Mobilisation strategies after hip fracture surgery in adults

Hdl Handle:
http://hdl.handle.net/10149/58212
Title:
Mobilisation strategies after hip fracture surgery in adults
Authors:
Handoll, H. H. G. (Helen); Sherrington, C. (Catherine)
Affiliation:
University of Sydney. School of Physiotherapy; University of Teesside. Research Institute for Health Sciences and Social Care. Centre for Rehabilitation Sciences (CRS).
Citation:
Handoll, H. H. G., Sherrington, C. and Parker, M. J. (2007) 'Mobilisation strategies after hip fracture surgery in adults', Cochrane Database of Systematic Reviews, 1, pp.1-94.
Publisher:
Wiley-Blackwell
Journal:
Cochrane Database of Systematic Reviews
Issue Date:
Jan-2007
URI:
http://hdl.handle.net/10149/58212
DOI:
10.1002/14651858.CD001704.pub3
Abstract:
Background: Hip fracture mainly occurs in older people. Mobilisation strategies such as gait retraining and exercises are used at various stages of rehabilitation after surgery. Objectives: To evaluate the effects of different mobilisation strategies after hip fracture surgery in adults. Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE and other databases, conference proceedings and reference lists of articles, up to January 2006. Selection criteria: All randomised or quasi-randomised trials comparing different mobilisation strategies after hip fracture surgery. Data collection and analysis: The authors independently selected trials, assessed trial quality and extracted data. There was no data pooling. Main results: Most of the 13 included trials (involving 1065 participants, generally over 65 years) were small and all had methodological limitations, including inadequate follow up. Seven trials evaluated mobilisation strategies started soon after hip fracture surgery. One historic trial found no significant differences in unfavourable outcomes for weight bearing started at two versus 12 weeks after internal fixation of a displaced intracapsular fracture. Two trials compared a more with a less intensive regimen of physiotherapy: one found no difference in recovery, the other found a higher level of drop-out in the more intensive group with no difference in length of hospital stay. One trial found short-term improvement in mobility and balance for a two-week programme of weight-bearing versus non-weight-bearing exercise. One trial found improved mobility in those given a quadriceps muscle strengthening exercise programme. One trial found no significant difference in recovery of mobility after a treadmill versus conventional gait retraining programme. One trial found a greater recovery of pre-fracture mobility after neuromuscular stimulation of the quadriceps muscle. Six trials evaluated strategies started after hospital discharge. Started soon after discharge, two trials found improved outcome after 12 weeks of intensive physical training and a home-based physical therapy programme respectively. Begun after completion of standard physical therapy, one trial found improved outcome after six months of intensive physical training whereas another trial found no significant effects of home-based resistance or aerobic training. One trial found improved outcome after home-based exercises started around 22 weeks from injury. One trial found home-based weight-bearing exercises starting at seven months produced no statistically significant differences aside for greater quadriceps strength. Authors' conclusions: There is insufficient evidence from randomised trials to establish the effectiveness of the various mobilisation strategies used in rehabilitation after hip fracture surgery. Further research is required to establish the possible benefits of the additional provision of interventions, including intensive supervised exercises, primarily aimed at enhancing mobility.
Type:
Article
Keywords:
mobilisation; hip fracture; adults; gait; exercises; rehabilitation; surgery
ISSN:
1469-493X
Rights:
In return for the grant of the licence, the author(s) shall have the following rights: The right to post the review as an electronic file on the author's own website and/or the author's institution's website, using the PDF version of the Review available in the Cochrane Database of Systematic Reviews. [Advice from CEO of The Cochrane Collaboration]
Citation Count:
10 [Scopus (print and online), 13/01/2010]

Full metadata record

DC FieldValue Language
dc.contributor.authorHandoll, H. H. G. (Helen)-
dc.contributor.authorSherrington, C. (Catherine)-
dc.date.accessioned2009-04-01T10:46:06Z-
dc.date.available2009-04-01T10:46:06Z-
dc.date.issued2007-01-
dc.identifier.citationCochrane Database of Systematic Reviews; 1: 1-94-
dc.identifier.issn1469-493X-
dc.identifier.doi10.1002/14651858.CD001704.pub3-
dc.identifier.urihttp://hdl.handle.net/10149/58212-
dc.description.abstractBackground: Hip fracture mainly occurs in older people. Mobilisation strategies such as gait retraining and exercises are used at various stages of rehabilitation after surgery. Objectives: To evaluate the effects of different mobilisation strategies after hip fracture surgery in adults. Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE and other databases, conference proceedings and reference lists of articles, up to January 2006. Selection criteria: All randomised or quasi-randomised trials comparing different mobilisation strategies after hip fracture surgery. Data collection and analysis: The authors independently selected trials, assessed trial quality and extracted data. There was no data pooling. Main results: Most of the 13 included trials (involving 1065 participants, generally over 65 years) were small and all had methodological limitations, including inadequate follow up. Seven trials evaluated mobilisation strategies started soon after hip fracture surgery. One historic trial found no significant differences in unfavourable outcomes for weight bearing started at two versus 12 weeks after internal fixation of a displaced intracapsular fracture. Two trials compared a more with a less intensive regimen of physiotherapy: one found no difference in recovery, the other found a higher level of drop-out in the more intensive group with no difference in length of hospital stay. One trial found short-term improvement in mobility and balance for a two-week programme of weight-bearing versus non-weight-bearing exercise. One trial found improved mobility in those given a quadriceps muscle strengthening exercise programme. One trial found no significant difference in recovery of mobility after a treadmill versus conventional gait retraining programme. One trial found a greater recovery of pre-fracture mobility after neuromuscular stimulation of the quadriceps muscle. Six trials evaluated strategies started after hospital discharge. Started soon after discharge, two trials found improved outcome after 12 weeks of intensive physical training and a home-based physical therapy programme respectively. Begun after completion of standard physical therapy, one trial found improved outcome after six months of intensive physical training whereas another trial found no significant effects of home-based resistance or aerobic training. One trial found improved outcome after home-based exercises started around 22 weeks from injury. One trial found home-based weight-bearing exercises starting at seven months produced no statistically significant differences aside for greater quadriceps strength. Authors' conclusions: There is insufficient evidence from randomised trials to establish the effectiveness of the various mobilisation strategies used in rehabilitation after hip fracture surgery. Further research is required to establish the possible benefits of the additional provision of interventions, including intensive supervised exercises, primarily aimed at enhancing mobility.-
dc.publisherWiley-Blackwell-
dc.rightsIn return for the grant of the licence, the author(s) shall have the following rights: The right to post the review as an electronic file on the author's own website and/or the author's institution's website, using the PDF version of the Review available in the Cochrane Database of Systematic Reviews. [Advice from CEO of The Cochrane Collaboration]-
dc.subjectmobilisation-
dc.subjecthip fracture-
dc.subjectadults-
dc.subjectgait-
dc.subjectexercises-
dc.subjectrehabilitation-
dc.subjectsurgery-
dc.titleMobilisation strategies after hip fracture surgery in adults-
dc.typeArticle-
dc.contributor.departmentUniversity of Sydney. School of Physiotherapy; University of Teesside. Research Institute for Health Sciences and Social Care. Centre for Rehabilitation Sciences (CRS).-
dc.identifier.journalCochrane Database of Systematic Reviews-
ref.assessmentRAE 2008-
ref.citationcount10 [Scopus (print and online), 13/01/2010]-
or.citation.harvardHandoll, H. H. G., Sherrington, C. and Parker, M. J. (2007) 'Mobilisation strategies after hip fracture surgery in adults', Cochrane Database of Systematic Reviews, 1, pp.1-94.-
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