Intervenciones para mejorar la movilidad después de la cirugía por fractura de cadera en adultos
Información
- DOI:
- https://doi.org/10.1002/14651858.CD001704.pub5Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 07 septiembre 2022see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Lesiones óseas, articulares y musculares
- Copyright:
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- Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
All authors have contributed to the production of this review.
NF was involved in screening, data extraction, data analysis and co‐led the writing of the review.
SD was involved in screening, data extraction, data analysis, contributed to writing the review and commented on drafts of the review.
JM was involved in screening, contributed to writing the review and commented on drafts of the review.
JD contributed to writing the review and commented on drafts of the review.
WK was involved in screening, data extraction and contributed to writing the review.
CS was involved in screening, data extraction, data analysis, co‐led the writing of the review and acted as guarantor of the review.
The contribution statements for all previous versions of the review up to 2011 are presented in Handoll 2011.
Sources of support
Internal sources
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N/A, Other
N/A
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Nil, Other
Nil
External sources
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National Health and Medical Research Council, Fellowship, Australia
Fellowship funding
Declarations of interest
NF: none
SD: none
JM: none
JD: none
WK: none
CS: as Catherine Sherrington is an active investigator in several randomised trials in this area, assessment of eligibility of these trials and quality assessment of the four included trials was done independently by two other review authors. Independent data extraction and entry into Review Manager software, presentation and interpretation of these trials were also performed.
Acknowledgements
For the current (sixth) update, we thank Helen Handoll, lead author on previous versions of this review, for the expert guidance in the methods section of this update. We thank Liz Bickerdike, Sharon Lewis and Joanne Elliott for their comments and help at editorial review, and Maria Clarke for her help with the literature searches. We thank Christine McDonough and Mattia Morri (external referees) and Janet Wale (consumer reviewer) for their helpful feedback.
The Acknowledgements for previous versions of this review can be found in Appendix 11.
This project was funded and supported by the National Institute for Health Research (NIHR). The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the Systematic Reviews Programme, the NIHR, the National Health Service or the Department of Health.
Editorial and peer‐reviewer contributions
Cochrane Bone, Joint and Muscle Trauma (BJMT) Group supported the authors in the development of this review.
The following people conducted the editorial process for this article:
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Sign‐off Editor (final editorial decision): Xavier Griffin, Co‐ordinating Editor, Cochrane BJMT Group
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Editor (advised on methodology and review content, edited the article): Sharon Lewis, Deputy Co‐ordinating Editor, Cochrane BJMT Group
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Methodological Editor (advised on methodology and review content): Liz Bickerdike, Cochrane Acute and Emergency Care Network Associate Editor
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Managing Editor (selected peer reviewers, collated peer‐reviewer comments, provided editorial guidance to authors, edited the article): Joanne Elliott, Managing Editor, Cochrane BJMT Group
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Information Specialist (developed search strategy, advised on search methods): Maria Clarke, Information Specialist, Cochrane BJMT Group
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Copy Editor (copy‐editing and production): Faith Armitage, Copy Edit Support
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Peer‐reviewers (provided comments and recommended an editorial decision): Christine McDonough, Mattia Morri (clinical reviewers) and Janet Wale (consumer reviewer)
Version history
| Published | Title | Stage | Authors | Version |
| 2022 Sep 07 | Interventions for improving mobility after hip fracture surgery in adults | Review | Nicola J Fairhall, Suzanne M Dyer, Jenson CS Mak, Joanna Diong, Wing S Kwok, Catherine Sherrington | |
| 2011 Mar 16 | Interventions for improving mobility after hip fracture surgery in adults | Review | Helen HG Handoll, Catherine Sherrington, Jenson CS Mak | |
| 2007 Jan 24 | Mobilisation strategies after hip fracture surgery in adults | Review | Helen HG Handoll, Catherine Sherrington | |
| 2004 Oct 18 | Mobilisation strategies after hip fracture surgery in adults | Review | Helen HG Handoll, Catherine Sherrington, Martyn J Parker | |
| 2003 Jan 20 | Mobilisation strategies after hip fracture surgery in adults | Review | Helen HG Handoll, Martyn J Parker, Catherine Sherrington | |
Differences between protocol and review
Summary of major changes in the current update (2022)
We updated the review methodology according to current Cochrane guidance: this included risk of bias assessment, GRADE assessment of the certainty of the evidence, and production of summary of findings tables.
Other key differences are as follows.
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In Objectives, we combined two objectives into one: to evaluate the effects (benefits and harms) of interventions aimed at improving mobility and physical functioning after hip fracture surgery in adults.
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In Types of studies, we clarified that we would not include trials reported only in conference abstracts and where sufficient data were not available from correspondence with study authors or from the final report of the trial.
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We expanded our account in Types of participants to clarify that we included trials where participants had undergone hip fracture surgery, irrespective of the type of hip fracture or surgery. We also described our expected population and clarified that we would include certain mixed population trials provided the majority of trial participants had hip fracture.
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In Types of interventions, we clarified that we included trials testing early versus late mobilisation (in the in‐hospital setting), different intensities of mobilisation interventions, as well as different types of exercise programmes.
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In Types of interventions, we indicated that we would now categorise exercise and physical training interventions using the ProFaNE classification. This is in addition to other intervention types (electrical stimulation, postoperative care programmes such as immediate or delayed weight bearing after surgery), which aim to improve walking ability and minimise functional impairments. We also specified our main comparisons and clarified that these included comparisons of different intensities of the same type of intervention.
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We restructured Types of outcome measures, with the categorisation of main or 'critical' outcomes for presentation in summary of findings tables, other important outcomes and economic outcomes. All outcomes previously listed in Handoll 2011 still feature. We gave a greater priority to outcomes at four months for in‐hospital trials.
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We listed the types of information, including details of intervention and co‐interventions, that we sought from reports of included studies in Data extraction and management.
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In Assessment of risk of bias in included studies, we assessed four additional sources of bias: bias resulting from imbalances in key baseline characteristics (e.g. pre‐injury mobility, mental test score, type of surgery); performance bias such as that resulting from lack of comparability in the experience of care providers; bias relating to the recall of falls due to unreliable methods of ascertaining occurrence of falls; and detection bias for staff‐reported (in‐hospital studies) and self‐reported (post‐hospital studies) outcomes such as falls, where some risk of bias is inherent but can be minimised by blinding of research staff and statisticians involved in data collection and analysis. In order to evaluate bias effectively at the outcome level, we re‐considered our approach to assessing performance bias, detection bias and attrition bias. For performance bias, we made judgements for all outcomes in a single domain. For detection bias and attrition bias, we separated these into three separate domains according to whether outcomes were reported by an observer (in which personal judgement was likely or not likely) or reported by a participant or proxy.
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We prespecified the following additional subgroup analyses in Subgroup analysis and investigation of heterogeneity: intervention delivered by expert health provider versus delivered by personnel not specified as an expert (for post‐hospital studies); trials excluding participants with cognitive impairment, dementia or delirium versus not excluding them; outpatient setting versus secondary and social care (for post‐hospital studies); in‐hospital ward versus rehabilitation ward; mean age of 80 years or less versus mean age over 80 years. We removed the following prespecified subgroup analysis, following direction from Cochrane: different types of interventions.
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Whilst undertaking the review, we did not perform a subgroup analysis prespecified in Subgroup analysis and investigation of heterogeneity. We did not perform the prespecified subgroup analysis by expert versus non‐expert delivery of intervention, as it was not possible (we assumed all interventions were delivered by experts in the in‐hospital setting, and the three post‐hospital studies that did not have experts deliver the intervention did not contribute to the main outcomes).
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In Sensitivity analysis, we prespecified additional sensitivity analyses with regard to publication status, risk of bias, study population and in‐hospital trials that measured outcomes at the end of the in‐hospital phase (the usual time point closest to four months). We undertook post hoc sensitivity analysis according to effects model (fixed‐effect versus random‐effects).
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We assessed the certainty of the evidence using GRADE, and we prepared two summary of findings tables for the main comparison groups. We also developed two bespoke summary of findings tables in order to summarise the effects for the mobility outcome according to the different categories of exercise interventions.
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In outcomes, we reported the main outcome (mobility) as an overall outcome, with one outcome from each study, prioritising objective measures over self‐report measures, broad mobility measures over (in order of priority) walking, balance and sit‐to‐stand measures. Because some studies reported multiple clinically useful measures of mobility and we were concerned that we would lose information, we also reported the objective measures separately for the broad mobility outcome, with a study able to contribute to multiple outcomes.
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For this update, we specified that we compare "Provision of any specific mobilisation strategy or programme and non‐provision, where the non‐provision control is defined as no intervention, usual care, sham exercise (the exercise was intended to be a control, or appeared to be of insufficient intensity and progression to have beneficial effects on mobility) or a social visit." In the in‐hospital setting, standard physiotherapy is therefore considered a control intervention. In previous versions of the review, Karumo 1977 was analysed under 'intensive versus usual physiotherapy' and Lauridsen 2002 had been considered a study of intensive versus standard physiotherapy. From this version of the review, we consider the interventions of these two studies versus control.
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We reported adherence to the intervention.
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Where mean and standard deviation were not reported and appropriate data were available, we calculated mean and standard deviation from the median IQR/1.35 in accordance with Higgins 2021a.
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The author team has changed since Handoll 2011. H Handoll is no longer an author. N Fairhall, S Dyer and J Diong became authors, and W Kowk became an author after work on this review commenced.
Most of these changes to protocol, which were made partly in response to a commissioning brief generated in relation to the Cochrane Programme Grant on the management of hip fracture, were established in April 2019 prior to the date of the final search.
Summary of major changes up to the update in 2011
The key differences made in the 2011 update were as follows (Handoll 2011).
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Title was revised to reflect better the scope of the review.
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Trials testing interventions that, in the majority of participants, started after approximately one year were excluded.
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Trials testing mobilisation strategies with nutrition as a co‐intervention were included.
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Types of outcomes were restructured, with the categorisation of primary and secondary outcomes.
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Risk of bias was assessed using the Cochrane risk of bias tool (RoB1), which replaced the assessment of 10 aspects of methodological quality.
The original review was confined to the topic of early weight bearing and mobilisation after internal fixation of intracapsular proximal femoral fractures in adults (Parker 1999). This was then expanded to include interventions that had been used in the mobilisation of all hip fracture patients after surgery and started in the first phase of rehabilitation, generally whilst the patient was in hospital (Handoll 2003). The third update extended the scope further to include mobilisation strategies applied in the later stages of rehabilitation, generally in the community (Handoll 2004).
Notes
This review is an expansion of the scope of the review described in the title of the protocol 'Early weight bearing and mobilisation after internal fixation of intracapsular proximal femoral fractures in adults'.
The main changes for the first update of this review, published Issue 2, 2002, were:
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date of search for trials was extended to February 2002;
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one new study (Mitchell 2001) of quadriceps muscle training was included;
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of the other seven newly identified studies, one was excluded, two were placed in 'Ongoing studies' and four were placed in 'Studies awaiting assessment';
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there was no substantive change to the conclusions of the review.
The main changes for the second update of this review, published Issue 1, 2003, were:
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date of search for trials was extended to October 2002;
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one new study (Lauridsen 2002) evaluating intensive physiotherapy was included;
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two newly identified studies were excluded (Barber 2002; Hauer 2002);
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additional details/results were added from the full publication of Lamb 2002, formerly Lamb 1998;
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availability of the full publication of Kuisma 2002, formerly Johnstone 1999, resulted in its exclusion;
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the identification of 3 more ongoing trials (Cameron 2004; Crotty 2003; Sherrington 2002);
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there was no substantive change to the conclusions of the review.
The main changes for the third update of this review, published Issue 4, 2004, were:
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expansion of the scope of the review to cover interventions aimed at initiating and enhancing mobilisation throughout the whole rehabilitation process;
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types of outcome measures and the order of presentation of the trials were revised upon reconsideration of the new scope of the review;
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date of search for trials was extended to May 2004;
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four studies were newly included. One (Sherrington 1993) applied to the early postoperative period; the other three (Hauer 2002; Sherrington 2004; Sherrington 1997) took place after hospital discharge;
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four newly identified studies were excluded (Crotty 2002; Hesse 2003; Lehmann 1961; Tinetti 1999);
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two previously ongoing studies are now excluded (Allegrante 2001; Maltby 2000) as is one trial previously awaiting assessment (Johnston 1995);
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one trial (Binder 2001) previously awaiting assessment is now listed as an ongoing study;
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one newly identified study (Mangione 2001) awaits assessment;
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various changes were made to comply with the Cochrane Style Guide;
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the conclusions of the review were revised to accommodate the new scope of the review.
The main changes for the fourth update of this review, published Issue 1, 2007, were:
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date of search for trials was extended to January 2006.
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three studies were newly included (Binder 2004; Tsauo 2005; Mangione 2005), one of which was previously waiting assessment (Mangione 2005, formerly Mangione 2001) and one was previously an ongoing study (Binder 2004, formerly Binder 2001). All three trials took place after hospital discharge;
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a study which was previously ongoing (Crotty 2003) has become Miller 2006 and is awaiting assessment;
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one study (Braid 2001) previously listed as ongoing is now excluded.
The main changes for the fifth update of this review, published Issue 3, 2011, were:
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updated title to reflect better the scope of the review;
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trials testing interventions started after the generally perceived recovery of around one year are now excluded;
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trials testing mobilisation strategies with nutrition as a co‐intervention are included;
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types of outcomes were restructured, with the categorisation of primary and secondary outcomes;
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risk of bias was assessed using the Cochrane risk of bias tool, replacing assessment of 10 aspects of methodological quality.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Aged, 80 and over; Female; Humans; Male;
PICO
Study flow diagram
Risk of bias summary: review authors' judgements about each risk of bias domain for each included study
Note: a 'Yes' (+) judgement means that review authors considered there was a low risk of bias associated with the item, whereas a 'No' (‐) means that there was a high risk of bias. Assessments that resulted in an 'Unclear' (?) verdict often reflected a lack of information upon which to judge the domain. However, lack of information on blinding for mobility outcomes was always taken to imply that there was no blinding and rated as a 'No'; similarly for unblinded staff/self‐reported outcomes (health‐related quality of life, pain, falls, patient‐reported questionnaires and satisfaction), lack of information on blinding of researchers was rated as 'No', data collated by blinded researchers was rated 'Unclear'. An empty square (no judgement) indicates the domain was not applicable to that study.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Funnel plot of comparison 4: post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes. Outcome 4.16: walking speed: combined data for all strategy types
Funnel plot of comparison 4: post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes. Outcome 4.31: health‐related quality of life (measured using HRQoL scales): combined data for all strategy types
Funnel plot of comparison 5: post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes. Outcome: 5.9 strength
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 1: Mobility (measured using mobility scales): combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 2: Mobility (failure to regain pre‐facture mobility): combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 3: Mobility (measured using self‐reported outcomes): combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 4: Mobility (measured using mobility scales): gait, balance and function
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 5: Mobility (measured using mobility scales): resistance/strength training
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 6: Mobility (measured in seconds using TUG): resistance/strength training
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 7: Mobility (measured using mobility scales) reporting individual outcome measures
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 8: Walking speed (measured as metres/time): combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 9: Walking speed (measured as metres/time): gait, balance and function
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 10: Walking speed (measured as metres/time): electrical stimulation
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 11: Functioning (measured using functioning scales): combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 12: Functioning (measured using functioning scales): gait, balance and function
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 13: Functioning (measured using functioning scales): resistance/strength training
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 14: Functioning (measured using functioning scales): electrical stimulation
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 15: Health‐related quality of life (measured using HRQoL scales): gait, balance and function
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 16: Mortality, short term: combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 17: Mortality, short term: gait, balance and function
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 18: Mortality, short term: resistance/strength training
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 19: Mortality, short term: electrical stimulation
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 20: Mortality, long term: combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 21: Mortality, long term: gait, balance and function
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 22: Mortality, long term: resistance/strength training
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 23: Adverse events (measured using dichotomous outcomes): combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 24: Adverse events (measured using rate of falls): all studies were gait, balance and function
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 25: Adverse events (measured using continuous measures of pain): combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 26: Return to living at pre‐fracture residence: combined data for all strategy types
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 27: Return to living at pre‐fracture residence: additional study not included in main analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 28: Return to living at pre‐fracture residence: gait, balance and function
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 29: Return to living at pre‐fracture residence: resistance/strength training
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 1: Walking, use of walking aid/need for assistance
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 2: Balance (measured using functional reach test, cm)
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 3: Balance (measured using balance scale)
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 4: Balance (measured using ability to tandem stand)
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 5: Balance (measured using step test; number of steps)
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 6: Balance (measured using self‐reported outcomes)
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 7: Sit to stand (measured as number of stand ups/second)
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 8: Strength
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 9: Activities of daily living (measured using ADL scales)
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 10: Resource use (measured by length of hospital stay)
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 11: Resource use (measured by use of community services)
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 1: Weight‐bearing at 2 wks v weight‐bearing at 12 weeks (mortality)
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 2: Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (mortality)
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 3: Weight‐bearing at 2 wks v weight‐bearing at 12 weeks (adverse events)
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 4: Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (return to living at home)
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 5: Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (walking aid/assistance)
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 1: Mobility (measured using mobility scales): combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 2: Mobility (measured using Timed Up and Go, seconds): combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 3: Mobility (measured using 6‐Minute Walk Test, metres): combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 4: Mobility (measured using mobility scales): gait, balance and function
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 5: Mobility (measured using Timed Up and Go, seconds): gait, balance and function
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 6: Mobility (measured using Timed Up and Go, seconds): resistance/strength training
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 7: Mobility (measured using 6‐Minute Walk Test, metres): resistance/strength training
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 8: Mobility (measured using 6‐Minute Walk Test, metres): endurance training
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 9: Mobility (measured using mobility scales): multiple component
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 10: Mobility (measured using 6‐Minute Walk Test, metres): multiple component
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 11: Mobility (measured using mobility scales): other type of exercise (non‐weight bearing exercise)
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 12: Mobility (measured using Timed Up and Go, seconds): other type of exercise OT +/‐ sensor)
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 13: Mobility (measured using mobility scales) reporting individual outcome measures
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 14: Mobility (measured using self‐report, continuous scales): combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 15: Mobility (measured using self‐reported, dichotomous outcome): combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 16: Walking speed: combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 17: Walking speed: gait, balance and function
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 18: Walking speed: resistance/strength training
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 19: Walking speed: endurance
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 20: Walking speed: multiple component
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 21: Walking speed: other (post‐discharge physio telephone support and coaching)
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 22: Walking speed: other (non‐weight bearing)
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 23: Walking speed subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 24: Walking speed: subgrouped by outpatient v secondary and social care setting
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 25: Walking speed subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategies
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 26: Functioning (measured using functioning scales): combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 27: Functioning (measured using functioning scales): gait, balance and function
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 28: Functioning (measured using functioning scales): resistance/strength training
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 29: Functioning (measured using functioning scales): multiple components
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 30: Functioning (measured using functioning scales): other: OT +/‐ sensor
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 31: Health‐related quality of life (measured using HRQoL scales): combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 32: Health‐related quality of life (measured using HRQoL scales): gait, balance and function
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 33: Health‐related quality of life (measured using HRQoL scales): resistance/strength training
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 34: Health‐related quality of life (measured using HRQoL scales): endurance
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 35: Health‐related quality of life (measured using HRQoL scales): multiple components
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 36: Health‐related quality of life subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 37: Health‐related quality of life subgrouped by outpatient v secondary and social care setting
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 38: Health‐related quality of life subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategy
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 39: Mortality, short term: combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 40: Mortality, short term: gait, balance and function
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 41: Mortality, short term: resistance/strength training
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 42: Mortality, short term: multiple components
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 43: Mortality, short term: other: non‐weight bearing
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 44: Mortality, long term: combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 45: Mortality, long term: gait, balance and function
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 46: Mortality, long term: multiple components
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 47: Adverse events (measured using dichotomous outcomes): combined data for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 48: Adverse events (measured using re‐admission rate: combined for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 49: Adverse events (measured using rate of falls): combined for all strategy types
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 50: Adverse events (measured using rate of falls): gait, balance and function
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 51: Adverse events (measured using rate of falls): other (additional phone support and coaching)
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 52: Adverse events (measured as number of people who experienced 1 or more falls)
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 53: Adverse events (measured using continuous measure of pain)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 1: Walking (measured as use of walking aid/need for assistance)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 2: Walking (measured using self‐reported outcomes)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 3: Balance (measured using functional reach test, cm)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 4: Balance (measured using timed standing in various positions)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 5: Balance (measured using balance scale)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 6: Balance (measured using continuous self‐reported meaure)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 7: Balance (measured using dichotomous self‐reported measure)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 8: Sit to stand (measured as number of stand ups/second)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 9: Strength
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 10: Strength subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 11: Strength subgrouped by stage of rehabilitation
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 12: Strength subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategies
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 13: Activities of daily living (measured using ADL scales)
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 14: Self‐reported measures of lower limb/hip function
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 1: Resistance/strength training v endurance training (mobility measured using 6‐Minute Walk Test
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 2: Resistance/strength training v endurance training (walking speed)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 3: Resistance/strength training v endurance training (health‐related quality of life)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 4: Resistance/strength training v endurance training (strength)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 5: Gait, balance and function v other (muscle contraction in supine) (mobility measured using mobility scale)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 6: Gait, balance and function v other (muscle contraction in supine) (walking speed)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 7: Gait, balance and function v other (muscle contraction in supine) (mortality)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 8: Gait, balance and function v other (muscle contraction in supine) (Adverse events: pain)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 9: Gait, balance and function v other (muscle contraction in supine) (Adverse events: number of people who fell)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 10: Gait, balance and function v other (muscle contraction in supine) (Balance, observed)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 11: Gait, balance and function v other (muscle contraction in supine) (Balance, self‐reported)
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 12: Gait, balance and function v other (muscle contraction in supine) (strength)
| Mobility strategies compared with control (e.g. usual care) after hip fracture surgery in the in‐hospital setting | ||||||
| Patient or population: adults following hip fracture surgery Settings: in‐hospital Intervention: mobility strategiesa Comparison: usual in‐hospital careb | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Controlc | Intervention | |||||
| Mobilityd ‐ overall analysis
Using different mobility scales: MILA (range 0 to 36), EMS (range 0 to 20), BBS (range 0 to 56), PPME (range 0 to 12), Koval (range 1 to 7). Higher values indicate better mobility (except MILA and Koval, where scale was inverted for consistency with other measures).
Follow‐up: range 5 days to 4 months | In the control group, the mean scores for the outcomes were: MILA = 19.2; EMS = 16.3 to 17; BBS = 26; PPME = 6.8 to 9.1; Koval = 4. | SMD 0.53 higher (0.10 higher to 0.96 higher)
| SMD 0.53 (0.10 to 0.96) | 507 (7) | ⊕⊕⊝⊝ | Re‐expressing the results using the 12‐point PPME, the intervention group scored 1.46 points higher (95% CI 0.28 to 2.64). MID for the PPME is typically 1.13 to 2.15 (de Morton 2008).
Based on Cohen’s effect sizesf, mobility strategies may cause a moderate increase in mobility compared with control (SMD 0.53).
Types of intervention in included trials: gait, balance and functional exercise: 6 studies; resistance exercise: 1 study
|
| Walking speedg ‐ overall analysis
Measured using metres/second (m/s) and metres/minute (m/min). A higher score indicates faster walking.
Follow‐up: range 2 weeks to 4 months | The mean walking speed score in the control group ranged from 0.19 m/s to 0.72 m/s, and was 24.4 m/min. | SMD 0.16 higher (0.05 lower to 0.37 higher) | SMD 0.16 (‐0.05 to 0.37) | 360 (6) | ⊕⊕⊕⊝ Moderateh | Overall, there is moderate‐certainty evidence of a small increase in walking (based on Cohen's effect sizes) compared with control (SMD 0.16); however, the confidence interval includes both slower and faster walking.
Re‐expressing the results using gait speed (m/s) showed an increase of 0.04 m/s in the intervention group (MD 0.04, 95% CI ‐0.01 to 0.08). Small meaningful change for gait speed is 0.04 m/s to 0.06 m/s (Perera 2006).
Types of intervention in included trials: gait, balance and functional exercise: 5 studies; electrical stimulation: 1 study |
| Functioningi ‐ overall analysis
Using different scales: mBI (range 0 to 20), BI (range 0 to 100), FIM (range 18 to 126), NEADL (range 0 to 66). A higher score indicates better functioning.
Follow‐up: range 3 weeks to 4 months | In the control group, the mean scores for the outcomes were: mBI: 18; BI: 95; FIM: 69 to 81; NEADL 33.4 | SMD 0.75 higher (0.24 higher to 1.26 higher) | SMD 0.75 (0.24 to 1.26)
| 379 (7) | ⊕⊝⊝⊝ | We are uncertain whether mobility strategies improve functioning as the certainty of the evidence is very low.
Re‐expressing the results using the BI, the intervention group scored 4.4 points higher (95% CI 1.4 to 7.38). MID for the BI (post‐ hip surgery) is typically 9.8 (Unnanuntana 2018).
Types of intervention in included trials: gait, balance and functional exercise: 5 studies; resistance exercise: 1 study. |
| HRQoL
Using EQ‐5D (range 0 to 1) and HOOS (range 0 to 100). A higher score indicates better quality of life.
Follow‐up: range 10 weeks to 6 months | In the control group, the mean scores for the outcomes were: EQ‐5D (range 0.54 to 0.62), HOOS 50.37 | SMD 0.26 higher (0.07 lower to 0.85 higher) | SMD 0.39 (‐0.07, 0.85)
| 314 (4) | ⊕⊝⊝⊝
| We are uncertain whether mobility strategies improve HRQoL as the certainty of the evidence is very low.
We calculated SMD for 3 trials with EQ‐5D and 1 trial with HOOS.
Re‐expressing the results using the EQ‐5D (0 to 1 scale), there was an increase in quality of life of 0.03 in the intervention group (95% CI ‐0.02 to 0.22). MID for the EQ‐5D is typically 0.074 (Walters 2005).
Types of intervention in included trials: gait, balance and functional exercise: 4 studies.
|
| Mortality
Follow‐up: short‐term range 10 days to 6 months; long‐term = 12 months | Short term: 45 per 1000
| Short term: 48 per 1000 (22 to 104)
| Short term: RR 1.06 (0.48 to 2.30)
| Short term: 489 (6)
| ⊕⊕⊝⊝ | It is unclear whether mobility strategies reduce mortality as the certainty of evidence is low and the 95% CI includes both a reduction and an increase in the risk of mortality, in both the short term and the long term.
Types of intervention in included trials: gait, balance and functional exercise: 4 studies; resistance exercise: 3 studies; electrical stimulation: 1 study. |
| Long term: 116 per 1000l | Long term: 142 per 1000 (56 to 362) | Long term: RR 1.22 (0.48 to 3.12) | Long term: 133 (2) | ⊕⊕⊝⊝ | ||
| Adverse event: number of people who were re‐admitted
Follow‐up: range 5 days to 4 months | 229 per 1000k | 160 (36 to 254) | RR 0.70 (0.44 to 1.11) | 322 (4) | ⊕⊕⊝⊝ | It is unclear whether mobility strategies reduce re‐admission compared with usual care, as the CI includes both a reduction and an increase in the risk of re‐admission.
Types of intervention in included trials: gait, balance and functional exercise: 3 studies; resistance exercise: 1 study |
| Number of people who returned to living at pre‐fracture residence
Follow‐up: range 10 days to 4 months | 705 per 1000k | 754 per 1000 (452 to 1099) | RR 1.07 (0.73 to 1.56) | 240 (2) | ⊕⊕⊝⊝
| It is unclear whether mobility strategies increase the odds of returning to living at the pre‐fracture residence: there is low‐certainty evidence and the CI includes both a reduction and an increase in the risk of re‐admission.
Types of intervention in included trials: gait, balance and functional exercise: 1 study; resistance exercise: 1 study. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
| aMobility strategies may include exercises, physical training and muscle stimulation, used at various stages in rehabilitation, which aim to improve walking and minimise functional impairments. | ||||||
| Different types of mobility strategies compared with control after hip fracture surgery, on mobility, in the in‐hospital setting | |||||||
| Patient or population: adults following hip fracture surgery Settings: in‐hospital Comparison: usual in‐hospital carea Outcome: mobility, measured using mobility scales, 6‐Minute Walk Test and Timed Up and Go testb | |||||||
| Intervention type (according to ProFaNE)c | Mobility outcome | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | ||||||
| Control | Intervention | ||||||
| Gait, balance and functional training
Follow‐up: range 5 days to 4 months | Mobility scales, using different mobility scales: MILA (range 0 to 36), EMS (range 0 to 20), BBS (range 0 to 56), PPME (range 0 to 12), Koval (range 1 to 7). Higher values indicate better mobility (except MILA and Koval, where scale was inverted for consistency with other outcomes). | In the control group, the mean scores for the outcomes were: MILA = 19.2; EMS = 16.3; BBS = 26; PPME = 6.8 to 9.1; Koval = 4. | SMD 0.57 higher (0.07 higher to 1.06 higher). | SMD 0.57 (0.07 to 1.06)
| 463 (6) | ⊕⊕⊕⊝ | Interventions classified as gait, balance and functional training probably cause a moderatee increase in mobility compared with control (SMD 0.57).
Re‐expressing the results using the 12‐point PPME, the intervention group scored 1.56 points higher (95% CI 0.02 to 2.92). MID for the PPME is typically 1.13 to 2.15 (de Morton 2008). |
| Resistance/strength training
Follow‐up: range 10 days to 4 months | Mobility scales, using EMS (range 0 to 20). Higher values indicate better mobility | The meanf score on the EMS in the control group was 17. | MD 1 point higher on the EMS (0.81 lower to 2.81 higher). | MD 1.0 (‐0.81 to 2.81) | 44 (1) | ⊕⊕⊝⊝ | It is unclear whether resistance/strength training interventions increase mobility as the certainty of evidence is low and the 95% CI includes both a reduction and an increase in mobility. |
|
| TUG (lower score = faster) | The mean TUG time in the control group was 25.4 seconds. | MD 1.5 second faster TUG time (6.4 seconds faster to 3.4 seconds slower) | MD ‐1.5 (‐6.4 to 3.4) | 74 (1) | ⊕⊕⊝⊝ | It is unclear whether resistance/strength training interventions improve TUG as the certainty of evidence is low and the 95% CI includes both a reduction and an increase in score. |
| Flexibility |
|
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being flexibility. |
| 3D (Tai Chi, dance) |
|
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being 3D. |
| General physical activity |
|
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being general physical activity. |
| Endurance |
|
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being endurance training. |
| Multiple types of exercise |
|
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as containing multiple types of exercise. |
| Electrical stimulation |
|
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being electrical stimulation. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | |||||||
| aA control intervention may be: usual orthopaedic, medical care or allied health care. | |||||||
| Mobility strategies compared with control (e.g. usual care) after hip fracture surgery in the post‐hospital setting | ||||||
| Patient or population: adults following hip fracture surgery Settings: post‐hospital Intervention: mobility strategiesa Comparison: non‐provision controlb | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Controlc | Intervention | |||||
| Mobilityd ‐ overall analysis
Using different mobility scales: mPPT (range 0 to 36), POMA (range 0 to 30), SPPB (range 0 to 12), PPME (range 0 to 12). A higher score indicates better mobility.
Follow‐up: range 2 months to 12 months | In the control group, the mean scores for the outcomes were: mPPT (23.3), POMA (20.7), SPPB (range 6 to 7.72), PPME (10.1) | SMD 0.32 higher (0.11 higher to 0.54 higher) | SMD 0.32 (0.11 to 0.54)
| 761 (7) | ⊕⊕⊕⊕ | Overall, there is a small (based on Cohen's effect sizesf) increase in mobility compared with control (SMD 0.32).
Re‐expressing the results using the 12‐point SPPB, the intervention group scored 0.89 points higher (95% CI 0.30 to 1.50). Small meaningful change for SPPB: 0.27 to 0.55 points; substantial meaningful change: 0.99 to 1.34 points (Perera 2006).
Types of intervention in included trials: gait, balance and functional exercise: 5 studies; multiple types: 2 studies. |
| Walking speedg ‐ overall analysis
Measured using metres/second (m/s) and metres/minute (m/min). A higher score indicates faster walking.
Follow‐up: range 1 month to 12 months | The mean walking speed score in the control group ranged from 0.44 m/s to 0.97 m/s, and 20 m/min to 59.4 m/min. | SMD 0.16 higher (0.04 higher to 0.29 higher) | SMD 0.16 (0.04 to 0.29) | 1067 (14) | ⊕⊕⊕⊕
| There is a small increase in walking speed compared with control (SMD 0.16).
Re‐expressing the results using gait speed (m/sec), there was an increase in gait speed of 0.05 m/s in the intervention group (MD 0.05, 95% CI 0.01 to 0.09). Small meaningful change for walking speed is 0.04 to 0.06 m/s (Perera 2006).
Types of intervention in included trials: gait, balance and functional exercise: 7 studies; resistance exercise: 3 studies; endurance exercise: 1 study; multiple types: 3 studies. |
| Functioningi ‐ overall analysis
Using different functioning scales: FSQ (range 0 to 36), BI (range 0 to 100), AM‐PAC daily activity (range 9 to 101), COPM (range 0 to 20), LEFS (range 0 to 80), NEADL (range 0 to 66). A higher score indicates better functioning.
Follow‐up: range 3 months to 12 months | In the control group, the mean scores for the outcomes were: FSQ (24.8), BI (94.5), AM‐PAC (58.6), COPM (6.54), LEFS (28.8), NEADL (range 14.2 to 43.2). | SMD 0.23 higher (0.10 higher to 0.36 higher) | SMD 0.23 (0.10 to 0.36) | 936 (9) | ⊕⊕⊕⊕ | Overall, there is a small increase in functioning compared with control (SMD 0.23).
Re‐expressing the results using the BI, the intervention group scored 1.4 points higher (95% CI 0.6 to 2.1). MID for the BI (post‐hip surgery) is typically 9.8 (Unnanuntana 2018).
Types of intervention in included trials: gait, balance and functional exercise: 4 studies; resistance exercise: 2 studies; multiple types: 2 studies; other: 1 study |
| HRQoL using EQ‐ 5D (range 0 to 1), SF‐36 (range 0 to 100), SF‐12 (range 0 to 100), and WHOQOL‐BREF (range 0 to 130). A higher score indicates better quality of life.
Follow‐up: range 3 months to 6 months | In the control group, the mean scores for the outcomes were: EQ‐5D (range 0.6 to 0.75), SF‐36 (range 48 to 63), SF‐12 (45.5), WHOQOL‐BREF (13.2). | SMD 0.14 higher (0.00 lower to 0.29 higher) | SMD 0.14 (0.00 to 0.29) | 785 (10) | ⊕⊕⊕⊝
| SMD was calculated for 5 trials with EQ‐5D, 3 trials with SF‐36, 1 trial with SF‐12, 1 trial with WHOQOL‐BREF.
Re‐expressing the results using the EQ‐5D (0 to 1 scale), there was an increase in quality of life of 0.01 in the intervention group (95% CI ‐0.007 to 0.08). MID for the EQ‐5D is typically 0.074 (Walters 2005).
Re‐expressing the results using the SF‐36 (0 to 100 scale), there was an increase in quality of life of 3 points in the intervention group (95% CI ‐0.6 to 5.7). MID for SF‐36 typically 3 to 5 (Walters 2003).
Mobility strategies probably make little important difference to patient‐reported health‐related quality of life compared with control.
Types of intervention in included trials: gait, balance and functional exercise: 4 studies; resistance exercise: 3 studies; endurance exercise: 1 study; multiple types: 1 study; other: 1 study |
| Mortality
Follow‐up: range 3 months to 12 months | Short term: 35 per 1000l | Short term: 35 per 1000 (14 to 72) | Short term: RR 1.01 (0.49 to 2.06)
| Short term: 737 (8)
| ⊕⊕⊕⊝ | Overall, there is moderate‐certainty evidence that mobility strategies probably make little or no difference to mortality compared to control in the short term.
It is unclear whether mobility strategies reduce mortality in the long term as the certainty of evidence is low and the 95% CI includes both a reduction in the risk of mortality and an increase in the risk of mortality.
Types of intervention in included trials: gait, balance and functional exercise: 3 studies; resistance exercise: 3 studies; multiple types: 5 studies. |
| Long term: 71 per 1000l | Long term: 52 per 1000 (28 to 97)
| Long term: RR 0.73 (0.39 to 1.37) | Long term: 588 (4) | ⊕⊕⊝⊝ | ||
| Adverse event: number of people who were re‐admitted
Follow‐up: range 1 month to 12 months | 231 per 1000l | 199 (120 to 328) | RR 0.86 (0.52 to 1.42) | 206 (2) | ⊕⊕⊝⊝ | The evidence is of low certainty: the intervention may decrease the number of re‐admissions by 14%; however, the 95% CI includes the possibility of both a 48% reduction and a 42% increase.
Types of intervention in included trials: multiple types: 1 study; other: 1 study. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
| a Postoperative care programmes such as exercises, physical training and muscle stimulation, used at various stages in rehabilitation, which aim to improve walking and minimise functional impairments. | ||||||
| Different types of mobility strategies compared with control after hip fracture surgery, on mobility, in the post‐hospital setting | |||||||
| Patient or population: adults following hip fracture surgery Settings: post‐hospital Comparison: non‐provision controla Outcome: mobilityb | |||||||
| Intervention type (according to ProFaNE)c | Mobility outcome | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | ||||||
| Control | Intervention | ||||||
| Gait, balance and functional training
Follow‐up: range 2 months to 12 months | Mobility scales, using different scales: SPPB (range 0 to 12), PPME (range 0 to 12). A higher score indicates better mobility. | In the control group, the mean scores for the outcomes were: SPPB (range 6 to 7.72), PPME (10.1). | SMD 0.20 higher (0.05 higher to 0.36 higher) | SMD 0.20 (95% CI 0.05 to 0.36)
| 621 (5) | ⊕⊕⊕⊕ | Interventions classified as gait, balance and functional training cause a smalle increase in mobility compared with control.
Re‐expressing the results using the 12‐point SPPB, the intervention group scored 0.55 points higher (95% CI 0.14 to 1.0). Small meaningful change for SPPB: 0.27 to 0.55 points; substantial meaningful change: 0.99 to 1.34 points (Perera 2006). |
|
| TUG (lower score = faster) | The mean TUG time in the control group was 30.22 seconds.
| MD 7.57 seconds faster (19.25 seconds faster to 4.11 seconds slower) | MD ‐7.57 (‐19.25 to 4.11)
| 128 (1) | ⊕⊝⊝⊝ | Gait, balance and functional training may increase TUG speed by 7.57 seconds; however, the 95% confidence interval includes both a reduction and increase in TUG. |
|
| 6 Minute Walk Test |
|
|
| 0 |
|
|
| Resistance/strength training Follow‐up: range 10 weeks to 3 months | Mobility scales |
|
|
| 0 |
|
|
|
| TUG | The mean TUG time in the control group was 20 seconds. | MD 6 seconds faster (12.95 seconds faster to 0.95 seconds slower) | MD ‐6.00 (‐12.95, 0.95) | 96 (1) | ⊕⊕⊝⊝ | Resistance/strength training may increase TUG speed by 6 seconds; however, the 95% confidence interval includes both a reduction and increase in TUG. |
|
| 6MWT | The mean 6MWT distance in the control group was 243 m. | MD 56 metres further (29 metres further to 83 metres further) | MD 55.65 (28.58 to 82.72) | 198 (3) | ⊕⊕⊝⊝ | Resistance/strength training may increase 6MWT by 53 metres. MID for the 6MWT (adults with pathology) is typically 14.0 to 30.5m (Bohannon 2017). |
| Flexibility | All |
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being flexibility. |
| 3D (Tai Chi, dance) | All |
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being 3D. |
| General physical activity | All |
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being general physical activity. |
| Endurance Follow‐up: 3 months | Mobility scales |
|
|
| 0 |
|
|
|
| TUG |
|
|
| 0 |
|
|
|
| 6MWT | The mean 6MWT distance in the control group was 266 m. | MD 12.7 metres further (72 metres less to 97 metres further). | MD 12.70 (‐72.12, 97.52) | 21 (1) | ⊕⊝⊝⊝ | We are uncertain whether endurance training improves mobility as the certainty of the evidence is very low. |
| Multiple primary types of exercise
Follow‐up: range 2 months to 6 months | Mobility scales, using different mobility scales: mPPT (range 0 to 36), POMA (range 0 to 30). | In the control group, the mean scores for the outcomes were: mPPT (23.3), POMA (range 20.7). | SMD 0.94 higher (0.53 higher to 1.34 higher) | SMD 0.94 (0.53 to 1.34) | 104 (2) | ⊕⊕⊕⊝ | Interventions that contain multiple types of exercise probably leads to a moderate increase in mobility.
Re‐expressing the results using the 12‐point SPPB, the intervention group scored 2.6 points higher (95% CI 1.47 to 3.71). Substantial meaningful change for SPPB: 0.99 to 1.34 points (Perera 2006). |
|
| TUG |
|
|
| 0 |
|
|
|
| 6MWT | The mean 6MWT distance in the control group was 233.1 m. | MD 9 metres further (15 metres less to 33 metres further) | 9.30 (‐14.62 to 33.22) | 187 (1) | ⊕⊕⊝⊝ | Interventions containing strength training and endurance training may increase 6MWT by 9 metres. MID for the 6MWT (adults with pathology) is typically 14.0 to 30.5m (Bohannon 2017). |
| Electrical stimulation |
|
|
|
| 0 |
| 0 studies contained a mobility strategy categorised as primarily being electrical stimulation |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | |||||||
| aA non‐provision control is defined as no intervention, usual care, sham exercise (the exercise was intended to be a control, or appeared to be of insufficient intensity and progression to have beneficial effects on mobility) or a social visit. | |||||||
| Study ID | Age (mean) | % women | Gait speed in control group at follow‐up (m/s) | Duration of intervention (weeks) | Type of intervention (ProFaNE) | Intervention delivered by expert health provider | Exclusion criterion based on impaired cognition |
| 84 | 100% | 0.43 | Not specified | Balance, gait & functional | Yes | No | |
| 80 | 74% | 0.99 | 24 | Balance, gait & functional; resistance | Yes | Yes | |
| 84 | 79% | NR | 52 | Balance, gait & functional | Yes | Yes | |
| 81 | 92% | NR | 6 | Electrical stimulation | Yes | Yes | |
| 71 | 67% | NR | 1.5 | Electrical stimulation | Yes | No | |
| NR | NR | NR | Early WB v late WB | Balance, gait & functional | Unclear | No | |
| 81 | 100% | 0.44 | 12 | Balance, gait & functional; resistance | Unclear | Yes | |
| 73 | 75% | NR | 4.7 | Balance, gait & functional | Yes | No | |
| 81 | 64% | NR | 1 | Balance, gait & functional | Yes | No | |
| 80 | 77% | NR | 10 days (or discharge, if discharged prior) | Resistance | Yes | Yes | |
| 84 | 100% | 0.43 | 6 | Electrical stimulation | No | Yes | |
| 83 | 63% | 0.83 | 16 | Other (telephone support and coaching) | Yes | Yes | |
| 78 | 69% | NR | 24 | Balance, gait & functional | Yes | Yes | |
| 80 | 100% | NR | 2 | Balance, gait & functional | Yes | No | |
| 81 | 77% | 0.74 | 16 | Resistance; endurance | Yes | No | |
| 79 | 73% | 0.65 | 12 | Resistance; endurance | Yes | Yes | |
| 81 | 81% | 0.91 | 10 | Resistance | Yes | Yes | |
| 84 | 77% | 0.5 | 12 | Resistance | Yes | Yes | |
| 80 | 84% | 0.42 | 6 | Balance, gait & functional; resistance | Unclear | Yes | |
| 77 | 71% | NR | 3 | Balance, gait & functional | Yes | Yes | |
| 84 | 81% | 0.6 | 16 | Balance, gait & functional | Yes | Yes | |
| 79 | 68% | NR | 2 | Balance, gait & functional | Yes | Yesa | |
| 90 | 100% | 0.35 | 12 | Balance, gait & functional | Yes | No | |
| 79 | 68% | NR | 1 | Balance, gait & functional | Yes | No | |
| 82 | 100% | NR | 52 | Resistance; endurance; other (self‐efficacy‐based motivational component) | No | Yes | |
| 80 | 89% | NR | 12 | Other (cognitive behavioural therapy (CBT), CBT plus sensory monitoring) | Yes | No | |
| 81 | 100% | NR | 52 | Resistance; endurance; other (motivational interventions) | No | Yes | |
| 80 | 78% | 0.97 | 52 | Balance, gait & functional | Yes | Yes | |
| 79 | 79% | 0.5 | 4 | Balance, gait & functional | Yes | Yes | |
| 81 | 68% | 0.19 | 2 | Balance, gait & functional | Yes | Yes | |
| (WB group; NWB group) | 79 | 80% | 0.55; 0.62 | 16 | Balance, gait & functional; other (specific group of muscle contractions in supine) | Yes | Yes |
| 78 | 76% | 0.83 | 52 | Balance, gait & functional | Yes | Yes | |
| 78 | 75% | NR | 12 | Resistance | Yes | No | |
| 75 | 66% | NR | 6 | Other (physical activity enhancing program, based on Resnick's self‐efficacy model) | No | No | |
| 82 | 83% | 0.51 | 12 | Resistance | Yes | Yes | |
| 82 | 81% | 0.8 | 12 | Resistance | Yes | Yes | |
| 83 | 77% | 0.62 | 10 | Balance, gait & functional | Yes | No | |
| 73 | 80% | 0.33 | 12 | Balance, gait & functional | Yes | Yes | |
| 83 | 73% | 0.72 | 6 | Balance, gait & functional | Yes | Yes | |
| 79 | 75% | 0.8 | 12 | Balance, gait & functional; other (workbook and goal setting diary) | Yes | Yes | |
| NR: not reported; NWB: non‐weight bearing; WB: weight bearing | |||||||
| Study ID | Setting | Length of follow‐up (months) | No. randomised | No. analysed | % lost to follow‐up |
| Inpatient | Until discharge from hospital | 40 | 40 | 0% | |
| Post‐hospital | 6 | 90 | 80 | 11% | |
| Post‐hospital | 12 | 173 | 128 | 26% | |
| Inpatienta | 3.5 | 26 | 18 | 31% | |
| Inpatient | 10 days | 60 | 60 | 0% | |
| Inpatient | 12 | 273 | 212 | 22% | |
| Post‐hospital | 6 | 28 | 24 | 14% | |
| Inpatient | 3 | 100 | 87 | 13% | |
| Inpatient | 6 | 92 | 92 | 0% | |
| Inpatient | 10 days | 90 | 74 | 18% | |
| Inpatienta | 3 | 27 | 24 | 11% | |
| Post‐hospitalb | 4 months | 30 | 26 | 13% | |
| Post‐hospital | 9 | 232 | 195 | 16% | |
| Inpatient | Until discharge from hospital | 88 | 60 | 32% | |
| Post‐hospital | 4 | 201 | 187 | 7% | |
| Post‐hospital | 3 | 41 | 33 | 20% | |
| Post‐hospital | 12 | 26 | 26 | 0% | |
| Inpatienta | 3 | 63 | 63 | 0% | |
| Inpatient | 4 | 80 | 44 | 45% | |
| Inpatienta | 12 (3 weeks used in analysis) | 52 | 52 | 0% | |
| Inpatienta | 4 | 160 | 150 | 6% | |
| Inpatient | 6 | 45 | 41 | 16% | |
| Inpatient | 3 | 27 | 18 | 33% | |
| Inpatient | 0.25 | 60 | 60 | 0% | |
| Post‐hospital | 12 | 180 | 180 | 0% | |
| Pol 2019c,d | Post‐hospital | 4 | 240 | 151 | 37% |
| Post‐hospital | 12 | 155 | 113 | 27% | |
| Post‐hospital | 12 | 81 | 75 | 7% | |
| Post‐hospital | 1 | 44 | 40 | 9% | |
| Inpatient | 0.5 | 80 | 77 | 4% | |
| Post‐hospital | 4 | 120 | 105 | 13% | |
| Post‐hospital | 12 | 336 | 159 | 53% | |
| Post‐hospitalb | 3 | 100 | 96 | 4% | |
| Post‐hospital | 1.5 | 46 | 46 | 0% | |
| Post‐hospital | 3 | 150 | 150 | 0% | |
| Post‐hospital | 3 | 95 | 90 | 5% | |
| Post‐hospital | 2 | 143 | 123 | 14% | |
| Post‐hospital | 3 | 54 | 25 | 54% | |
| Inpatient | 13 (4 weeks used in analysis) | 70 | 51 | 27% | |
| Post‐hospital | 3 | 61 | 24 | 61% | |
| aIntervention delivered in hospital and after discharge. Majority of intervention delivered in inpatient setting | |||||
| Clearly defined study population? | Interventions sufficiently described? | Main outcomes sufficiently | Appropriate timing of outcome measurement? | Assessment of compliance with interventions | |
| Yes | Partial: frequency and intensity of gait retraining not described | Yes | No: only followed up until discharge: mean stay in rehabilitation hospital for intervention group was 54 days. | No: although mention of treadmill participants aiming to exceed previous performance on the treadmill | |
| Yes | Yes | Yes | Partial: although 6 months follow‐up, it was only until the end of the intervention. | Yes: in both groups | |
| Yes | Yes | Yes | Yes | Yes | |
| Yes | Partial: usual post‐discharge | Yes | Partial: 14 weeks. Intervention ended after 6 weeks. | Partial: compliance and tolerance to electrical stimulation only reported for intervention group | |
| Yes | Yes | Yes (although limited) | No: 10 days marking end of treatment. | Yes: it is stated that intervention was received by all participants | |
| Partial: inadequate description; excluded post‐randomisation if unsuitable to walk at 2 weeks | Partial: little description of rehabilitation | Partial: no record of mobility outcomes | Yes: 1 year | No | |
| Yes | Yes | Partial: however, clarification on some outcome measures was obtained via contact with trial author | Yes: 6 months (3 months after the end of the intervention). Two year follow‐up results reported for whole study population | Yes: in both groups | |
| Partial: no mention of exclusion criteria. Though the inclusion criteria were a displaced femoral neck fracture, the implants used for some participants (9 Jewett nails, 1 Rush nail, 1 Kuntscher nail) suggest that some extracapsular fractures were included. | Yes | Partial: incomplete descriptions | No: 9 weeks only for function (3 months for mortality) | No | |
| Yes | Yes | Yes | No: length of follow‐up is Day 5 or discharge if discharged before Day 5 | No | |
| Yes | Yes | Yes | No: 10 days or discharge if sooner | Yes: in both groups | |
| Yes | Yes | Yes | Partial: 13 weeks from surgery. | Yes: “All of the women used their stimulators for more than 75% of the cumulative time requested” | |
| Yes | Yes | Yes | Partial | No | |
| Yes | Yes | Yes | Partial: 9 months | Yes: compliance with interventions assessed: "adherence was 98%” | |
| Yes | Yes | Yes | No: primary outcome = length of training period; otherwise until discharge | Yes: in terms of the interventions (although not the components) | |
| Yes | Yes | Yes | Partial: 40 weeks | Yes | |
| Yes | Yes | Yes | No: 12 weeks for the two intervention groups but 8 weeks only for the control group. | Partial: only compliance of the intervention groups recorded | |
| Yes | Yes | Yes | Partial: majority followed up for 16 weeks | Yes | |
| Yes | Yes | Yes | Partial: 12 weeks only for mobility outcomes. One year follow‐up data for mortality, re‐admissions and admission to higher level of care | Partial: only compliance of the intervention groups recorded | |
| Yes | Yes | Yes | Partial: 16 weeks follow‐up. Intervention ended at 6 weeks | Partial: only compliance with intervention recorded | |
| Yes | Partial: dosage about open kinetic chain exercises in the control group not described | Yes | Partial | Yes: “Physiotherapists’ systematic checking of the exercise administration manual revealed excellent compliance rates in both groups". | |
| Yes | Yes | Yes | Partial: 16 weeks follow‐up. | Yes: “Participants completed exercise diaries which were analysed to ascertain adherence to the programmes.” | |
| Yes | Yes | Yes | Partial: 6 months follow‐up (5 months after the end of intervention) | No | |
| Yes | No: standard physical therapy not described. Intensity of treadmill training not described | Yes | Partial: average of approximately 6 months | No | |
| Yes | Yes | Yes | No: only until acute hospital discharge. Mobility outcomes at 7 days | Yes: time to first walk recorded in both groups | |
| Yes | Yes | Yes | Yes. Outcomes were assessed at 2, 6, and 12 months after hip fracture | Yes. Hours spent exercising quantified | |
| Yes | Yes | Yes | Partial | Yes | |
| Yes | Yes | Yes | No: although follow‐up was 12 months from fracture, this coincided with the end of treatment | Partial: no data for usual care group | |
| Yes | Partial: control standard care did not have specific dosage for the exercise “5‐7 exercises for the lower limbs” | Yes | Partial | Partial: only compliance in intervention group reported but reported “None of the participants were followed for compliance” in control | |
| Yes | Partial: "Usual care" not described | Yes | No: final assessment at 1 month (27 to 43 days) | Partial: only the intervention group completed diaries and were asked about the specific exercises. However, all participants were asked about general exercise. | |
| Yes | Yes | Yes | No: 2 weeks follow‐up only | Partial: some data available but not regarding weight bearing | |
| Yes | Yes | Yes | Partial: 4 months follow‐up only | Partial: compliance data collected for the two exercise groups but not for the control group. | |
| Yes | Yes | Yes | Yes: 12 months | Partial: compliance data collected for intervention group via diaries | |
| Yes | Yes | No | Partial: 6 months | No | |
| No | No | Unclear | No: 6 weeks after discharge | No | |
| Yes | Yes | Yes | No: intervention is only 12 weeks following an observation period of 12 weeks | No: not assessed | |
| Yes | Yes | Yes | Partial: although is 36 weeks after fracture, trial 1 starts 12 weeks after fracture, final follow‐up is 24 weeks after start of 2011 intervention | No: not assessed | |
| Yes | Yes | Yes | Yes: T3 = 48 to 56 weeks | Yes | |
| Yes | Yes | Yes | Yes: 6 months' follow‐up. | No. However, 4 participants in the intervention group were excluded because of poor compliance. | |
| Yes | Yes | Yes | Partial: 12 months' follow‐up for some but not all outcomes | No, included in protocol bot not reported | |
| Yes | Yes | Yes | No: 3 months | No |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Mobility (measured using mobility scales): combined data for all strategy types Show forest plot | 7 | 507 | Std. Mean Difference (IV, Random, 95% CI) | 0.53 [0.10, 0.96] |
| 1.2 Mobility (failure to regain pre‐facture mobility): combined data for all strategy types Show forest plot | 2 | 64 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.27, 0.85] |
| 1.3 Mobility (measured using self‐reported outcomes): combined data for all strategy types Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.4 Mobility (measured using mobility scales): gait, balance and function Show forest plot | 6 | 463 | Std. Mean Difference (IV, Random, 95% CI) | 0.57 [0.07, 1.06] |
| 1.5 Mobility (measured using mobility scales): resistance/strength training Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.6 Mobility (measured in seconds using TUG): resistance/strength training Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.7 Mobility (measured using mobility scales) reporting individual outcome measures Show forest plot | 8 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.7.1 Elderly Mobility Scale | 2 | 95 | Mean Difference (IV, Random, 95% CI) | 0.49 [‐0.81, 1.79] |
| 1.7.2 Physical Performance and Mobility Examination Score | 2 | 227 | Mean Difference (IV, Random, 95% CI) | 0.34 [‐0.31, 0.99] |
| 1.7.3 Berg Balance Scale | 2 | 93 | Mean Difference (IV, Random, 95% CI) | 12.39 [8.79, 15.98] |
| 1.7.4 Modified Iowa Level of Assistance | 1 | 92 | Mean Difference (IV, Random, 95% CI) | 2.70 [‐0.94, 6.34] |
| 1.7.5 Timed Up and Go | 3 | 158 | Mean Difference (IV, Random, 95% CI) | 4.03 [‐6.17, 14.23] |
| 1.7.6 Performance Oriented Mobility Assessment | 1 | 51 | Mean Difference (IV, Random, 95% CI) | 0.90 [‐1.14, 2.94] |
| 1.7.7 Koval Walking Ability score | 1 | 41 | Mean Difference (IV, Random, 95% CI) | 1.53 [0.72, 2.34] |
| 1.7.8 Western Ontario and McMaster Universities OA Index (self‐reported) | 1 | 52 | Mean Difference (IV, Random, 95% CI) | ‐25.40 [‐28.72, ‐22.08] |
| 1.8 Walking speed (measured as metres/time): combined data for all strategy types Show forest plot | 6 | 360 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.16 [‐0.05, 0.37] |
| 1.9 Walking speed (measured as metres/time): gait, balance and function Show forest plot | 5 | 336 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.15 [‐0.07, 0.36] |
| 1.10 Walking speed (measured as metres/time): electrical stimulation Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.11 Functioning (measured using functioning scales): combined data for all strategy types Show forest plot | 7 | 379 | Std. Mean Difference (IV, Random, 95% CI) | 0.75 [0.24, 1.26] |
| 1.12 Functioning (measured using functioning scales): gait, balance and function Show forest plot | 5 | 312 | Std. Mean Difference (IV, Random, 95% CI) | 0.56 [‐0.00, 1.13] |
| 1.13 Functioning (measured using functioning scales): resistance/strength training Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.14 Functioning (measured using functioning scales): electrical stimulation Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.15 Health‐related quality of life (measured using HRQoL scales): gait, balance and function Show forest plot | 4 | 314 | Std. Mean Difference (IV, Random, 95% CI) | 0.39 [‐0.07, 0.85] |
| 1.16 Mortality, short term: combined data for all strategy types Show forest plot | 6 | 489 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.06 [0.48, 2.30] |
| 1.17 Mortality, short term: gait, balance and function Show forest plot | 3 | 293 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.43 [0.44, 4.66] |
| 1.18 Mortality, short term: resistance/strength training Show forest plot | 2 | 170 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.26, 2.62] |
| 1.19 Mortality, short term: electrical stimulation Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 1.20 Mortality, long term: combined data for all strategy types Show forest plot | 2 | 133 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.48, 3.12] |
| 1.21 Mortality, long term: gait, balance and function Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 1.22 Mortality, long term: resistance/strength training Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 1.23 Adverse events (measured using dichotomous outcomes): combined data for all strategy types Show forest plot | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.23.1 Re‐admission | 4 | 322 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.44, 1.11] |
| 1.23.2 Re‐operation | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.32 [0.01, 7.57] |
| 1.23.3 Surgical complications | 1 | 18 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 1.23.4 Pain | 3 | 245 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.12 [0.80, 1.57] |
| 1.23.5 Falls (number of people who experienced one or more falls) | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.32, 1.38] |
| 1.23.6 Other: orthopaedic complication (as reason for withdrawal from study) | 1 | 88 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.50 [0.45, 4.95] |
| 1.24 Adverse events (measured using rate of falls): all studies were gait, balance and function Show forest plot | 3 | Rate Ratio (IV, Fixed, 95% CI) | 0.85 [0.64, 1.12] | |
| 1.25 Adverse events (measured using continuous measures of pain): combined data for all strategy types Show forest plot | 2 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.26 Return to living at pre‐fracture residence: combined data for all strategy types Show forest plot | 2 | 240 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.73, 1.56] |
| 1.27 Return to living at pre‐fracture residence: additional study not included in main analysis Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 1.28 Return to living at pre‐fracture residence: gait, balance and function Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 1.29 Return to living at pre‐fracture residence: resistance/strength training Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Walking, use of walking aid/need for assistance Show forest plot | 2 | 230 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.74, 1.11] |
| 2.2 Balance (measured using functional reach test, cm) Show forest plot | 2 | 121 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.37 [0.01, 0.73] |
| 2.3 Balance (measured using balance scale) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 2.4 Balance (measured using ability to tandem stand) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 2.5 Balance (measured using step test; number of steps) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 2.6 Balance (measured using self‐reported outcomes) Show forest plot | 2 | 226 | Risk Ratio (M‐H, Random, 95% CI) | 0.96 [0.71, 1.29] |
| 2.7 Sit to stand (measured as number of stand ups/second) Show forest plot | 2 | 227 | Mean Difference (IV, Fixed, 95% CI) | 0.04 [0.01, 0.07] |
| 2.8 Strength Show forest plot | 8 | 498 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.11 [‐0.07, 0.28] |
| 2.9 Activities of daily living (measured using ADL scales) Show forest plot | 5 | 206 | Std. Mean Difference (IV, Random, 95% CI) | 0.87 [0.35, 1.38] |
| 2.10 Resource use (measured by length of hospital stay) Show forest plot | 4 | 335 | Mean Difference (IV, Fixed, 95% CI) | ‐0.83 [‐3.94, 2.28] |
| 2.11 Resource use (measured by use of community services) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Weight‐bearing at 2 wks v weight‐bearing at 12 weeks (mortality) Show forest plot | 1 | 273 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.74 [0.43, 1.29] |
| 3.2 Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (mortality) Show forest plot | 1 | 60 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.20 [0.14, 75.55] |
| 3.3 Weight‐bearing at 2 wks v weight‐bearing at 12 weeks (adverse events) Show forest plot | 1 | 594 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.54, 1.37] |
| 3.3.1 Avascular necrosis | 1 | 112 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.33, 1.42] |
| 3.3.2 Infection | 1 | 270 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.11, 3.81] |
| 3.3.3 Non‐union | 1 | 212 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.06 [0.56, 2.03] |
| 3.4 Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (return to living at home) Show forest plot | 1 | 60 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.72, 1.02] |
| 3.5 Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (walking aid/assistance) Show forest plot | 1 | 60 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.51 [0.29, 0.89] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Mobility (measured using mobility scales): combined data for all strategy types Show forest plot | 7 | 761 | Std. Mean Difference (IV, Random, 95% CI) | 0.32 [0.11, 0.54] |
| 4.2 Mobility (measured using Timed Up and Go, seconds): combined data for all strategy types Show forest plot | 3 | 375 | Mean Difference (IV, Fixed, 95% CI) | ‐1.98 [‐5.59, 1.63] |
| 4.3 Mobility (measured using 6‐Minute Walk Test, metres): combined data for all strategy types Show forest plot | 4 | 396 | Mean Difference (IV, Fixed, 95% CI) | 28.66 [10.88, 46.44] |
| 4.4 Mobility (measured using mobility scales): gait, balance and function Show forest plot | 5 | 621 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.20 [0.05, 0.36] |
| 4.5 Mobility (measured using Timed Up and Go, seconds): gait, balance and function Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.6 Mobility (measured using Timed Up and Go, seconds): resistance/strength training Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.7 Mobility (measured using 6‐Minute Walk Test, metres): resistance/strength training Show forest plot | 3 | 198 | Mean Difference (IV, Fixed, 95% CI) | 55.65 [28.58, 82.72] |
| 4.8 Mobility (measured using 6‐Minute Walk Test, metres): endurance training Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.9 Mobility (measured using mobility scales): multiple component Show forest plot | 2 | 104 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.94 [0.53, 1.34] |
| 4.10 Mobility (measured using 6‐Minute Walk Test, metres): multiple component Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.11 Mobility (measured using mobility scales): other type of exercise (non‐weight bearing exercise) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.12 Mobility (measured using Timed Up and Go, seconds): other type of exercise OT +/‐ sensor) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.13 Mobility (measured using mobility scales) reporting individual outcome measures Show forest plot | 14 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 4.13.1 Modified Physical Performance Test | 1 | 80 | Mean Difference (IV, Random, 95% CI) | 5.70 [2.74, 8.66] |
| 4.13.2 Physical Performance and Mobility Examination Score | 1 | 105 | Mean Difference (IV, Random, 95% CI) | 0.32 [‐0.42, 1.05] |
| 4.13.3 Short Physical Performance Battery | 4 | 552 | Mean Difference (IV, Random, 95% CI) | 0.68 [0.15, 1.21] |
| 4.13.4 Performance Oriented Mobility Assessment | 1 | 24 | Mean Difference (IV, Random, 95% CI) | 4.90 [2.11, 7.69] |
| 4.13.5 Timed Up and Go | 3 | 366 | Mean Difference (IV, Random, 95% CI) | 1.69 [‐2.74, 6.12] |
| 4.13.6 6 Minute Walk Test | 4 | 396 | Mean Difference (IV, Random, 95% CI) | 33.98 [7.08, 60.89] |
| 4.14 Mobility (measured using self‐report, continuous scales): combined data for all strategy types Show forest plot | 2 | 355 | Mean Difference (IV, Fixed, 95% CI) | 1.46 [‐0.62, 3.53] |
| 4.15 Mobility (measured using self‐reported, dichotomous outcome): combined data for all strategy types Show forest plot | 1 | 108 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.45 [0.29, 0.72] |
| 4.16 Walking speed: combined data for all strategy types Show forest plot | 14 | 1067 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.16 [0.04, 0.29] |
| 4.17 Walking speed: gait, balance and function Show forest plot | 7 | 511 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.08 [‐0.09, 0.25] |
| 4.18 Walking speed: resistance/strength training Show forest plot | 3 | 197 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.29 [‐0.01, 0.58] |
| 4.19 Walking speed: endurance Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.20 Walking speed: multiple component Show forest plot | 3 | 285 | Std. Mean Difference (IV, Random, 95% CI) | 0.53 [‐0.13, 1.18] |
| 4.21 Walking speed: other (post‐discharge physio telephone support and coaching) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.22 Walking speed: other (non‐weight bearing) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.23 Walking speed subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types Show forest plot | 14 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 4.23.1 People with cognitive impairment included | 2 | 304 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.07 [‐0.16, 0.29] |
| 4.23.2 People with cognitive impairment excluded | 12 | 762 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.19 [0.04, 0.34] |
| 4.24 Walking speed: subgrouped by outpatient v secondary and social care setting Show forest plot | 14 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 4.24.1 Outpatient | 2 | 229 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.35 [0.08, 0.62] |
| 4.24.2 Secondary and social care | 12 | 838 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.11 [‐0.02, 0.25] |
| 4.25 Walking speed subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategies Show forest plot | 14 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 4.25.1 Mean age in study 80 years or less | 8 | 536 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.12 [‐0.05, 0.30] |
| 4.25.2 Mean age in study > 80 years | 6 | 530 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.18 [0.01, 0.36] |
| 4.26 Functioning (measured using functioning scales): combined data for all strategy types Show forest plot | 9 | 936 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.23 [0.10, 0.36] |
| 4.27 Functioning (measured using functioning scales): gait, balance and function Show forest plot | 4 | 432 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.17 [‐0.02, 0.36] |
| 4.28 Functioning (measured using functioning scales): resistance/strength training Show forest plot | 2 | 246 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.29 [0.03, 0.55] |
| 4.29 Functioning (measured using functioning scales): multiple components Show forest plot | 2 | 107 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.34 [‐0.04, 0.72] |
| 4.30 Functioning (measured using functioning scales): other: OT +/‐ sensor Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.31 Health‐related quality of life (measured using HRQoL scales): combined data for all strategy types Show forest plot | 10 | 785 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.14 [‐0.00, 0.29] |
| 4.32 Health‐related quality of life (measured using HRQoL scales): gait, balance and function Show forest plot | 4 | 316 | Std. Mean Difference (IV, Random, 95% CI) | 0.08 [‐0.37, 0.53] |
| 4.33 Health‐related quality of life (measured using HRQoL scales): resistance/strength training Show forest plot | 3 | 197 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.15 [‐0.14, 0.45] |
| 4.34 Health‐related quality of life (measured using HRQoL scales): endurance Show forest plot | 1 | 22 | Mean Difference (IV, Random, 95% CI) | 9.50 [‐8.56, 27.56] |
| 4.35 Health‐related quality of life (measured using HRQoL scales): multiple components Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.36 Health‐related quality of life subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types Show forest plot | 10 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 4.36.1 People with cognitive impairment included | 1 | 120 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.00 [‐0.36, 0.36] |
| 4.36.2 People with cognitive impairment excluded | 9 | 665 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.17 [0.01, 0.33] |
| 4.37 Health‐related quality of life subgrouped by outpatient v secondary and social care setting Show forest plot | 10 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 4.37.1 Outpatient | 2 | 233 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.18 [‐0.09, 0.45] |
| 4.37.2 Secondary and social care | 8 | 552 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.13 [‐0.04, 0.30] |
| 4.38 Health‐related quality of life subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategy Show forest plot | 10 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 4.38.1 Mean age in study 80 years or less | 4 | 184 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.25 [‐0.05, 0.55] |
| 4.38.2 Mean age in study > 80 years | 6 | 601 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.11 [‐0.05, 0.27] |
| 4.39 Mortality, short term: combined data for all strategy types Show forest plot | 7 | 737 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.49, 2.06] |
| 4.40 Mortality, short term: gait, balance and function Show forest plot | 3 | 264 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.12 [0.46, 2.72] |
| 4.41 Mortality, short term: resistance/strength training Show forest plot | 2 | 123 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.40 [0.19, 10.03] |
| 4.42 Mortality, short term: multiple components Show forest plot | 2 | 290 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.08, 4.55] |
| 4.43 Mortality, short term: other: non‐weight bearing Show forest plot | 1 | 60 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.50 [0.03, 7.59] |
| 4.44 Mortality, long term: combined data for all strategy types Show forest plot | 4 | 588 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.39, 1.37] |
| 4.45 Mortality, long term: gait, balance and function Show forest plot | 2 | 254 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.34, 1.67] |
| 4.46 Mortality, long term: multiple components Show forest plot | 2 | 334 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.25, 1.96] |
| 4.47 Adverse events (measured using dichotomous outcomes): combined data for all strategy types Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.47.1 Re‐admission | 2 | 206 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.52, 1.42] |
| 4.47.2 Re‐operation | 1 | 173 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.46 [0.20, 1.08] |
| 4.47.3 Surgical complications | 1 | 25 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.06, 13.18] |
| 4.48 Adverse events (measured using re‐admission rate: combined for all strategy types Show forest plot | 1 | Rate Ratio (IV, Fixed, 95% CI) | Totals not selected | |
| 4.49 Adverse events (measured using rate of falls): combined for all strategy types Show forest plot | 3 | Rate Ratio (IV, Fixed, 95% CI) | 0.79 [0.63, 0.99] | |
| 4.50 Adverse events (measured using rate of falls): gait, balance and function Show forest plot | 2 | Rate Ratio (IV, Fixed, 95% CI) | 0.78 [0.62, 0.99] | |
| 4.51 Adverse events (measured using rate of falls): other (additional phone support and coaching) Show forest plot | 1 | Rate Ratio (IV, Fixed, 95% CI) | Totals not selected | |
| 4.52 Adverse events (measured as number of people who experienced 1 or more falls) Show forest plot | 4 | Risk Ratio (IV, Fixed, 95% CI) | 1.03 [0.85, 1.25] | |
| 4.53 Adverse events (measured using continuous measure of pain) Show forest plot | 3 | 242 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.04 [‐0.29, 0.22] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Walking (measured as use of walking aid/need for assistance) Show forest plot | 4 | 314 | Risk Ratio (M‐H, Random, 95% CI) | 0.46 [0.16, 1.31] |
| 5.2 Walking (measured using self‐reported outcomes) Show forest plot | 2 | 182 | Risk Ratio (M‐H, Random, 95% CI) | 0.55 [0.28, 1.06] |
| 5.3 Balance (measured using functional reach test, cm) Show forest plot | 2 | 144 | Mean Difference (IV, Fixed, 95% CI) | 1.30 [‐1.70, 4.31] |
| 5.4 Balance (measured using timed standing in various positions) Show forest plot | 2 | 234 | Std. Mean Difference (IV, Random, 95% CI) | 0.24 [‐0.37, 0.86] |
| 5.5 Balance (measured using balance scale) Show forest plot | 2 | 212 | Std. Mean Difference (IV, Random, 95% CI) | 0.28 [‐0.52, 1.08] |
| 5.6 Balance (measured using continuous self‐reported meaure) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 5.7 Balance (measured using dichotomous self‐reported measure) Show forest plot | 2 | 148 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.82 [0.69, 0.98] |
| 5.8 Sit to stand (measured as number of stand ups/second) Show forest plot | 5 | 457 | Mean Difference (IV, Random, 95% CI) | ‐6.49 [‐12.23, ‐0.75] |
| 5.9 Strength Show forest plot | 14 | 1121 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.30 [0.18, 0.42] |
| 5.10 Strength subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types Show forest plot | 14 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 5.10.1 People with cognitive impairment included | 2 | 230 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.07 [‐0.19, 0.33] |
| 5.10.2 People with cognitive impairment excluded | 12 | 891 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.37 [0.23, 0.50] |
| 5.11 Strength subgrouped by stage of rehabilitation Show forest plot | 12 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 5.11.1 Outpatient | 2 | 227 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.67 [0.39, 0.95] |
| 5.11.2 Secondary and social care | 12 | 890 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.39 [0.25, 0.52] |
| 5.12 Strength subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategies Show forest plot | 14 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 5.12.1 Mean age in study 80 years or less | 8 | 464 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.35 [0.16, 0.54] |
| 5.12.2 Mean age in study > 80 years | 6 | 657 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.27 [0.11, 0.43] |
| 5.13 Activities of daily living (measured using ADL scales) Show forest plot | 6 | 683 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.01 [‐0.26, 0.23] |
| 5.14 Self‐reported measures of lower limb/hip function Show forest plot | 2 | 106 | Std. Mean Difference (IV, Random, 95% CI) | 0.78 [‐0.20, 1.77] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Resistance/strength training v endurance training (mobility measured using 6‐Minute Walk Test Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 6.2 Resistance/strength training v endurance training (walking speed) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 6.3 Resistance/strength training v endurance training (health‐related quality of life) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 6.4 Resistance/strength training v endurance training (strength) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 6.5 Gait, balance and function v other (muscle contraction in supine) (mobility measured using mobility scale) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 6.6 Gait, balance and function v other (muscle contraction in supine) (walking speed) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 6.7 Gait, balance and function v other (muscle contraction in supine) (mortality) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 6.8 Gait, balance and function v other (muscle contraction in supine) (Adverse events: pain) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 6.8.1 Pain from fracture | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 6.8.2 Pain during exercise | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 6.9 Gait, balance and function v other (muscle contraction in supine) (Adverse events: number of people who fell) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 6.10 Gait, balance and function v other (muscle contraction in supine) (Balance, observed) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 6.11 Gait, balance and function v other (muscle contraction in supine) (Balance, self‐reported) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 6.12 Gait, balance and function v other (muscle contraction in supine) (strength) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
