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Meta-Analysis
. 2023 Aug 1;52(8):afad154.
doi: 10.1093/ageing/afad154.

Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis

Mitchell N Sarkies  1 , Luke Testa  2 , Ann Carrigan  2 , Natalie Roberts  2 , Rene Gray  3 , Catherine Sherrington  4   5 , Rebecca Mitchell  2 , Jacqueline C T Close  6   7 , Catherine McDougall  8   9 , Katie Sheehan  10
Affiliations
Meta-Analysis

Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis

Mitchell N Sarkies et al. Age Ageing. .

Abstract

Background: Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery.

Objective: Determine the effectiveness of perioperative interventions on early mobilisation and physical function after hip fracture.

Methods: Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science were searched from January 2000 to March 2022. English language experimental and quasi-experimental studies were included if patients were hospitalised for a fractured proximal femur with a mean age 65 years or older and reported measures of early mobilisation and physical function during the acute hospital admission. Data were pooled using a random effect meta-analysis.

Results: Twenty-eight studies were included from 1,327 citations. Studies were conducted in 26 countries on 8,192 participants with a mean age of 80 years. Pathways and models of care may provide a small increase in early mobilisation (standardised mean difference [SMD]: 0.20, 95% confidence interval [CI]: 0.01-0.39, I2 = 73%) and physical function (SMD: 0.07, 95% CI 0.00 to 0.15, I2 = 0%) and transcutaneous electrical nerve stimulation analgesia may provide a moderate improvement in function (SMD: 0.65, 95% CI: 0.24-1.05, I2 = 96%). The benefit of pre-operative mobilisation, multidisciplinary rehabilitation, recumbent cycling and clinical supervision on mobilisation and function remains uncertain. Evidence of no effect on mobilisation or function was identified for pre-emptive analgesia, intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, occupational therapy training or nutritional supplements.

Conclusions: Perioperative interventions may improve early mobilisation and physical function after hip fracture surgery. Future studies are needed to model the causal mechanisms of perioperative interventions on mobilisation and function after hip fracture.

Keywords: analgesia; model of care; older people; post-operative; pre-operative; surgery; systematic review.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
PRISMA flow diagram of studies in the review.
Figure 2
Figure 2
Forest plot of comparison: analgesia interventions versus control on mobilisation.
Figure 3
Figure 3
Forest plot of comparison: analgesia interventions versus control on function.
Figure 4
Figure 4
Forest plot of comparison: pathways and models of care versus control on mobilisation.
Figure 5
Figure 5
Forest plot of comparison: pathways and models of care versus control on function.
See this image and copyright information in PMC

References

    1. Mitchell R, Draper B, Brodaty H. et al. An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study. Osteoporos Int 2020; 31: 465–74. - PubMed
    1. Griffin XL, Parsons N, Achten J, Fernandez M, Costa ML. Recovery of health-related quality of life in a United Kingdom hip fracture population. Bone Joint J 2015; 97-B: 372–82. - PubMed
    1. Papadimitriou N, Tsilidis KK, Orfanos P. et al. Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Glob Health 2017; 2: e239–46. - PubMed
    1. Mitchell R, Harvey L, Brodaty H, Draper B, Close J. One-year mortality after hip fracture in older individuals: the effects of delirium and dementia. Arch Gerontol Geriatr 2017; 72: 135–41. - PubMed
    1. Dyer SM, Crotty M, Fairhall N. et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016; 16: 158. 10.1186/s12877-016-0332-0. - DOI - PMC - PubMed

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