Systematic review of hip fracture rehabilitation practices in the elderly.
OBJECTIVE
To address the need for a research synthesis on the effectiveness of the full range of hip fracture rehabilitation interventions for older adults and make evidence based conclusions.


METHODS
Medline, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched from 1980 to 2007 for studies published in English. The terms rehabilitation and hip fracture were exploded in order to obtain related search terms and categories.


METHODS
In the initial search of the databases, a combined total of 1031 articles was identified. Studies that did not focus on hip fracture rehabilitation, did not include persons over the age of 50 years, and/or did not include measures of physical outcome were excluded.


METHODS
Only studies with an Oxford Center for Evidence-Based Medicine Levels of Evidence level of I (randomized controlled trial, RCT) or II (cohort) were reviewed. The methodologic quality of both types of studies was assessed using a modified version of the Downs and Black checklist.


RESULTS
There were 55 studies that met our selection criteria: 30 RCTs and 25 nonrandomized trials. They were distributed across 6 categories for rehabilitation intervention (care pathways, early rehabilitation, interdisciplinary care, occupational and physical therapy, exercise, intervention not specified) and 3 settings (acute care hospital, postacute care/rehabilitation, postrehabilitation).


CONCLUSIONS
When looking across all of the intervention types, the most frequently reported positive outcomes were associated with measures of ambulatory ability. Eleven intervention categories across 3 settings were associated with improved ambulatory outcomes. Seven intervention approaches were related to improved functional recovery, while 6 intervention approaches were related to improved strength and balance recovery. Decreased length of stay and increased falls self-efficacy were associated with 2 interventions, while 1 intervention had a positive effect on lower-extremity power generation.
Chudyk
Anna M
AM
Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada. achudyk@uwo.ca
Jutai
Jeffrey W
JW
Petrella
Robert J
RJ
Speechley
Mark
M
D000368:Aged; D019091:Critical Pathways; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D007297:Inpatients; D033183:Interdisciplinary Communication; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D010045:Outpatients; D026741:Physical Therapy Modalities / Q000458:organization & administration*; D011182:Postoperative Care / Q000379:methods; D013997:Time Factors; D016138:Walking