Multi-disciplinary rehabilitation after hip fracture is associated with improved outcome: A systematic review

Abstract

Background: while hip fractures are an important cause of disability, dependency and death in older adults, the benefit of multi-disciplinary rehabilitation for people who have sustained hip fracture has not been demonstrated. Methods: Systematic review of randomized controlled trials which compare co-ordinated multi-disciplinary rehabilitation with usual orthopaedic care in older people who had sustained a hip fracture. Outcome measures included: mortality, return home, "poor outcome", total length of hospital stay, readmissions and level of function. Results: We identified 11 trials including 2177 patients. Patients who received multi-disciplinary rehabilitation were at a lower risk (Risk Ratio 0.84, 95% CI 0.73-0.96) of a "poor outcome" -that is dying or admission to a nursing home at discharge from the programme, and showed a trend towards higher levels of return home (Risk Ratio 1.07, 95% CI 1.00-1.15). Pooled data for mortality did not demonstrate any difference between multi-disciplinary rehabilitation and usual orthopaedic care. Conclusion: This is the first review of randomized trials to demonstrate a benefit from multi-disciplinary rehabilitation; a 16% reduction in the pooled outcome combining death or admission to a nursing home. this result supports the routine provision of organized care for patients following hip fracture, as is current practice for patients after stroke.

Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review

“…Despite these reports, however, there exists a consensus that effective rehabilitation with respect to mobility and function for people who have sustained hip fractures, whether or not they also have dementia, is crucial to their return to their previous dwelling places in the community. [16][17][18][19][20][21][22] Several strategies have been suggested for health care professionals to reduce the negative impact of cognitive and behavioural symptoms, thereby improving prognoses for these patients. 23,24 However, not all health care professionals are aware of strategies for working with patients with dementia or put these strategies into practice.…”

Exercise prescription after fragility fracture in older adults: a scoping review

“…Knowledge syntheses summary-There were 13 secondary/knowledge synthesis (CPG or SR) studies identified related to the examination of some aspect of exercise prescription (therapeutic exercise, physical activity, active rehabilitation) in an older adult fracture population [74][75][76][77][78][79][80][81][82][83][84][85][86]. Table 4 provides a summary of the purpose, population(s) included and the key 'exercise prescription' related practice and/or research findings or recommendations in each synthesis, including a footer note for citation details of any subsequent updated or new of knowledge syntheses published after the final July 3, 2009.…”

“…One study had a mixed fracture focus, including any fracture in older adults [74], whereas, the remaining 12 studies specifically focused on one type of fracture, including eight hip fracture [75][76][77][78][79][80][81][82], two ankle fracture [83,84], one proximal humerus fracture [85] and one distal radius fracture study [86]. There was no knowledge synthesis study found for vertebral fracture populations.…”

“…Six of the nine hip fracture-related syntheses examined the effectiveness of multidisciplinary, coordinated care in acute healthcare settings compared to standard or orthopedic care programs [74][75][76][77][78][79]82]. Four of the nine hip-related studies [76,78,80,81] examined the effectiveness of different elements or approaches to mobilization or exercise or physical therapy interventions following hip fracture.…”

Nursing Care after Hip Fracture Surgery Predicts Patient Ambulatory Ability at 3 Months after Surgery

“…From a systematic review, multi-disciplinary rehabilitation after hip fracture surgery is associated with improved outcomes [8] in which nursing roles or nursing care are not specifically stated. Gregersen et al [9] reported that multidisciplinary geriatric in-hospital intervention that included a nurse with geriatric expertise reduced LOS but did not affect patient outcome in terms of discharge destination, in-hospital mortality, or 3month mortality.…”