Article

OBJECTIVE: To address the need for a research synthesis on the effectiveness of
the full range of hip fracture rehabilitation interventions for older adults and
make evidence based conclusions. DATA SOURCES: Medline, PubMed, EMBASE, CINAHL,
and the Cochrane Central Register of Controlled Trials were searched from 1980 to
2007 for studies published in English. The terms rehabilitation and hip fracture
were exploded in order to obtain related search terms and categories. STUDY SELECTION: In the initial search of the databases, a combined total of 1031
articles was identified. Studies that did not focus on hip fracture
rehabilitation, did not include persons over the age of 50 years, and/or did not
include measures of physical outcome were excluded.
DATA EXTRACTION: Only studies
with an Oxford Center for Evidence-Based Medicine Levels of Evidence level of I
(randomized controlled trial, RCT) or II (cohort) were reviewed. The methodologic
quality of both types of studies was assessed using a modified version of the
Downs and Black checklist. DATA SYNTHESIS: There were 55 studies that met our
selection criteria: 30 RCTs and 25 nonrandomized trials. They were distributed
across 6 categories for rehabilitation intervention (care pathways, early
rehabilitation, interdisciplinary care, occupational and physical therapy,
exercise, intervention not specified) and 3 settings (acute care hospital,
postacute care/rehabilitation, postrehabilitation). CONCLUSIONS: When looking
across all of the intervention types, the most frequently reported positive
outcomes were associated with measures of ambulatory ability. Eleven intervention
categories across 3 settings were associated with improved ambulatory outcomes.
Seven intervention approaches were related to improved functional recovery, while
6 intervention approaches were related to improved strength and balance recovery.
Decreased length of stay and increased falls self-efficacy were associated with 2
interventions, while 1 intervention had a positive effect on lower-extremity power generation.

Langue : ANGLAIS