The effect of care pathways for hip fractures: a systematic overview of secondary studies

Abstract

The aim of this paper was to perform a systematic overview of secondary literature studies on care pathways (CPs) for hip fracture (HF). The online databases MEDLINE-PubMed, Ovid-EMBASE, CINAHL-EBSCO-host, and The Cochrane Library were searched. A total of six papers, corresponding to six secondary studies, were included but only four secondary studies were HF-specific and thus assessed. Secondary studies were evaluated for patients' clinical outcomes. There were wide differences among the studies that assessed the effects of CPs on HF patients, with some contrasting clinical outcomes reported. Secondary studies that were non-specific for CPs and included other multidisciplinary care approaches as well showed, in some cases, a shorter hospital length of stay (LOS) compared to usual care; studies that focused on promoting early mobilization showed better outcomes of mortality, morbidity, function, or service utilization; CPs mainly based on intensive occupational therapy and/or physical therapy exercises improved functional recovery and reduced LOS, with patients also discharged to a more favorable discharge destination; CPs principally focused on early mobilization improved functional recovery. A secondary study specifically designed for CPs showed lower odds of experiencing common complications of hospitalization after HF. In conclusion, although our overview suggests that CPs can reduce significantly LOS and can have a positive impact on different outcomes, data are insufficient for formal recommendations. To properly understand the effects of CPs for HF, a systematic review is needed of primary studies that specifically examined CPs for HF.

Older patients' perception of their own capacity to regain pre-fracture function after hip fracture surgery – an explorative qualitative study

“…This routine includes steps such as giving patients with a suspected hip fracture fluids and pain relief in the ambulance and transiting the patient rapidly from the ambulance to the orthopaedic ward directly after radiography. Fast-track care for hip fracture patients can minimise complications, increase priorities and decrease length of stay (LOS) (Hommel et al, 2008;Larsson and Holgers, 2011;Leigheb et al, 2013). Surgery within 24 hours following fracture reduces hospital stay and may also reduce complications and mortality (Al-Ani et al, 2008;Simunovic et al, 2010).…”

Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider

“…In contrast, Leighbeg et al 67 found no clear evidence of reduced mortality from their systematic overview of four secondary studies investigating the effect of care pathways and/or multidisciplinary team care approaches for people following hip fracture. However, diversity of study settings and difficulty with classification of studies in relation to the status of their interventions (care pathways or not care pathways) may have influenced the findings.…”

“…Multisiciplinary team32 care was defined as care provided by two or more different care practitioners working together as/or supported by a multidisciplinary team. Selected publications focused on orthogeriatric inpatient care,32 65 fracture liaison services (FLS)25 66 and care pathways for people following hip fracture 67…”

Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients

“…Our protocol emphasizes early mobilization with unrestricted weight bearing. Early mobilization in elderly hip fracture patients has been shown to improve mortality, morbidity and accelerate functional recovery [8, 9, 22, 23]. Limiting weight bearing status after surgery complicates the recovery period by prolonging dependency on walking aids and the need for the patient to remain in an extended care facility [4–7].…”