Exercise Therapy Is Effective at Improving Short- and Long-Term Mobility, Activities of Daily Living, and Balance in Older Patients Following Hip Fracture: A Systematic Review and Meta-Analysis

Abstract

Background A systematic review and meta-analysis was performed to evaluate the short- and long-term effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, and secondly, whether the effect was modified by trial level characteristics such as intervention modality, duration and initiation timepoint. Methods Medline, CENTRAL, Embase, CINAHL and PEDro was searched up-to November 2020. Eligibility criteria was randomized controlled trials investigating the effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, initiated from time of surgery up-to 1-year. Results Forty-nine studies involving 3905 participants showed a small to moderate effect of exercise therapy at short term (end of intervention) on mobility (Standardized mean difference, SMD 0.49, 95%CI 0.22-0.76); Activities of Daily Living (ADL) (SMD 0.31, 95%CI 0.16-0.46); lower limb muscle strength (SMD 0.36, 95%CI 0.13-0.60); balance (SMD 0.34, 95%CI 0.14-0.54). At long term (closest to 1-year), small to moderate effects were found for mobility (SMD 0.74, 95%CI 0.15-1.34); ADL (SMD 0.42, 95%CI 0.23-0.61); balance (SMD 0.50, 95%CI 0.07-0.94) and Health related Quality of Life (HRQoL) (SMD 0.31, 95%CI 0.03-0.59). Certainty of evidence was evaluated using GRADE ranging from moderate to very low, due to study limitation and inconsistency. Conclusion We found low certainty of evidence for a moderate effect of exercise therapy on mobility in older patients following hip fracture at end-of-treatment and follow-up. Further, low evidence was found for small to moderate short-term effect on ADL, lower limb muscle strength and balance.

Effects of a 12‐month home‐based exercise program on functioning after hip fracture – Secondary analyses of an RCT

“… 41 , 44 , 45 , 46 In these studies, as in ours, the amount of physical activity was evaluated with self‐reported questionnaires, and thus the results should be interpreted with caution. In the systematic review of Hulsbæk et al, 47 a small, but nonsignificant effect of exercise on physical activity was observed. A cohort study reported old age and frailty to be explanatory variables for unchanged physical activity levels (number of physical activity sessions per week or month) among home‐dwelling patients with hip fractures.…”

Rehabilitation Outcomes Following Hip Fracture of Home-Based Exercise Interventions Using a Wearable Device—A Randomized Controlled Pilot and Feasibility Study

“…Compared to pre-fracture, there is a decrease in ADL [ 44 ]. A systematic review found that rehabilitation has a small-to-moderate effect on ADL in the short and long term (1 year) [ 13 ]. This review also showed a small effect of rehabilitation after hip fracture on HRQoL in the short and long term.…”

“…Moreover, what type of exercise that is most beneficial for this population is not fully explored [ 11 , 12 ]. A lack of high-quality RCTs’ exploring the effects of rehabilitation after hip fractures among older people has also been identified [ 13 ].…”

Short-Term Outcomes of Surgery and Rehabilitation on Activities of Daily Living after Displaced Femoral Neck Fractures: Structural Equation Modeling

“…In 2021, dementia was reported to significantly negatively impact postoperative walking ability [4]. In 2022, rehabilitation intensity was reported to affect activities of daily living (ADL) [5].…”