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Mobilisation strategies after hip fracture surgery in adults

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Abstract

Background

Hip fracture, which happens in predominantly elderly populations, often results in a reduction in mobility. Care programmes after hip fracture surgery include strategies for mobilisation, such as early weight bearing and gait retraining. Other mobilisation strategies, such as exercises and physical training, are used at various stages in rehabilitation including after discharge from hospital.

Objectives

To evaluate the effects of different mobilisation strategies and programmes after hip fracture surgery.

Search methods

We searched the Cochrane Musculoskeletal Injuries Group Specialised Register (May 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004), MEDLINE and other databases, conference proceedings and reference lists of articles.

Selection criteria

All randomised or quasi‐randomised trials comparing different mobilisation strategies/programmes after hip fracture surgery.

Data collection and analysis

The reviewers independently assessed trial quality and extracted data.

Main results

Our third update, which extended the review scope to cover the whole rehabilitation period, included four new trials. Most of the 10 included trials were small and all had methodological limitations, including inadequate follow up.

Seven trials evaluated mobilisation strategies started soon after hip fracture surgery. One trial (273 participants) found no statistically significant differences in unfavourable outcomes for weight bearing started at two versus 12 weeks after internal fixation of a displaced intracapsular fracture. Of two trials (188 participants) comparing a more with a less intensive regimen of physiotherapy, one reported a lack of demonstrable difference in recovery of the two patient groups, and the other found a higher level of drop‐out in the more intensive group with no difference in length of hospital stay. One trial (80 participants) comparing two‐week programmes of weight‐bearing versus non‐weight‐bearing exercise found some short‐term improvement in mobility and balance in the weight‐bearing exercise group. One trial (80 participants) found improved mobility, leg extension power and Barthel score in those given a quadriceps muscle strengthening exercise programme. One trial (40 participants) found no statistically significant difference in recovery of mobility and time to hospital discharge after a treadmill versus conventional gait retraining programme. One trial (27 participants) comparing neuromuscular stimulation of the quadriceps muscle with placebo found a greater recovery of pre‐fracture mobility in the stimulation group.

The interventions tested by the three remaining trials started after hospital discharge. One trial (28 participants) found improved outcome after 12 weeks of intensive physical training. One trial (120 participants) found improved outcome after home‐based exercises started around 22 weeks from injury. One trial (44 participants) found home‐based weight‐bearing exercises starting at seven months produced no statistically significant differences aside, perhaps, for greater quadriceps strength.

Authors' conclusions

There is insufficient evidence from randomised trials to determine the effectiveness of the various mobilisation strategies examined in this review that start either in the early post‐operative period or during the later rehabilitation period. Further research is required to establish the possible benefits of the additional provision of interventions primarily aimed at enhancing mobility.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

Not enough evidence to assess the effects of interventions to get people back on their feet after hip fracture surgery, and to keep them mobile

The aim of care after surgery for hip fracture is to get people safely back on their feet and walking again. People may be asked to rest in bed, restrict weight bearing, or restrict particular activities. Different physiotherapy and exercise programmes may be used. The review found there was not enough evidence from randomised trials to show the effects of these different strategies for helping people walk after hip fracture surgery. The review also found there was not enough evidence from trials testing the effects of exercise programmes to improve and maintain mobility after discharge from hospital.