Gorges Medical College, Chongqing, China.
Zilong WangFirst Department of Orthopaedics and Traumatology, Fengjie County Hospital of Traditional Chinese Medicine, Chongqing, China.
Han ZhaoDepartment of Orthopaedics, Chongqing High-Tech Zone People's Hospital, Chongqing, China.
Gang WeiDepartment of Orthopaedics and Traumatology, Yubei District Hospital of Traditional Chinese Medicine, Chongqing, China.
Zhen XuDepartment of Orthopaedics, De'an County People's Hospital, Jiangxi, China.
Senping FengDepartment of Orthopaedics, Duchang County People's Hospital, Jiangxi, China.
Ping OuyangDepartment of Orthopaedics, Hukou County People's Hospital, Jiangxi, China.
Jie XiaoDepartment of Orthopaedic Trauma, Hukou County Hospital of Traditional Chinese Medicine, Jiangxi, China.
Jianhua ZhangDepartment of Orthopaedics I, Lushan City People's Hospital, Jiangxi, China.
Feng WuDepartment of Orthopaedics, Pengze County People's Hospital, Jiangxi, China.
Fengcai WuDepartment of Orthopaedics, Ruichang People's Hospital, Jiangxi, China.
Yuandong XiaoDepartment of Orthopaedics and Traumatology, Yongxiu County Hospital of Traditional Chinese Medicine, Jiangxi, China.
Hongji XingDepartment of Orthopaedics, Xiangqiao District Hospital of Traditional Chinese Medicine, Chaozhou, China.
Zhanpeng WuDepartment of Orthopaedics, Huilai County People's Hospital, Guangdong, China.
Liehao LinDepartment of Surgery, Nan'ao County People's Hospital, Guangdong, China.
Jie LinDepartment of Orthopaedics, Chaonan District People's Hospital, Shantou, China.
Jianbiao XuDepartment of Orthopaedics, Dafeng Hospital of Chaoyang District, Guangdong, China.
Chubiao LinDepartment of Orthopaedics, Dafeng Hospital of Chaoyang District, Guangdong, China.
Zijian ZhaoDepartment of Orthopaedic Surgery, Shantou People's Hospital, Guangdong, China.
Zhaoxiong WuDepartment of Orthopaedics, Jinping District People's Hospital, Shantou, China.
Ruizhong LinOrthopedics Center, People's Hospital of Chenghai, Shantou, China.
Funding
Beijing Hospital Authority
Abstract
Aims: The primary aim of the Action on Hip Fracture Management Quality Improvement (ACTIVE) trial is to evaluate whether a context-tailored quality improvement programme improves health-related quality of life at 120 days after hospital admission, among adults aged 65 years or older with a hip fracture, in less-resourced hospitals in China. Secondary aims are to compare health-related quality of life at 30 days, complication and morbidity at 30 and 120 days, proportion of patients receiving surgery, proportion of patients on full weightbearing at one week after surgery, time from admission to surgery, length of hospital stay, 120-day mortality, and inpatient costs between the two groups, and to evaluate the implementation and cost-effectiveness of the intervention. Methods: This is a multicentre, open-label, pragmatic, parallel-group, cluster-randomized controlled trial conducted in 80 less-resourced county- or district-level public general hospitals across ten provinces in China (all hospitals are graded 3B or below; 3A is considered the most high-ranking or well-resourced hospital). Hospitals are randomized 1:1 within each province to either intervention or the control group. Eligible participants are adults aged 65 years or older with acute unilateral hip fracture confirmed by radiography or CT. The intervention consists of optimization of in-hospital management processes, empowerment of surgeons and physicians, and health education for patients and their family members. Hospitals allocated to the control group continue usual orthopaedic-led care. Participants are followed up at 30 and 120 days after admission. The primary outcome is health-related quality of life at 120 days after admission. A total of 8,800 participants will be recruited. Conclusion: The results of the ACTIVE trial will inform whether a context-tailored quality improvement programme, consisting of interventions on health administrators, health providers, and patients, can improve outcomes for older adults with hip fracture in less-resourced hospitals in China, and many countries beyond with emerging burden of ageing population.
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