Cochrane Database Systematic Reviews
The Cochrane group have undertaken several systematic reviews relating to rehabilitation of hip fracture sufferers:
- Interventions for improving mobility after hip fracture surgery in adults (2011): A heterogeneous group of small trials evaluated a range of mobilisation strategies started soon after hip fracture. Whilst individual trials reported improved mobility for a range of interventions, there was insufficient evidence to establish best strategies to enhance mobility.
- Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people (2010): A heterogeneous group of small trials using a range of interventions. There was insufficient evidence to recommend practice changes.
- Multidisciplinary rehabilitation for older people with hip fractures (2009): Randomised and quasi-randomised trials using multidisciplinary rehabilitation of hip fracture sufferers. The trend towards better overall results for patients receiving multidisciplinary inpatient rehabilitation did not achieve statistical significance.
An editorial, which summarised the findings of these and other Cochrane reviews relating to hip fracture, noted that whilst these results are disappointing, taken in a broader context, the current evidence base does inform how best to manage hip fractures. With regard to mobilisation, the most successful strategies involve more intensive exercise. However, the authors do appeal for high-quality randomised controlled trials to be undertaken. With regard to multidisciplinary inpatient rehabilitation programmes, the authors stated that ‘there is some rationale to justify its adoption, pending further research’.
The following reviews were published after the Cochrane reviews above:
- Evidence-Based Management in the Rehabilitation of Osteoporotic Patients with Fragility Fractures(2012): This book chapter provides a comprehensive literature review for hip, vertebral and Colles fractures.
- Extended exercise rehabilitation after hip fracture improves patients’ physical function: a systematic review and meta-analysis (2012): This review evaluated all randomised controlled trials which compared extended exercise programmes with usual care for community dwelling hip fracture sufferers. To the author’s knowledge, this is the first meta-analysis to report significant effects on various functional outcome measures for extended rehabilitation.
- Rehabilitation in patients with dementia following hip fracture: a systematic review (2012): A significant proportion of hip fracture sufferers are also living with dementia. In 2007, the Scottish Hip Fracture Audit reported that 28% of hip fracture patients in Scotland had a previous diagnosis of dementia. Accordingly, a clear need exists to establish best practice in rehabilitation for this sizeable sub-group of hip fracture sufferers. This systematic review concluded that rehabilitation programmes for people with mild to moderate dementia may improve function and ambulation, and decrease falls risk. More research is required for those with moderate to severe dementia.