Multidisciplinary rehabilitation for older people with hip fractures

Hdl Handle:
http://hdl.handle.net/10149/92051
Title:
Multidisciplinary rehabilitation for older people with hip fractures
Authors:
Handoll, H. H. G. (Helen); Cameron, I. D. (Ian); Mak, J. C. S. (Jenson); Finnegan, T. P. (Terence)
Affiliation:
University of Teesside. Research Institute for Health Sciences and Social Care. Centre for Rehabilitation Sciences (CRS).
Citation:
Handoll, H. H. G. et al. (2009) 'Multidisciplinary rehabilitation for older people with hip fractures', The Cochrane Database of Systematic Reviews; 4
Publisher:
Wiley-Blackwell
Journal:
The Cochrane Database of Systematic Reviews
Issue Date:
2009
URI:
http://hdl.handle.net/10149/92051
DOI:
10.1002/14651858.CD007125.pub2
Abstract:
Background: Hip fracture is a major cause of morbidity and mortality in older people and its impact on society is substantial. Objectives: To examine the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older patients with hip fracture. Search strategy: The authors searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2009), The Cochrane Library (2009, Issue 2), MEDLINE and EMBASE (both to April 2009). Selection criteria: Randomised and quasi-randomised trials of post-surgical care using multidisciplinary rehabilitation of older patients (aged 65 years or over) with hip fracture. The primary outcome, 'poor outcome' was a composite of mortality and decline in residential status at long-term (generally one year) follow-up. Data collection and analysis: Trial selection was by consensus. Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate. Main results: The 13 included trials involved 2498 older, usually female, patients who had undergone hip fracture surgery. Though generally well conducted, some trials were at risk of bias such as from imbalances in key baseline characteristics. There was substantial clinical heterogeneity in the trial interventions and populations. Multidisciplinary rehabilitation was provided primarily in an inpatient setting in 11 trials. Pooled results showed no statistically significant difference between intervention and control groups for poor outcome (risk ratio 0.89; 95% confidence interval 0.78 to 1.01), mortality (risk ratio 0.90, 95% confidence interval 0.76 to 1.07) or hospital readmission. Individual trials found better results, often short-term only, in the intervention group for activities of daily living and mobility. There was considerable heterogeneity in length of stay and cost data. Three trials reporting carer burden showed no evidence of detrimental effect from the intervention. Overall, the evidence indicates that multidisciplinary rehabilitation is not harmful. The trial comparing primarily home-based multidisciplinary rehabilitation with usual inpatient care found marginally improved function and a clinically significantly lower burden for carers in the intervention group. Participants of this group had shorter hospital stays, but longer periods of rehabilitation. One trial found no significant effect from doubling the number of weekly contacts at the patient's home from a multidisciplinary rehabilitation team. Authors' conclusions: While there was a tendency to a better overall result in patients receiving multidisciplinary inpatient rehabilitation, these results were not statistically significant. Future trials of multidisciplinary rehabilitation should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than evaluate its components.
Type:
Article
Language:
en
Keywords:
multidisciplinary; rehabilitation; older people; elderly; hip fractures
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:
0 [Scopus, 12/02/2010]

Full metadata record

DC FieldValue Language
dc.contributor.authorHandoll, H. H. G. (Helen)en
dc.contributor.authorCameron, I. D. (Ian)en
dc.contributor.authorMak, J. C. S. (Jenson)en
dc.contributor.authorFinnegan, T. P. (Terence)en
dc.date.accessioned2010-02-12T16:43:45Z-
dc.date.available2010-02-12T16:43:45Z-
dc.date.issued2009-
dc.identifier.citationThe Cochrane Database of Systematic Reviews; 4en
dc.identifier.issn1469-493X-
dc.identifier.doi10.1002/14651858.CD007125.pub2-
dc.identifier.urihttp://hdl.handle.net/10149/92051-
dc.description.abstractBackground: Hip fracture is a major cause of morbidity and mortality in older people and its impact on society is substantial. Objectives: To examine the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older patients with hip fracture. Search strategy: The authors searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2009), The Cochrane Library (2009, Issue 2), MEDLINE and EMBASE (both to April 2009). Selection criteria: Randomised and quasi-randomised trials of post-surgical care using multidisciplinary rehabilitation of older patients (aged 65 years or over) with hip fracture. The primary outcome, 'poor outcome' was a composite of mortality and decline in residential status at long-term (generally one year) follow-up. Data collection and analysis: Trial selection was by consensus. Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate. Main results: The 13 included trials involved 2498 older, usually female, patients who had undergone hip fracture surgery. Though generally well conducted, some trials were at risk of bias such as from imbalances in key baseline characteristics. There was substantial clinical heterogeneity in the trial interventions and populations. Multidisciplinary rehabilitation was provided primarily in an inpatient setting in 11 trials. Pooled results showed no statistically significant difference between intervention and control groups for poor outcome (risk ratio 0.89; 95% confidence interval 0.78 to 1.01), mortality (risk ratio 0.90, 95% confidence interval 0.76 to 1.07) or hospital readmission. Individual trials found better results, often short-term only, in the intervention group for activities of daily living and mobility. There was considerable heterogeneity in length of stay and cost data. Three trials reporting carer burden showed no evidence of detrimental effect from the intervention. Overall, the evidence indicates that multidisciplinary rehabilitation is not harmful. The trial comparing primarily home-based multidisciplinary rehabilitation with usual inpatient care found marginally improved function and a clinically significantly lower burden for carers in the intervention group. Participants of this group had shorter hospital stays, but longer periods of rehabilitation. One trial found no significant effect from doubling the number of weekly contacts at the patient's home from a multidisciplinary rehabilitation team. Authors' conclusions: While there was a tendency to a better overall result in patients receiving multidisciplinary inpatient rehabilitation, these results were not statistically significant. Future trials of multidisciplinary rehabilitation should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than evaluate its components.en
dc.language.isoenen
dc.publisherWiley-Blackwellen
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]en
dc.subjectmultidisciplinaryen
dc.subjectrehabilitationen
dc.subjectolder peopleen
dc.subjectelderlyen
dc.subjecthip fracturesen
dc.titleMultidisciplinary rehabilitation for older people with hip fracturesen
dc.typeArticleen
dc.contributor.departmentUniversity of Teesside. Research Institute for Health Sciences and Social Care. Centre for Rehabilitation Sciences (CRS).en
dc.identifier.journalThe Cochrane Database of Systematic Reviewsen
ref.citationcount0 [Scopus, 12/02/2010]en
or.citation.harvardHandoll, H. H. G. et al. (2009) 'Multidisciplinary rehabilitation for older people with hip fractures', The Cochrane Database of Systematic Reviews; 4-
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