A technology assessment report 1 on geriatric rehabilitation following fractures in older people was abstracted in the Health Technology Assessment Database 2. Comparative studies comparing different treatments and strategies were of poor to moderate quality. Geriatric service interventions after hip fracture were strongly influenced by local conditions. As an overall strategy for rehabilitation after hip and other lower limb fractures, geriatric orthopaedic rehabilitation units are unlikely to be cost-effective, but some frailer patients may benefit in respect of reduced readmission rates and need for nursing home placement. Geriatric hip fracture programmes and early supported discharge are probably cost-effective, since they appear to shorten the average length of hospital stay, and are associated with significantly increased rates of return to previous residential status. Early supported discharge is suitable only for a subset of less disabled patients, and an alternative programme for more disabled patients is needed, initially in an inpatient setting.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by imprecise results (few patients and wide confidence intervals).
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