Multi-disciplinary rehabilitation after hip fracture is associated with improved outcome: A systematic review.
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.
Halbert
Julie
J
Rehabilitation Studies Unit (Flinders University), Repatriation General Hospital, Daws Park, SA, Australia. julie.halbert@rgh.sa.gov.au
Crotty
Maria
M
Whitehead
Craig
C
Cameron
Ian
I
Kurrle
Susan
S
Graham
Susan
S
Handoll
Helen
H
Finnegan
Terry
T
Jones
Tim
T
Foley
Amanda
A
Shanahan
Michael
M
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