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  • Project No: NDORMS 2024/03
  • Intake: 2024


Older people are more likely to break (fracture) a bone such as a hip or wrist because of a fall, as their bones are weakened by osteoporosis. These ‘fragility’ fractures have serious consequences; in the UK one in four patients who break their hip, die within a year and survivors have a reduction in their quality-of-life similar to having a stroke.1 Outcomes may be even worse in Low Middle Income Countries (LMIC) without the same level of healthcare resource.

Asia is particularly affected by rapidly ageing populations. The number of people experiencing hip fractures is expected to increase from 1.1 million now to 2.6 million in 2050. The healthcare costs will therefore increase from US$9.5 billion to US$15 billion. Improving the care for patients with a hip fracture is therefore a priority in this region.

Looking after older, often frail, patients following a hip fracture requires healthcare workers from many different backgrounds to work together. These include surgeons, doctors specialising in looking after older patients, nurses and therapists. In the UK, this approach has reduced the number of people dying after hip fracture and improved their quality of life.2,3,4 This project is about assessing health-related quality of life and the potential benefits of ‘multi-disciplinary’ care in Nepal.

Design and methods

The main aim of this DPhil is to assess quality of life for patients in Nepal after hip fracture. The project will be nested in a larger project looking at the potential for multi-disciplinary care for patients with hip fracture in low and middle income countries in South and Southeast Asia.

The proposed DPhil will review the existing literature related to patient-reported quality of life in LMIC settings, bring together patients and healthcare workers in Nepal to review the evidence and co-design clinical reporting forms for data collection and then set-up a comprehensive cohort study in 8 representative hospitals to report health-related quality of life before hip fracture and again 4 months into the patients’ recovery.

Research questions

  1. How is health-related quality of life affected by hip fracture in patients in low and middle income countries? A systematic review of the evidence.
  2. Can patient-centred outcomes be collected in the Nepalese healthcare system? A nominal group consensus exercise to co-design data collection forms.
  3. How does a hip fracture affect health-related quality of life for patients in Nepal? A prospective observational study


Alongside departmental training opportunities listed below, we will ensure hands-on training in clinical study design, consensus meetings, data management and analysis using data generated in Nepal. Our interdisciplinary research groups contain a variety of students and post-doctoral researchers with expertise in health data science and clinical research methods. The student will be based in Nepal but benefit from an experienced, collaborative supervisory team in the UK and Nepal.

A core curriculum of lectures will be taken to provide a solid foundation in a broad range of subjects including statistics, epidemiology, and analysis. All students will be required to attend a 2-day Statistical and Experimental Design course at NDORMS. Students will also be required to attend regular online seminars within the Department and have access to a variety of other courses run by the Medical Sciences Division Skills Training Team

Finally, the student(s) will be expected to regularly present data in Departmental seminars, the Oxford Trauma and Emergency Care seminars and the Global Fragility Fracture Network Congress.


1)     Griffin XL, Parsons N, Achten J, Fernandez M, Costa ML.

Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation--a prospective cohort study.

Bone Joint J. 2015 Mar;97-B(3):372-82

2)     Griffin XL, Achten J, Parsons N, Costa ML; WHiTE collaborators.

Does performance-based remuneration improve outcomes in the treatment of hip fracture?

Bone Joint J. 2021 May;103-B(5):881-887.

3)     Fernandez MA, Achten J, Parsons N, Griffin XL, Png ME, Gould J, McGibbon A, Costa ML; WHiTE 5 Investigators.

Cemented or Uncemented Hemiarthroplasty for Intracapsular Hip Fracture.

N Engl J Med. 2022 Feb 10;386(6):521-530.

4)     Agni NR, Costa ML, Achten J, Peckham N, Dutton SJ, Png ME, Reed MR; WHiTE 8 Investigators

High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial.

Lancet. 2023 Jun 21:S0140-6736(23)00962-5


Hip fracture, trials, quality standards, Nepal 


It is recommended that, in the first instance, you contact the relevant supervisor(s) and the Graduate Studies Office ( who will be able to advise you of the essential requirements.

Interested applicants should have, or expect to obtain, a first or upper second-class BSc degree or equivalent in a relevant subject and will need to provide evidence of English language competence (where applicable).

The application guide and form is found online and the DPhil will commence in October 2024. Applications should be made to the following programme using the specified course code:

DPhil in Musculoskeletal Sciences (course code RD_ML2)

For further information, please visit