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Evidence summaries

Interventions for Improving Mobility after Hip Fracture Surgery

Evidence is insufficient to determine the effectiveness of various mobilisation strategies either in the early post-operative period or during the later rehabilitation period after hip fracture surgery. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 19 studies with a total of 1 589 older adult participants. 12 trials evaluated mobilisation strategies started soon after hip fracture surgery.

Single trials found improved mobility from, respectively, a two-week weight-bearing programme, a quadriceps muscle strengthening exercise programme and electrical stimulation aimed at alleviating pain. Single trials found no significant improvement in mobility from, respectively, a treadmill gait retraining programme, 12 weeks of resistance training, and 16 weeks of weight-bearing exercise. One trial testing ambulation started within 48 hours of surgery found contradictory results. One historic trial found no significant difference in unfavourable outcomes for weight bearing started at two versus 12 weeks. Of two trials evaluating more intensive physiotherapy regimens, one found no difference in recovery, the other reported a higher level of drop-out in the more intensive group. Two trials tested electrical stimulation of the quadriceps: one found no benefit and poor tolerance of the intervention; the other found improved mobility and good tolerance.

Seven 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, one trial found increased activity levels from a one year exercise programme, and one 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 significant improvement in mobility.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by study quality (several issues, including inadequate follow up).

References

  • Handoll HH, Sherrington C, Mak JC. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2011;(3):CD001704. [PubMed]

Primary/Secondary Keywords