A Cochrane review [Abstract] 1 included 40 RCTs with 4059 participants from 17 countries. On average, participants were 80 years old and 80% were women. The median number of study participants was 81 and all trials had unclear or high risk of bias for one or more domains. Most trials excluded people with cognitive impairment (70%), immobility and/or medical conditions affecting mobility (72%).
In-hospital setting: 18 trials (n=1433) compared mobility strategies with control (usual care) in hospitals. Mobility strategies may lead to a moderate clinically meaningful increase in mobility (SMD 0.53, 95% CI 0.10 to 0.96; 7 studies, n=507) and some improvement in walking speed (SMD 0.16, 95% CI -0.05 to 0.37; 6 studies, n=360). Mobility strategies may make little or no difference to short-term (RR 1.06, 95% CI 0.48 to 2.30; 6 studies, n=489) or long-term mortality (RR 1.22, 95% CI 0.48 to 3.12; 2 studies, n=133), adverse events measured by hospital re-admission (RR 0.70, 95% CI 0.44 to 1.11; 4 studies, n=322), or return to pre-fracture residence (RR 1.07, 95% CI 0.73 to 1.56; 2 studies, n=240). Gait, balance and functional training probably causes a moderate improvement in mobility (SMD 0.57, 95% CI 0.07 to 1.06; 6 studies, n=463).
Post-hospital setting: 22 trials (n=2626) compared mobility strategies with control (usual care, no intervention, sham exercise or social visit) in the post-hospital setting. Mobility strategies lead to a small clinically meaningful increase in mobility (SMD 0.32, 95% CI 0.11 to 0.54; 7 studies, n=761) and a small clinically meaningful improvement in walking speed compared to control (SMD 0.16, 95% CI 0.04 to 0.29; 14 studies, n=1067). Mobility strategies lead to a small, non-clinically meaningful increase in functioning (SMD 0.23, 95% CI 0.10 to 0.36; 9 studies, n=936), and probably lead to a slight increase in quality of life that may not be clinically meaningful (SMD 0.14, 95% CI -0.00 to 0.29; 10 studies, n=785). Mobility strategies probably make little or no difference to short-term mortality (RR 1.01, 95% CI 0.49 to 2.06; 8 studies, n=737). Mobility strategies may make little or no difference to long-term mortality (RR 0.73, 95% CI 0.39 to 1.37; 4 studies, n=588) or adverse events measured by hospital re-admission (95% CI includes a large reduction and large increase, RR 0.86, 95% CI 0.52 to 1.42; 2 studies, n=206).Training involving gait, balance and functional exercise leads to a small, clinically meaningful increase in mobility (SMD 0.20, 95% CI 0.05 to 0.36; 5 studies, n=621), while training classified as being primarily resistance or strength exercise may lead to a clinically meaningful increase in mobility measured using distance walked in six minutes (mean difference (MD) 55.65, 95% CI 28.58 to 82.72; 3 studies, n=198). Training involving multiple intervention components probably leads to a substantial, clinically meaningful increase in mobility (SMD 0.94, 95% CI 0.53 to 1.34; 2 studies, n=104).
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by study quality (unclear risk of bias on several studies).
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