Cochrane · systematic review · CD007125
Multidisciplinary rehabilitation for older people with hip fractures
Handoll, HHG, Cameron, ID, Mak, JCS, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Bone, Joint and Muscle TraumaAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
25
current version
GRADE rated
23
No studies
2
Included studies
NR
No studies 2 · 8%Ungraded 0 · 0%Very low 15 · 60%Low 7 · 28%Moderate 1 · 4%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Multidisciplinary inpatient rehabilitation versus usual care
Population: older people undergoing rehabilitation soon after surgically treated hip fracture
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
'Poor outcome' (dead or deterioration in residential status, generally requiring institutional care) Multidisciplinary inpatient rehabilitation vs usual care | RR 0.88 [0.8, 0.98] | 13 studies · 3036 participants | Moderate Downgraded: risk of bias |
Quality of life: EQ‐5D (0: dead to 1: best quality)c Multidisciplinary inpatient rehabilitation vs usual care | no estimate extracted | 1 study · 347 participants | Very low Downgraded: risk of bias, imprecision |
Mortality (at discharge) Multidisciplinary inpatient rehabilitation vs usual care | RR 0.77 [0.58, 1.04] | 11 studies · 2455 participants | Low Downgraded: risk of bias, imprecision |
Mortality (end of scheduled Multidisciplinary inpatient rehabilitation vs usual care | RR 0.91 [0.8, 1.05] | 18 studies · 3973 participants | Low Downgraded: risk of bias, imprecision |
Greater dependence in personal activities of daily livingg Multidisciplinary inpatient rehabilitation vs usual care | RR 0.87 [0.76, 0.99] | 4 studies · 754 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Greater dependence in personal activities of daily livingg Multidisciplinary inpatient rehabilitation vs usual care | RR 0.64 [0.51, 0.81] | 2 studies · 238 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Greater dependency in mobility (e.g. requiring help by another person) Multidisciplinary inpatient rehabilitation vs usual care | RR 0.83 [0.71, 0.98] | 5 studies · 1085 participants | Low Downgraded: risk of bias, imprecision |
Hip‐related pain Multidisciplinary inpatient rehabilitation vs usual care | no estimate extracted | NR | No studies |
Delirium in hospitalj Multidisciplinary inpatient rehabilitation vs usual care | RR 0.85 [0.74, 0.98] | 4 studies · 980 participants | Low Downgraded: risk of bias, imprecision |
Supported discharge and multidisciplinary home rehabilitation versus usual care: mainly for people living in their own homes (ambulatory setting)
Population: older people, mainly living in the community, undergoing rehabilitation after surgically treated hip fracture
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
'Poor outcome' (dead or moved to higher level of care or unable to walk) Supported discharge and multidisciplinary home rehabilitation vs usual care: mainly | RR 0.91 [0.62, 1.35] | 3 studies · 377 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life: SF‐36 Physical Component score (0: worst to 100: best) Supported discharge and multidisciplinary home rehabilitation vs usual care: mainly | no estimate extracted | 1 study · 56 participants | Very low Downgraded: risk of bias, imprecision |
Mortality (at 4 months) Supported discharge and multidisciplinary home rehabilitation vs usual care: mainly | RR 0.77 [0.34, 1.76] | 2 studies · 275 participants | Very low Downgraded: risk of bias, imprecision |
Mortality (end of scheduled Supported discharge and multidisciplinary home rehabilitation vs usual care: mainly | RR 1 [0.61, 1.63] | 3 studies · 377 participants | Very low Downgraded: risk of bias, imprecision |
Independent in personal activities of daily living Supported discharge and multidisciplinary home rehabilitation vs usual care: mainly | RR 1.06 [0.71, 1.57] | 1 study · 159 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Permanent move to higher level of care (hostel, nursing home, sheltered housing) Supported discharge and multidisciplinary home rehabilitation vs usual care: mainly | RR 0.35 [0.07, 1.69] | 2 studies · 168 participants | Very low Downgraded: risk of bias, imprecision |
Unable to walk Supported discharge and multidisciplinary home rehabilitation vs usual care: mainly | RR 0.89 [0.38, 2.04] | 2 studies · 214 participants | Very low Downgraded: risk of bias, imprecision |
Pain (end of Supported discharge and multidisciplinary home rehabilitation vs usual care: mainly | no estimate extracted | NR | No studies |
Supported discharge and multidisciplinary home rehabilitation versus usual care: people living in a nursing home setting (ambulatory setting)
Population: older people from nursing homes undergoing rehabilitation after surgically treated hip fracture
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
'Poor outcome' (dead or unable to walk) Supported discharge and multidisciplinary home rehabilitation vs usual care: people living | RR 1.04 [0.87, 1.24] | 1 study · 240 participants | Low Downgraded: risk of bias, imprecision |
Quality of life: EQ‐5D (0: dead to 1: best quality)c Supported discharge and multidisciplinary home rehabilitation vs usual care: people living | no estimate extracted | 1 study · 235 participants | Very low Downgraded: risk of bias, imprecision |
Mortality (at 4 months) Supported discharge and multidisciplinary home rehabilitation vs usual care: people living | RR 1.05 [0.7, 1.56] | 1 study · 240 participants | Low Downgraded: risk of bias, imprecision |
Mortality (end of scheduled Supported discharge and multidisciplinary home rehabilitation vs usual care: people living | RR 1.13 [0.86, 1.49] | 1 study · 240 participants | Low Downgraded: risk of bias, imprecision |
Functional dependency: modified Barthel Index (0 to 100: total independence in personal care) Supported discharge and multidisciplinary home rehabilitation vs usual care: people living | no estimate extracted | 1 study · 202 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Functional dependency: modified Barthel Index (0 to 100: total independence in personal care) Supported discharge and multidisciplinary home rehabilitation vs usual care: people living | no estimate extracted | 1 study · 125 participants | Very low Downgraded: risk of bias, imprecision |
Unable to walk Supported discharge and multidisciplinary home rehabilitation vs usual care: people living | RR 0.89 [0.38, 2.04] | 1 study · 130 participants | Very low Downgraded: risk of bias, imprecision |
Pain: PAINAD (0 to 10; severest pain) Supported discharge and multidisciplinary home rehabilitation vs usual care: people living | no estimate extracted | 1 study · 126 participants | Very low Downgraded: risk of bias, imprecision |