title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rehabilitation Studies Unit (Flinders University), Repatriation General Hospital, Daws Park, SA, Australia. julie.halbert@rgh.sa.gov.au
authors.forename: Julie
authors.initials: J
authors.lastname: Halbert
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
authors.forename: Craig
authors.initials: C
authors.lastname: Whitehead
authors.forename: Ian
authors.initials: I
authors.lastname: Cameron
authors.forename: Susan
authors.initials: S
authors.lastname: Kurrle
authors.forename: Susan
authors.initials: S
authors.lastname: Graham
authors.forename: Helen
authors.initials: H
authors.lastname: Handoll
authors.forename: Terry
authors.initials: T
authors.lastname: Finnegan
authors.forename: Tim
authors.initials: T
authors.lastname: Jones
authors.forename: Amanda
authors.initials: A
authors.lastname: Foley
authors.forename: Michael
authors.initials: M
authors.lastname: Shanahan
mesh_terms: D000328:Adult; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome