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. 2021 Nov 12;11(11):CD007125.
doi: 10.1002/14651858.CD007125.pub3.

Multidisciplinary rehabilitation for older people with hip fractures

Helen Hg Handoll  1   2 , Ian D Cameron  3 , Jenson Cs Mak  4   3 , Claire E Panagoda  3 , Terence P Finnegan  5
Affiliations

Multidisciplinary rehabilitation for older people with hip fractures

Helen Hg Handoll et al. Cochrane Database Syst Rev. .

Abstract

Background: Hip fracture is a major cause of morbidity and mortality in older people, and its impact on society is substantial. After surgery, people require rehabilitation to help them recover. Multidisciplinary rehabilitation is where rehabilitation is delivered by a multidisciplinary team, supervised by a geriatrician, rehabilitation physician or other appropriate physician. This is an update of a Cochrane Review first published in 2009.

Objectives: To assess the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older people with hip fracture.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, MEDLINE and Embase (October 2020), and two trials registers (November 2019).

Selection criteria: We included randomised and quasi-randomised trials of post-surgical care using multidisciplinary rehabilitation of older people (aged 65 years or over) with hip fracture. The primary outcome - 'poor outcome' - was a composite of mortality and decline in residential status at long-term (generally one year) follow-up. The other 'critical' outcomes were health-related quality of life, mortality, dependency in activities of daily living, mobility, and related pain.

Data collection and analysis: Pairs of review authors independently performed study selection, assessed risk of bias and extracted data. We pooled data where appropriate and used GRADE for assessing the certainty of evidence for each outcome.

Main results: The 28 included trials involved 5351 older (mean ages ranged from 76.5 to 87 years), usually female, participants who had undergone hip fracture surgery. There was substantial clinical heterogeneity in the trial interventions and populations. Most trials had unclear or high risk of bias for one or more items, such as blinding-related performance and detection biases. We summarise the findings for three comparisons below. Inpatient rehabilitation: multidisciplinary rehabilitation versus 'usual care' Multidisciplinary rehabilitation was provided primarily in an inpatient setting in 20 trials. Multidisciplinary rehabilitation probably results in fewer cases of 'poor outcome' (death or deterioration in residential status, generally requiring institutional care) at 6 to 12 months' follow-up (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.80 to 0.98; 13 studies, 3036 participants; moderate-certainty evidence). Based on an illustrative risk of 347 people with hip fracture with poor outcome in 1000 people followed up between 6 and 12 months, this equates to 41 (95% CI 7 to 69) fewer people with poor outcome after multidisciplinary rehabilitation. Expressed in terms of numbers needed to treat for an additional harmful outcome (NNTH), 25 patients (95% CI 15 to 100) would need to be treated to avoid one 'poor outcome'. Subgroup analysis by type of multidisciplinary rehabilitation intervention showed no evidence of subgroup differences. Multidisciplinary rehabilitation may result in fewer deaths in hospital but the confidence interval does not exclude a small increase in the number of deaths (RR 0.77, 95% CI 0.58 to 1.04; 11 studies, 2455 participants; low-certainty evidence). A similar finding applies at 4 to 12 months' follow-up (RR 0.91, 95% CI 0.80 to 1.05; 18 studies, 3973 participants; low-certainty evidence). Multidisciplinary rehabilitation may result in fewer people with poorer mobility at 6 to 12 months' follow-up (RR 0.83, 95% CI 0.71 to 0.98; 5 studies, 1085 participants; low-certainty evidence). Due to very low-certainty evidence, we have little confidence in the findings for marginally better quality of life after multidisciplinary rehabilitation (1 study). The same applies to the mixed findings of some or no difference from multidisciplinary rehabilitation on dependence in activities of daily living at 1 to 4 months' follow-up (measured in various ways by 11 studies), or at 6 to 12 months' follow-up (13 studies). Long-term hip-related pain was not reported. Ambulatory setting: supported discharge and multidisciplinary home rehabilitation versus 'usual care' Three trials tested this comparison in 377 people mainly living at home. Due to very low-certainty evidence, we have very little confidence in the findings of little to no between-group difference in poor outcome (death or move to a higher level of care or inability to walk) at one year (3 studies); quality of life at one year (1 study); in mortality at 4 or 12 months (2 studies); in independence in personal activities of daily living (1 study); in moving permanently to a higher level of care (2 studies) or being unable to walk (2 studies). Long-term hip-related pain was not reported. One trial tested this comparison in 240 nursing home residents. There is low-certainty evidence that there may be no or minimal between-group differences at 12 months in 'poor outcome' defined as dead or unable to walk; or in mortality at 4 months or 12 months. Due to very low-certainty evidence, we have very little confidence in the findings of no between-group differences in dependency at 4 weeks or at 12 months, or in quality of life, inability to walk or pain at 12 months.

Authors' conclusions: In a hospital inpatient setting, there is moderate-certainty evidence that rehabilitation after hip fracture surgery, when delivered by a multidisciplinary team and supervised by an appropriate medical specialist, results in fewer cases of 'poor outcome' (death or deterioration in residential status). There is low-certainty evidence that multidisciplinary rehabilitation may result in fewer deaths in hospital and at 4 to 12 months; however, it may also result in slightly more. There is low-certainty evidence that multidisciplinary rehabilitation may reduce the numbers of people with poorer mobility at 12 months. No conclusions can be drawn on other outcomes, for which the evidence is of very low certainty. The generally very low-certainty evidence available for supported discharge and multidisciplinary home rehabilitation means that we are very uncertain whether the findings of little or no difference for all outcomes between the intervention and usual care is true. Given the prevalent clinical emphasis on early discharge, we suggest that research is best orientated towards early supported discharge and identifying the components of multidisciplinary inpatient rehabilitation to optimise patient recovery within hospital and the components of multidisciplinary rehabilitation, including social care, subsequent to hospital discharge.

Trial registration: ClinicalTrials.gov NCT01254942 NCT03906864 NCT00667914 NCT01052636 NCT01350557 NCT01051830 NCT01009268 NCT00000436 NCT03301584 NCT01435538 NCT00951691 NCT00962910.

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Conflict of interest statement

None of the authors have a conflict of interest. As Ian Cameron was an investigator in three of the included trials, these trials were assessed independently by other review authors.

Figures

1
1
Hip fracture rehabilitation services – programme components (extract from Sheehan 2019)
2
2
Study flow diagram for the first phase of the search update 2009 to January 2016 (former scope)
3
3
Study flow diagram for the second phase of the search updates up to February/March 2019, November 2019 and October 2020 (revised scope)
4
4
Summary of review authors' assessments (+ = low; ? = unclear; ‐ = high risk of bias) for aspects of study conduct for individual trials
5
5
Multidisciplinary inpatient rehabilitation versus usual care: 'Poor outcome' (long‐term follow‐up at 6 or 12 months)
1.1
1.1. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 1: 'Poor outcome' (long‐term follow‐up at 6 or 12 months)
1.2
1.2. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 2: 'Poor outcome' (long‐term follow‐up): subgrouped by intervention type
1.3
1.3. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 3: 'Poor outcome' (long‐term follow‐up) by selection bias
1.4
1.4. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 4: 'Poor outcome' (at discharge)
1.5
1.5. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 5: Mortality (end of scheduled follow‐up: 4 to 12 months)
1.6
1.6. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 6: Mortality (end of scheduled follow‐up) ‐ with 12 month data for Cameron 1993
1.7
1.7. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 7: Mortality (end of scheduled follow‐up): subgrouped by intervention type
1.8
1.8. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 8: Mortality (at discharge)
1.9
1.9. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 9: Quality of life: EQ‐5D (‐0.594: worse than death, 0: dead to 1: best quality)
1.10
1.10. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 10: Quality of life: SF‐36 (Taiwan version) (each domain: 0 to 100; best quality) at 1 year
1.11
1.11. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 11: Greater dependency in ADL up to 4 months
1.12
1.12. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 12: Regain in former level of ADL independence in the short term (up to 4 months)
1.13
1.13. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 13: Greater dependency in ADL in the long term (6 to 12 months)
1.14
1.14. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 14: ADL: Barthel scores (higher scores = greater independence)
1.16
1.16. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 16: Loss in activities of daily living at 6 months (Katz index; 6 maximum)
1.18
1.18. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 18: Greater dependency in mobility
1.19
1.19. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 19: Mobility: Short Physical Performance Battery (0 to 12: best mobility)
1.21
1.21. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 21: Institutional care at 6 to 12 months (survivors)
1.22
1.22. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 22: Complications
1.23
1.23. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 23: Readmitted to hospital during follow‐up
1.24
1.24. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 24: Dead or readmitted to hospital during follow‐up
1.25
1.25. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 25: Length of hospital stay (days)
1.26
1.26. Analysis
Comparison 1: Inpatient setting: multidisciplinary rehabilitation (MDR) versus usual care, Outcome 26: Subgroup analysis ‐ death at 12 months
2.1
2.1. Analysis
Comparison 2: Inpatient setting: multidisciplinary rehabilitation (MDR) with an integrated care pathway versus MDR alone, Outcome 1: Poor outcome, dead, couldn't walk as before, or nursing home stay post discharge (12 months)
2.2
2.2. Analysis
Comparison 2: Inpatient setting: multidisciplinary rehabilitation (MDR) with an integrated care pathway versus MDR alone, Outcome 2: SF‐12 scores at 12 months (0: worst to 100: best)
2.4
2.4. Analysis
Comparison 2: Inpatient setting: multidisciplinary rehabilitation (MDR) with an integrated care pathway versus MDR alone, Outcome 4: Hospital readmission (at set times)
3.1
3.1. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 1: 'Poor outcome', mortality, and unable to walk (3 or 4 months)
3.2
3.2. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 2: 'Poor outcome', mortality, institutional care and unable to walk (12 months)
3.3
3.3. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 3: Subgroup analysis: poor outcome (dead or non‐recovery of indoor walking ability) at 1 year, subgrouped by dementia status
3.4
3.4. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 4: Subgroup analysis: mortality at 1 year, subgrouped by dementia status
3.5
3.5. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 5: SF‐36 scores at 12 months (0: worst to 100: best)
3.6
3.6. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 6: Independence in personal activities of daily living (PADL) and outdoor walking
3.9
3.9. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 9: Complications (discharge to 12 months)
3.10
3.10. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 10: Readmission to hospital and reoperation
3.11
3.11. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 11: Falls outcomes
3.12
3.12. Analysis
Comparison 3: Ambulatory setting: supported discharge and multidisciplinary home‐based rehabilitation versus usual inpatient rehabilitation, Outcome 12: Lengths of hospital or rehabilitation stays (days)
4.1
4.1. Analysis
Comparison 4: Ambulatory setting: outreach multidisciplinary rehabilitation versus usual care in nursing homes, Outcome 1: 'Poor outcome', mortality, and unable to walk (12 months)
4.2
4.2. Analysis
Comparison 4: Ambulatory setting: outreach multidisciplinary rehabilitation versus usual care in nursing homes, Outcome 2: All cause mortality
4.3
4.3. Analysis
Comparison 4: Ambulatory setting: outreach multidisciplinary rehabilitation versus usual care in nursing homes, Outcome 3: Quality of life at 12 months: DEMQOL & DEMQOL‐Proxy
4.4
4.4. Analysis
Comparison 4: Ambulatory setting: outreach multidisciplinary rehabilitation versus usual care in nursing homes, Outcome 4: EQ‐5D quality of life index at 12 months (0 dead to 1 best quality)
4.5
4.5. Analysis
Comparison 4: Ambulatory setting: outreach multidisciplinary rehabilitation versus usual care in nursing homes, Outcome 5: Modified Barthel Index (0 to 100: total independence in personal care)
4.6
4.6. Analysis
Comparison 4: Ambulatory setting: outreach multidisciplinary rehabilitation versus usual care in nursing homes, Outcome 6: Nursing Home Life‐Space Diameter (0 to 50; leaves facility daily)
4.7
4.7. Analysis
Comparison 4: Ambulatory setting: outreach multidisciplinary rehabilitation versus usual care in nursing homes, Outcome 7: Pain: PAINAD (0 to 10; severe pain)
4.8
4.8. Analysis
Comparison 4: Ambulatory setting: outreach multidisciplinary rehabilitation versus usual care in nursing homes, Outcome 8: Fall outcomes (adverse events)
5.1
5.1. Analysis
Comparison 5: Ambulatory setting: intensive versus less intensive community rehabilitation, Outcome 1: 'Poor outcome', mortality and institutional care (12 months)
5.3
5.3. Analysis
Comparison 5: Ambulatory setting: intensive versus less intensive community rehabilitation, Outcome 3: Number of contacts over 12 weeks (for participants with hip fracture or stroke)
6.1
6.1. Analysis
Comparison 6: Ambulatory setting: extended multidisciplinary ambulatory rehabilitation versus usual care, Outcome 1: 'Poor outcome', mortality and institutional care (12 months)
6.2
6.2. Analysis
Comparison 6: Ambulatory setting: extended multidisciplinary ambulatory rehabilitation versus usual care, Outcome 2: ALSAR: Assessment of Living Skills And Resources
7.1
7.1. Analysis
Comparison 7: Outpatient multidisciplinary clinic between 3 to 12 months post fracture versus usual care, Outcome 1: Mortality and institutional care
8.1
8.1. Analysis
Comparison 8: Exploratory analysis: inpatient and supported discharge (home‐based) settings, Outcome 1: 'Poor outcome' (long‐term follow‐up): subgrouped by intervention type
8.2
8.2. Analysis
Comparison 8: Exploratory analysis: inpatient and supported discharge (home‐based) settings, Outcome 2: Mortality (end of scheduled follow‐up): subgrouped by intervention type
See this image and copyright information in PMC

Update of

Comment in

References

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    1. NCT01052636. Intervention program for elderly patients with hip fracture. clinicaltrials.gov/show/NCT01052636 (first received 20 January 2010).
    1. Shyu Y. personal communication December 9 2008.
    1. Shyu YI, Liang J, Wu CC, Cheng HS, Chen MC. An interdisciplinary intervention for olderTaiwanese patients after surgery for hip fracture improves health-related quality of life. BMC Musculoskeletal Disorders 2010;11(225):[10 p.]. [DOI: 10.1186/1471-2474-11-225] - DOI - PMC - PubMed
    1. Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, et al. A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. Journal of the American Geriatrics Society 2005;53(5):811-8. [PMID: ] - PubMed
    1. Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, et al. Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. Journals of Gerontology Series A - Biological Sciences and Medical Sciences 2008;63(1):92-7. [PMID: ] - PubMed
Shyu 2013a {published data only}
    1. Liu HY, Tseng MY, Li HJ, Wu CC, Cheng HS, Yang CT, et al. Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status. Journal of the American Medical Directors Association 2014;15(6):416-22. - PubMed
    1. Liu HY, Yang CT, Cheng HS, Wu CC, Chen CY, Shyu YIL. Family caregivers' mental health is associated with postoperative recovery of elderly patients with hip fracture: a sample in Taiwan. Journal of Psychosomatic Research. 2015;78(5):452-8. - PubMed
    1. Liu HY, Yang CT, Tseng MY, Chen CY, Wu CC, Cheng HS, et al. Trajectories in postoperative recovery of elderly hip-fracture patients at risk for depression: a follow-up study. Rehabilitation Psychology 2018;63(3):438-46. - PubMed
    1. NCT01350557. Three care models for elderly patients with hip fracture. clinicaltrials.gov/ct2/show/NCT01350557 (first received 10 May 2011).
    1. Shyu Y. personal communication May 4 2016.
Singh 2012 {published data only}
    1. ACTRN12605000164695. Hip Fracture Intervention Trial [Hip Fracture Intervention Trial (HIPFIT): a randomized controlled trial of a targeted multifactorial intervention to improve long term disability after hip fracture]. www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12605000164695 (first received 11 August 2005).
    1. Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM, et al. Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. Journal of the American Medical Directors Association 2012;13(1):24-30. - PubMed
Stenvall 2007a {published data only}
    1. Berggren M, Stenvall M, Englund U, Olofsson B, Gustafson Y. Co-morbidities, complications and causes of death among people with femoral neck fracture - a three-year follow-up study. BMC Geriatrics 2016;16(120):[10 p.]. [DOI: 10.1186/s12877-016-0291-5] - DOI - PMC - PubMed
    1. Berggren M, Stenvall M, Olofsson B, Gustafson Y. Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up. Osteoporosis International 2008;19(6):801-9. - PubMed
    1. Gustafson Y. Outcomes of hip fractures: Rehabilitation programmes: Comprehensive Geriatric Assessment and Rehabilitation - a prerequisite for successful treatment of people who have suffered a hip-fracture (abstract). European Geriatric Medicine 2012;3:S19.
    1. Lundstrom M, Olofsson B, Stenvall M, Karlsson S, Nyberg L, Englund U, et al. Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clinical and Experimental Research 2007;19(3):178-86. - PubMed
    1. Olofsson B, Stenvall M, Lundstrom M, Svensson O, Gustafson Y. Malnutrition in hip fracture patients: an intervention study. Journal of Clinical Nursing 2007;16(11):2027-38. - PubMed
Swanson 1998 {published and unpublished data}
    1. Day GA, Swanson C, Yelland C, Broome J, Dimitri K, Massey L, et al. Surgical outcomes of a randomized prospective trial involving patients with a proximal femoral fracture. Australian & New Zealand Journal of Surgery 2001;71(1):11-4. - PubMed
    1. Day GA, Yelland C, Swanson CE, Dimitri K, Broome J, Massey L, et al. Early rehabilitation in patients with hip fractures [abstract]. Journal of Bone and Joint Surgery - British Volume 1997;79 Suppl 4:410.
    1. Swanson CE, Day GA, Yelland CE, Broome JR, Massey L, Richardson HR, et al. The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care. Medical Journal of Australia 1998;169(10):515-8. [PMID: ] - PubMed
    1. Swanson CE. personal communication December 5 2001.
Tseng 2019 {unpublished data only}
    1. NCT01051830. A care model for hip-fractured elderly persons with diabetes mellitus. clinicaltrials.gov/show/NCT01051830 (first received 20 January 2010).
    1. Shyu YL. Personal communication (data for nursing home admittance and poor outcome at 6 and 12 months) 15 January 2020.
    1. Tseng MY, Huang YF, Liang J, Wang JS, Yang CT, Wu CC, et al. Diabetic neuropathies influence recovery from hip-fracture surgery in older persons with diabetes. Experimental Gerontolology 2019;119:168-73. [DOI: 10.1016/j.exger.2019.02.004] - DOI - PubMed
    1. Tseng MY, Liang J, Wang JS, Yang CT, Wu CC, Cheng HS, et al. Effects of a diabetes-specific care model for hip fractured older patients with diabetes: A randomized controlled trial. Experimental Gerontology 2019 Aug 9 [Epub ahead of print]. [DOI: 10.1016/j.exger.2019.110689] - DOI - PubMed
Uy 2008 {published data only}
    1. Uy C, Kurrle SE, Cameron ID. Inpatient multidisciplinary rehabilitation after hip fracture for residents of nursing homes: a randomised trial. Australasian Journal on Ageing 2008;27(1):43-4. [MEDLINE: ] - PubMed
Vidan 2005 {published and unpublished data}
    1. Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. Journal of the American Geriatrics Society 2005;53(9):1476-82. - PubMed
    1. Vidan M. personal communication December 10 2008.
Watne 2014 {published data only}
    1. NCT01009268. The effect of a pre- and postoperative orthogeriatric service. clinicaltrials.gov/ct2/show/NCT01009268 (first received 6 November 2009).
    1. Watne LO, Torbergsen AC, Conroy S, Engedal K, Frihagen F, Hjorthaug GA, et al. The effect of a pre- and postoperative orthogeriatric service on cognitive function inpatients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Medicine 2014;12(63):[12 p.]. [DOI: 10.1186/1741-7015-12-63] - DOI - PMC - PubMed
    1. Wyller TB, Watne LO, Torbergsen A, Engedal K, Frihagen F, Juliebø V, et al. The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatrics 2012;12(36):[13 p.]. [DOI: 10.1186/1471-2318-12-36] - DOI - PMC - PubMed
Ziden 2008 {published data only}
    1. Zidén L, Kreuter M, Frändin K. Long-term effects of home rehabilitation after hip fracture - 1-year follow-up of functioning, balance confidence, and health-related quality of life in elderly people. Disability and Rehabilitation 2010;32(1):18-32. - PubMed
    1. Ziden L, Frandin K, Kreuter M. Home rehabilitation after hip fracture. A randomized controlled study on balance confidence, physical function and everyday activities. Clinical Rehabilitation 2008;22(12):1019-33. [PMID: ] - PubMed

References to studies excluded from this review

Abe 2001 {published data only}
    1. Abe T, Tsuchida N, Ishibashi H, Yamamoto S. Comparison between the short program and long program of post-operative rehabilitation of hip fracture for making the critical path. Nippon Ronen Igajkkai Zasshi - Japanese Journal of Geriatrics 2001;38(4):514-8. [PMID: ] - PubMed
ACTRN12619000296134 2019 {published data only}
    1. ACTRN12619000296134. Reducing the risk of post-operative delirium in elderly hip fracture surgical patients by implementing a multidisciplinary approach to analgesia, education, and medications [Delirium reduction after hip fracture surgery through a multidisciplinary care bundle]. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376995 (first received 26 February 2019).
Allegrante 2001 {published and unpublished data}
    1. Allegrante JP, Peterson MG, Cornell CN, MacKenzie CR, Robbins L, Horton R. Methodological challenges of multiple-component intervention: Lessons learned from a randomized controlled trial of functional recovery following hip fracture. Hospital for Special Surgery Journal 2007;3(1):63-70. - PMC - PubMed
    1. NCT00000436. Improving functional recovery after hip fracture. clinicaltrials.gov/ct2/show/NCT00000436 (first received 31 January 2000).
    1. Peterson MG, Ganz SB, Allegrante JP, Cornell CN. High-intensity exercise training following hip fracture. Topics in Geriatric Rehabilitation 2004;20(4):273-284.
    1. Ruchlin HS, Elkin EB, Allegrante JP. The economic impact of a multifactorial intervention to improve postoperative rehabilitation of hip fracture patients. Arthritis & Rheumatism 2001;45(5):446-52. [PMID: ] - PubMed
Asplin 2017 {published data only}
    1. Asplin G, Carlsson G, Ziden L, Kjellby-Wendt G. Early coordinated rehabilitation in acute phase after hip fracture - a model for increased patient participation. BMC Geriatrics 2017;17(240):[12 p.]. [DOI: 10.1186/s12877-017-0640-z] - DOI - PMC - PubMed
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Bai 2003 {published data only}
    1. Bai B, Wang KZ, Liu WK, Song JH, Chen JC. Comprehensive treatment for old patients with hip fractures. Chinese Journal of Traumatology 2003;6(5):297-301. - PubMed
Bai 2009 {published data only}
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Barone 2006 {published data only}
    1. Barone A, Giusti A, Pizzonia M, Razzano M, Palummeri E, Pioli G. A comprehensive geriatric intervention reduces short- and long-term mortality in older people with hip fracture. Journal of the American Geriatrics Society 2006;54:1145-7. - PubMed
Beaupre 2019 {published data only}
    1. Beaupre LA, Magaziner JS, Jones CA, Jhangri GS, Johnston DW, Wilson DM, et al. Rehabilitation after hip fracture for nursing home residents: a controlled feasibility trial. Journals of Gerontology Series A, Biological Sciences and Medical Sciences 2019;74(9):1518-25. - PMC - PubMed
Binder 2004 {published data only}
    1. Binder EF, Brown M, Sinacore DR, Steger-May K, Yarasheski KE, Schechtman KB. Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA 2004;292:837-46. - PubMed
Boyer 1986 {published data only}
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Choong 2000 {published data only}
    1. Choong PF, Langford AK, Dowsey MM, Santamaria NM. Clinical pathway for fractured neck of femur: a prospective, controlled study. Medical Journal of Australia 2000;172(9):423-6. - PubMed
Cuncliffe 2004 {published data only}
    1. Cuncliffe A, Dewey M, Gladman J, Harwood R, Husbands S, Miller P. Evaluation of an early discharge scheme for elderly people: outcomes at 3 months [abstract]. www.nottingham.ac.uk/rehab/whatwentright/eds_gladman.pdf (accessed 04 September 2003).
    1. Cuncliffe A, Dewey M, Gladman J, Harwood R, Husbands S, Miller P. Evaluation of an early discharge scheme for elderly people: use of hospital beds at 3 months [abstract]. Age & Ageing 2001;30(Suppl 2):33.
    1. Cuncliffe A, Dewey M, Gladman J, Harwood R, Husbands S, Miller P. Evaluation of an early discharge scheme for elderly people: use of hospital beds at 3 months [abstract]. www.nottingham.ac.uk/rehab/whatwentright/eds_gladman.pdf (accessed 04 September 2003).
    1. Cuncliffe A, Dewey M, Gladman J, Harwood R, Husbands S, Miller P. Evaluation of an early discharge scheme for older people: outcomes at 12 months [abstract]. www.nottingham.ac.uk/rehab/whatwentright/eds_gladman.pdf (accessed 04 September 2003).
    1. Cunliffe AL, Gladman JR, Husbands SL, Miller P, Dewey ME, Harwood RH. Sooner and healthier: a randomised controlled trial and interview study of an early discharge rehabilitation service for older people. Age & Ageing 2004;33(3):246-52. [PMID: ] - PubMed
Dautel 2019 {published data only}
    1. Dautel A, Eckert T, Gross M, Hauer K, Schaufele M, Lacroix A, et al. Multifactorial intervention for hip and pelvic fracture patients with mild to moderate cognitive impairment: study protocol of a dual-centre randomised controlled trial (OF-CARE). BMC Geriatrics 2019;19(125):doi: 10.1186/s12877-019-1133-z. - PMC - PubMed
Deneckere 2012 {published data only}
    1. Deneckere S, Euwema M, Lodewijckx C, Panella M, Mutsvari T, Sermeus W, et al. Better interprofessional teamwork, higher level of organized care, and lower risk of burnout in acute health care teams using care pathways: a cluster randomized controlled trial. Medical Care 2013;51(1):99-107. - PubMed
    1. Deneckere S, Euwema M, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. The European Quality of Care Pathways (EQCP) study on the impact of care pathways on interprofessional teamwork in an acute hospital setting: study protocol: for a cluster randomised controlled trial and evaluation of implementation processes. Implementation Science 2012;7:[47 p.]. - PMC - PubMed
    1. NCT01435538. European Quality of Care Pathways Study on the Effect of Care Pathways on Interprofessional Teamwork (EQCP-TEAM) (EQCP-TEAM). clinicaltrials.gov/show/NCT01435538 (first received 16 September 2011).
Deschodt 2011 {published data only}
    1. Deschodt M, Braes T, Broos P, Sermon A, Boonen S, Flamaing J, et al. Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. Journal of the American Geriatrics Society 2011;59(7):1299-308. - PubMed
    1. Deschodt M, Braes T, Flamaing J, Detroyer E, Broos P, Haentjens P, et al. Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. Journal of the American Geriatrics Society 2012;60(4):733-9. - PubMed
Edgren 2015 {published data only}53680197
    1. Edgren J, Salpakoski A, Sihvonen SE, Portegijs E, Kallinen M, Arkela M, et al. Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial. Journal of the American Medical Directors Association 2015;16(4):350-7. - PubMed
    1. ISRCTN53680197. Mobility recovery after hip fracture: physical activity and rehabilitation program among community-dwelling hip fracture patients. isrctn.com/ISRCTN53680197 (first received 24 September 2009).
    1. Portegijs E, Rantakokko M, Edgren J, Salpakoski A, Heinonen A, Arkela M, et al. Effects of a rehabilitation program on perceived environmental barriers in older patients recovering from hip fracture: a randomized controlled trial. BioMed Research International 2013;Article ID 769645:[8 p.]. - PMC - PubMed
    1. Salpakoski A, Tormakangas T, Edgren J, Kallinen M, Sihvonen SE, Pesola M, et al. Effects of a multicomponent home-based physical rehabilitation program on mobility recovery after hip fracture: a randomized controlled trial. Journal of the American Medical Directors Association 2014;15(5):361-8. - PubMed
    1. Sipilä S, Salpakoski A, Edgren J, Heinonen A, Kauppinen MA, et al. Promoting mobility after hip fracture (ProMo): study protocol and selected baseline results of a year-long randomized controlled trial among community-dwelling older people. BMC Musculoskeletal Disorders 2011;12(277):[10 p.]. [DOI: 10.1186/1471-2474-12-277] - DOI - PMC - PubMed
FIT‐HIP 2019 {published data only}
    1. NL5573 (NTR5695). A randomised controlled trial to improve outcomes of hip fracture patients with fear of falling in geriatric rehabilitation. www.trialregister.nl/trial/5573 (first received 07 March 2016).
    1. Scheffers-Barnhoorn MN, Van Eijk M, Van Haastregt JC, Schols JM, Van Balen R, Van Geloven N, et al. Effects of the FIT-HIP intervention for fear of falling after hip fracture: a cluster-randomized controlled trial in geriatric rehabilitation. Journal of the American Medical Directors Association 2019;20(7):857-65. [DOI: 10.1016/j.jamda.2019.03.009] - DOI - PubMed
    1. Scheffers-Barnhoorn MN, Van Haastregt JC, Schols JM, Kempen GI, Van Balen R, Visschedijk JH, et al. A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial. BMC Geriatrics 2017;17(71):[10 p.]. [DOI: 10.1186/s12877-017-0465-9] - DOI - PMC - PubMed
Fordham 1995 {published data only}
    1. Fordham RJ. Hip Fracture Rehabilitation: Economic Evaluation & Outcome Assessment of Geriatric Orthopaedic Care [thesis]. Perth (Australia): University of Western Australia, 1995.
Gonzalez‐Montalvo 2010 {published data only}
    1. Gonzalez-Montalvo JI, Alarcon T, Mauleon JL, Gil-Garay E, Gotor P, Martin-Vega A. The orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture. Hip International 2010;20(2):229-35. - PubMed
    1. Gonzalez Montalvo JI, Gotor Perez P, Martin Vega A, Alarcon Alarcon T, Alvarez de Linera JL, Gil Garay E, et al. The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact. Revista Espanola de Geriatria y Gerontologia 2011;46:193-9. - PubMed
Hagsten 2004 {published data only}
    1. Hagsten B, Svensson O, Gardulf A. Early individualized postoperative occupational therapy training in 100 patients improves ADL after hip fracture: a randomized trial. Acta Orthopaedica Scandinavica 2004;75:177-83. - PubMed
Hempsall 1990 {published data only}
    1. Hempsall VJ, Robertson DR, Campbell MJ, Briggs RS. Orthopaedic geriatric care - is it effective? A prospective population-based comparison of outcome in fractured neck of femur. Journal of the Royal College of Physicians of London 1990;24(1):47-50. - PMC - PubMed
HIPFRAC 2017 {published data only}
    1. Bruun-Olsen V, Bergland A, Heiberg KE. "I struggle to count my blessings": recovery after hip fracture from the patients' perspective. BMC Geriatrics 2018;18(18):[10 p.]. [DOI: 10.1186/s12877-018-0716-4] - DOI - PMC - PubMed
    1. Heiberg KE, Bruun-Olsen V, Bergland A. The effects of habitual functional training on physical functioning in patients after hip fracture: the protocol of the HIPFRAC study. BMC Geriatrics 2017;17(23):[8 p.]. [DOI: 10.1186/s12877-016-0398-8] - DOI - PMC - PubMed
    1. NCT02780076. Recovery of Physical Functioning After Hip Fracture (HIPFRAC). clinicaltrials.gov/ct2/show/NCT02780076 (first received 23 May 2016).
Houldin 1995 {published data only}
    1. Houldin AD, Hogan-Quigley B. Psychological intervention for older hip fracture patients. Journal of Gerontological Nursing 1995;21(12):20-6. - PubMed
Huang 2005 {published data only}
    1. Huang TT, Liang SH. A randomized clinical trial of the effectiveness of a discharge planning intervention in hospitalized elders with hip fracture due to falling. Journal of Clinical Nursing 2005;14(10):1193-201. [PMID: ] - PubMed
IRCT2016072119141N2 {published data only}
    1. IRCT2016072119141N2. The effect of family caregiver-oriented discharge planning program on nutritional status, laboratory nutritional parameters and quality of life in patient suffering from hip fractures. en.irct.ir/trial/17198 (first received 30 September 2016).
ISRCTN22464643 {published and unpublished data}22464643
    1. ISRCTN22464643. Fracture in the elderly multidisciplinary rehabilitation (phase 2). www.isrctn.com/ISRCTN22464643 (first received 10 July 2014).
    1. Roberts JL, Pritchard AW, Williams M, Totton N, Morrison V, In D, et al. Mixed methods process evaluation of an enhanced community-based rehabilitation intervention for elderly patients with hip fracture. BMJ Open 2018;8:e021486. - PMC - PubMed
    1. Williams NH, Hawkes C, Din NU, Roberts JL, Charles JM, Morrison VL. Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): study protocol for a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture [ISRCTN22464643]. Pilot and Feasibility Studies 2015;1(13):[8 p.]. [DOI: 10.1186/s40814-015-0008-0] - DOI - PMC - PubMed
    1. Williams NH, Roberts JL, Din NU, Charles JM, Totton N, Williams M, et al. Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technology Assessment (Winchester, England) 2017;21:1-528. - PMC - PubMed
    1. Williams NH, Roberts JL, Din NU, Totton N, Charles JM, Hawkes CA, et al. Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture. BMJ Open 2016;6(10):e012422. - PMC - PubMed
ISRCTN28376407 {published data only}
    1. ISRCTN28376407. Community-based rehabilitation for the elderly following hip fracture. www.isrctn.com/ISRCTN28376407 (first received 20 November 2018).
Joeris 2017 {published data only}
    1. Joeris A, Hurtado-Chong A, Hess D, Kalampoki V, Blauth M. Evaluation of the geriatric co-management for patients with fragility fractures of the proximal femur (Geriatric Fracture Centre (GFC) concept): protocol for a prospective multicentre cohort study. BMJ Open 2017;7(7):e014795. - PMC - PubMed
Krichbaum 2007 {published data only}
    1. Krichbaum K. GAPN postacute care coordination improves hip fracture outcomes. Western Journal of Nursing 2007;29(5):523-44. - PubMed
Kuisma 2002 {published data only}
    1. Kuisma R. A randomized, controlled comparison of home versus institutional rehabilitation of patients with hip fracture. Clinical Rehabilitation 2002;16(5):553-61. - PubMed
Lahtinen 2015 {published data only}ISRCTN94467061
    1. Harmainen S, Leppilahti J, Sipilä J, Antikainen R, Seppänen M, Willig R, et al. Geriatric and physiatric oriented rehabilitation after hip fracture temporarily improves the ability to live independently. A randomised comparison of 538 patients. Suomen Ortopedia ja Traumatologia 2010;33(2):155-71.
    1. ISRCTN94467061. Geriatric- and physiatric-oriented rehabilitation after hip fracture to improve the ability to live independently: a randomised controlled trial. www.isrctn.com/ISRCTN94467061 (first received 10 March 2009).
    1. Lahtinen A, Leppilahti J, Harmainen S, Sipila J, Antikainen R, Seppanen ML, et al. Geriatric and physically oriented rehabilitation improves the ability of independent living and physical rehabilitation reduces mortality: a randomised comparison of 538 patients. Clinical Rehabilitation 2015;29(9):892-906. - PubMed
    1. Lahtinen A, Leppilahti J, Vähänikkilä H, Harmainen S, Koistinen O, Rissanenm P, et al. Costs after hip fracture in independently living patients: a randomised comparison of three rehabilitation modalities. Clinical Rehabilitation 2017;31(5):672-85. [DOI: 10.1177/0269215516651480] - DOI - PubMed
Lin 2009 {published data only}
    1. Lin PC, Wang CH, Chen CS, Liao LP, Kao SF, Wu HF. To evaluate the effectiveness of a discharge-planning programme for hip fracture patients. Journal of Clinical Nursing 2009;18:1632-9. - PubMed
Lofgren 2015 {published data only}
    1. Lofgren S, Hedstrom M, Ekstrom W, Lindberg L, Flodin L, Ryd L. Power to the patient: care tracks and empowerment a recipe for improving rehabilitation for hip fracture patients. Scandinavian Journal of Caring Sciences 2015;29(3):462-9. - PubMed
Martin‐Martin 2014 {published data only}
    1. Martin-Martin LM, Valenza-Demet G, Jimenez-Moleon JJ, Cabrera-Martos I, Revelles-Moyano FJ, Valenza MC. Effect of occupational therapy on functional and emotional outcomes after hip fracture treatment: a randomized controlled trial. Clinical Rehabilitation 2014;28:541-51. - PubMed
NCT00951691 {published and unpublished data}
    1. Lenze EJ, Host HH, Hildebrand MW, Morrow-Howell N, Carpenter B, Freeland KE, et al. Enhanced medical rehabilitation increases therapy intensity and engagement and improves functional outcomes in postacute rehabilitation of older adults: a randomized-controlled trial. Journal of the American Medical Directors Association 2012;13(8):708-12. - PMC - PubMed
    1. NCT00951691. Enhanced medical rehabilitation for disablement. clinicaltrials.gov/show/NCT00951691 (first received 4 August 2009).
NCT01537523 {published data only}
    1. NCT01537523. To Investigate the effect of early community-care program on fracture hip patient. clinicaltrials.gov/show/NCT01537523 (first received 23 February 2012).
NCT02058329 {published data only}
    1. NCT02058329. A geriatric home visit program to reduce post-hip fracture complications. clinicaltrials.gov/show/NCT02058329 (first received 12 Feburary 2014).
NCT03430193 {published data only}
    1. Aftab A, Awan WA, Habibullah S, Lim JY. Effects of fragility fracture integrated rehabilitation management on mobility, activity of daily living and cognitive functioning in elderly with hip fracture. Pakistan Journal of Medical Sciences 2020;36(5):965-70. - PMC - PubMed
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NCT03822247 {published data only}
    1. NCT03822247. Evaluation of multidisciplinary recovery after surgery program in orthopedics and traumatology. clinicaltrials.gov/ct2/show/NCT03822247 (first received 30 January 2019).
Pearson 1988 {published data only}
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References to other published versions of this review

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