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.

Authors

Minghui Yang, Tingzhuo Liu, Gang Liu, Ning Tang, Xinyi Zhang, Rebecca Ivers, Yongchen Wang, Maoyi Tian, ACTIVE trial Investigators, Zhenghua Sun, Jiarong Shen, Boya Nan, Wei Tian, Qiang Li, Lei Si, Ronald Man Yeung Wong, Jing Zhang, Shangzhi Xiong, Pengpeng Ye, Lei Yang, Liming Li, Matthew Costa, Jianyu Liu, Chenguang Hao, Tingting Zhou, Baorui Xing, Wenming Luo, Xuecheng Sun, Haibin Sun, Shuyuan Wang, Xuefei Wu, Honghua Dong, Fuhong Cheng, Dongsheng Wu, Bihui Song, Kangquan Shou, Yang Li, Zhengqiang Liu, Jun Li, Shangmin Chen, Zhigang Zhong, Zhichao Zhu, Wenbo Yang, Jianbang Yan, Chunlei Shi, Zhuhui Xi, Baozhu Wen, Jinbao Guo, Chengyu Feng, Desheng Wu, Sheng Guo, Xiaowei Zhang, Xingke Chi, Yongli Peng, Tianliang Li, Qingzheng Fan, Zhiwen An, Yue Guan, Zhichang Lv, Jianbing Wang, Yanguang Yuan, Xuehao Cheng, Haipeng Liu, Fei Du, Ruiyong Tan, Liangquan Ji, Zhaoyong Liu, Fengquan Dou, Yuzhu Guo, Qifu Liu, Shuwei Wang, Fuwei Zhao, Hongchao Sun, Xingyan Wang, Yu Cao, Yuhu Zhang, Hao Wang, Dongfeng An, Wenfeng Jia, Heng Yang, Xiaohui Ni, Shunbing Wang, Xiang Chen, Cheng Li, Yuehua Zhu, Haitao Zhu, Fuwen Zhao, Tongwei Ni, Xia Guo, Wanqing Lu, Junping Shan, Wenpeng Jia, Yongle Bai, Xiqing Wang, Pingzhou Jiao, Guoliang Chen, Kai Sun, Junfeng Zhao, Yupeng Xie, Minzhi Tan, Shaoping Liu, Wei Lu, Jianbo Zhou, Quanchuan Huang, Jing Tu, Xingchun Long, Yuanchun Liu, Yonghua Chen, Demeng Tan, Qiqi Peng, Xiaolin Zhang, Yiguang Mou, Lunhua Peng, Yinzhi Tang, Yanyang Hou, Zilong Wang, Han Zhao, Gang Wei, Zhen Xu, Senping Feng, Ping Ouyang, Jie Xiao, Jianhua Zhang, Feng Wu, Fengcai Wu, Yuandong Xiao, Hongji Xing, Zhanpeng Wu, Liehao Lin, Jie Lin, Jianbiao Xu, Chubiao Lin, Zijian Zhao, Zhaoxiong Wu, Ruizhong Lin

Published in

Bone & joint open. Volume 7. Issue 8. Pages 1101-1109. Aug 19, 2026. Epub Aug 19, 2026.

Abstract

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.
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.
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.

PMID:
42613022
Bibliographic data and abstract were imported from PubMed on 19 Aug 2026.

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