Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis

Abstract

Background Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery. Objective Determine the effectiveness of perioperative interventions on early mobilisation and physical function after hip fracture. Methods Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science were searched from January 2000 to March 2022. English language experimental and quasi-experimental studies were included if patients were hospitalised for a fractured proximal femur with a mean age 65 years or older and reported measures of early mobilisation and physical function during the acute hospital admission. Data were pooled using a random effect meta-analysis. Results Twenty-eight studies were included from 1,327 citations. Studies were conducted in 26 countries on 8,192 participants with a mean age of 80 years. Pathways and models of care may provide a small increase in early mobilisation (standardised mean difference [SMD]: 0.20, 95% confidence interval [CI]: 0.01–0.39, I2 = 73%) and physical function (SMD: 0.07, 95% CI 0.00 to 0.15, I2 = 0%) and transcutaneous electrical nerve stimulation analgesia may provide a moderate improvement in function (SMD: 0.65, 95% CI: 0.24–1.05, I2 = 96%). The benefit of pre-operative mobilisation, multidisciplinary rehabilitation, recumbent cycling and clinical supervision on mobilisation and function remains uncertain. Evidence of no effect on mobilisation or function was identified for pre-emptive analgesia, intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, occupational therapy training or nutritional supplements. Conclusions Perioperative interventions may improve early mobilisation and physical function after hip fracture surgery. Future studies are needed to model the causal mechanisms of perioperative interventions on mobilisation and function after hip fracture.

Early mobilisation after hip fracture surgery is associated with improved patient outcomes: A systematic review and meta‐analysis

“…A review conducted by Sarkies et al., found other peri‐operative factors which could further influence early mobilisation (Sarkies et al., 2023). They identified that use of peripheral nerve blocks and TENS analgesia therapies could reduce reliance to opioids and thus reduce side effects such as confusion, nausea, and haemodynamic instability (Sarkies et al., 2023). Furthermore, liaison with orthogeriatric services optimises management of co‐morbidities and thus optimises medically stability, reducing complications (Sarkies et al., 2023).…”

“…They identified that use of peripheral nerve blocks and TENS analgesia therapies could reduce reliance to opioids and thus reduce side effects such as confusion, nausea, and haemodynamic instability (Sarkies et al., 2023). Furthermore, liaison with orthogeriatric services optimises management of co‐morbidities and thus optimises medically stability, reducing complications (Sarkies et al., 2023). They also highlighted that delays in hip fracture surgery leads to poorer outcomes (Sarkies et al., 2023).…”

“…Furthermore, liaison with orthogeriatric services optimises management of co‐morbidities and thus optimises medically stability, reducing complications (Sarkies et al., 2023). They also highlighted that delays in hip fracture surgery leads to poorer outcomes (Sarkies et al., 2023). Many patients wait more than 48 h for hip fracture surgery, due to strains on the health care system (Sarkies et al., 2023).…”

“…They also highlighted that delays in hip fracture surgery leads to poorer outcomes (Sarkies et al., 2023). Many patients wait more than 48 h for hip fracture surgery, due to strains on the health care system (Sarkies et al., 2023). They advised that pre‐operative mobilisation in this period could reduce rates of pneumonia, and delirium (Sarkies et al., 2023).…”

“…Enhanced Recovery After Surgery encompasses streamlined and standardised preoperative, intraoperative and postoperative interventions, which was described by Kehlet in 1997 (Kehlet, 1997). Since then, many professional bodies have incorporated early mobilisation into their standards, as part of ERAS, to help recovery after hip fracture surgery (Sarkies et al., 2023). The National Institute for Health & Care Excellence recommends that all patients undergoing surgical management for a hip fracture should receive physiotherapy assessment and attempted mobilisation the day after surgery (NICE, 2023).…”