WITHDRAWN: Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures.
BACKGROUND
Hip fracture is a major cause of morbidity and mortality in older people and its impact, both on the individual and to society, is substantial.


OBJECTIVE
To examine the effects of co-ordinated multidisciplinary inpatient rehabilitation, compared with usual (orthopaedic) care, for older patients with hip fracture.


METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (December 2002), MEDLINE (1966 to December 2002), conference proceedings and reference lists of articles and books. We also contacted colleagues and trialists.


METHODS
Randomised and quasi-randomised trials of post-surgical care using specialised rehabilitation of mainly older patients (aged 65 years or over) with hip fracture.


METHODS
Trial assignment to included, excluded and awaiting assessment categories, was by consensus. Two reviewers independently assessed trial quality and extracted data. Limited additional information was sought from most trialists. As well as pooling data from primary outcomes, supplementary analyses were performed to combine clinically relevant outcomes and investigate possible explanatory factors.


RESULTS
In this minor update, new data for two already included trials have been incorporated, resulting in only slight changes to the pooled results.The nine included trials involved 1887 patients. The combined outcomes of death or requiring institutional care showed no significant difference between intervention and control groups (relative risk 0.93; 95% confidence interval 0.83 to 1.05). There was considerable heterogeneity in length of stay and cost data. Using death and deterioration in function as a further combined outcome variable yielded a relative risk of 0.91 (95% confidence interval 0.83 to 1.01). This should be interpreted with caution due to heterogeneity. No quality of life measures were reported and the two trials investigating carer burden showed no evidence of detrimental effect from the intervention. The review update did not result in any new data for these outcomes.


CONCLUSIONS
The available trials reviewed had different aims, interventions and outcomes. Combined outcome measures (e.g. death or institutional care) tended to be better for patients receiving co-ordinated inpatient rehabilitation, but the results were heterogeneous and not statistically significant.Future trials of post-surgical care involving inpatient rehabilitation, or other models such as 'early supported discharge' and 'hospital at home' schemes, should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than attempt to evaluate its components.
Cameron
Ian D
ID
Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, PO Box 6, Ryde, NSW, Australia, 1680.
Handoll
Helen Hg
HH
Finnegan
Terence P
TP
Madhok
Rajan
R
Langhorne
Peter
P
D000368:Aged; D005264:Femoral Fractures / Q000534:rehabilitation; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D007297:Inpatients; D010348:Patient Care Team; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome