{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:07:30Z","timestamp":1791958050517,"version":"4.3.4"},"reference-count":13,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T00:00:00Z","timestamp":1574812800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["CLAHRC West Midlands"],"award-info":[{"award-number":["CLAHRC West Midlands"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2019,11,1]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To examine implementation of evidence in orthopaedic practice following publication of the results of three pivotal clinical trials.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Case studies based on three orthopaedic trials funded in sequence by the National Institute for Health Research Health Technology Assessment (HTA) programme. These trials dealt with treatment of fractures of the humerus, radius and ankle, respectively. For each case study, we conducted time-series analyses to examine the relationship between publication of findings and the implementation (or not) of the findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The results of all three trials favoured the less expensive and less invasive option. In two cases, a change of practice, in line with the evidence that eventually emerged, preceded publication. Furthermore, the upturn in use of the intervention most supported by each of these two trials corresponded to the start of recruitment to the respective trial. The remaining trial failed to influence practice despite yielding clear-cut evidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Implementation of results of all three HTA orthopaedic trials favoured the less expensive and less invasive option. In two of the three studies, a change in practice, in line with the evidence that eventually emerged, preceded publication of that evidence. A trend or a change in practice, at around the start of the trial, indicates that the direction of causation opposes our hypothesis that publication of trial findings would lead to changes in practice. Our results provide provocative insight into the nuanced topic of research and practice, but further qualitative work is needed to fully explain what led to the pre-emptive change in practice we observed and why there was no change in the third case.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2019-010056","type":"journal-article","created":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T17:15:40Z","timestamp":1574874940000},"page":"374-381","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Implementation of research evidence in orthopaedics: a tale of three trials"],"prefix":"10.1136","volume":"29","author":[{"given":"Katharine","family":"Reeves","sequence":"first","affiliation":[{"name":"Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Chan","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair","family":"Marsh","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzy","family":"Gallier","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catrin","family":"Wigley","sequence":"additional","affiliation":[{"name":"Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamlesh","family":"Khunti","sequence":"additional","affiliation":[{"name":"College of Life Sciences, University of Leicester, Leicester, Leicestershire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0634-984X","authenticated-orcid":false,"given":"Richard J","family":"Lilford","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, West Midlands, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,11,27]]},"reference":[{"key":"2025090410364460000_29.5.374.1","unstructured":"Lilford R . Why the CLAHRC WM director loves orthopaedic trials. NIHR CLAHRC West Midlands News Blog, 2018."},{"key":"2025090410364460000_29.5.374.2","doi-asserted-by":"publisher","DOI":"10.3310\/hta19880"},{"key":"2025090410364460000_29.5.374.3","doi-asserted-by":"publisher","DOI":"10.3310\/hta19880"},{"key":"2025090410364460000_29.5.374.4","doi-asserted-by":"publisher","DOI":"10.3310\/hta20220"},{"key":"2025090410364460000_29.5.374.5","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.O.00565"},{"key":"2025090410364460000_29.5.374.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-029954","article-title":"Guidance on how to develop complex interventions to improve health and healthcare","volume":"9","author":"O'Cathain","year":"2019","journal-title":"BMJ Open"},{"key":"2025090410364460000_29.5.374.7","doi-asserted-by":"crossref","unstructured":"Craig P , Dieppe P , Macintyre S , et al . Developing and evaluating complex interventions: the new Medical Research Council guidance. 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