This updated review conducted by Helen Handoll and colleagues in 2021 aims to assess the effects of multidisciplinary rehabilitation (MDR), in either inpatient or ambulatory-care settings, for older people with hip fractures.
Hip fractures represent a major health problem particularly in elderly people, with a high burden of morbidity and mortality. Low bone mineral density and high frequency of falls are responsible for the high incidence of hip fractures in this population. Moreover, chronic pain, disability, poor quality of life, and premature death are well-recognized consequences of this fracture.
Authors updated a previous review to examine the effects of post-surgical care using MDR (as rehabilitation supervised by a geriatrician, rehabilitation physician, or other appropriate physicians) in people ages 65 and over with hip fracture, assessing as primary outcome 'poor outcome' (a composite of mortality and decline in residential status at long-term follow-up). Other outcomes were health-related quality of life (HR-QOL), mortality, dependency in activities of daily living, mobility, and related pain.
Twenty-eight studies fulfilled the inclusion criteria. Twenty trials compared MDR versus 'usual care' in an inpatient setting concluding that MDR probably results in fewer cases of 'poor outcome' up to 12 months follow-up. MDR may result in fewer deaths in hospitals and fewer people with poorer mobility up to 12 months follow-up.
It was uncertain if MDR improves QOL or makes little or no difference on dependence in activities of daily living (ADLs) in the short-term (1 to 4 months follow-up) or long-term (6 to 12 months) (13 studies).
Three trials compared supported discharge and multidisciplinary home rehabilitation versus 'usual care' in the ambulatory setting. It was uncertain if there are no between-group differences in poor outcome, QOL, mortality, independence in ADLs, moving permanently to a higher level of care, or being unable to walk up to 12 months.
One trial tested this comparison in nursing home residents, concluding there may be no or minimal between-group differences at 12 months in 'poor outcome' or in mortality at 4 months or 12 months. It was uncertain if there are no between-group differences in dependency at 4 weeks or at 12 months, or in quality of life, inability to walk, or pain at 12 months.
Authors concluded that compared to usual care:
· in an inpatient setting, MDR showed fewer cases of poor outcome with moderate-certainty evidence and both fewer deaths in hospital and fewer people with poorer mobility with low-certainty evidence, respectively. Evidence on other outcomes has been considered as very low-certainty.
· in an ambulatory setting, evidence was judged very low-certainty for all outcomes considered, for the supported discharge and multidisciplinary home rehabilitation.
· in nursing home residents, little or no difference was found on poor outcome and mortality with low-certainty evidence. Evidence on other outcomes has been considered as very low-certainty.
Future research including larger trials with standardized outcome measures, careful monitoring of direct and indirect costs, and assessing cost-effectiveness and care burden should be conducted.
Commented by Sara Liguori