Key result
Perioperative care models slightly improve early mobilization and physical function after hip fracture surgery.
Why the study?
Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery, but their effectiveness needed determination.
Do perioperative interventions improve early mobilisation and physical function in patients hospitalised for a fractured proximal femur?
Meta-Analysis (n=8,192)
Yes
Do perioperative interventions improve early mobilisation and physical function in patients hospitalised for a fractured proximal femur?
Effect estimate: SMD 0.20 (95% CI 0.01-0.39)
Perioperative pathways, models of care, and transcutaneous electrical nerve stimulation analgesia may provide small to moderate improvements in early mobilisation and physical function after hip fracture surgery.
Supports perioperative pathways to modestly boost early mobilisation after hip fracture; extends Level 1 evidence for care models.
BACKGROUND: Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery. OBJECTIVE: Determine the effectiveness of perioperative interventions on early mobilisation and physical function after hip fracture. METHODS: Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science were searched from January 2000 to March 2022. English language experimental and quasi-experimental studies were included if patients were hospitalised for a fractured proximal femur with a mean age 65 years or older and reported measures of early mobilisation and physical function during the acute hospital admission. Data were pooled using a random effect meta-analysis. RESULTS: Twenty-eight studies were included from 1,327 citations. Studies were conducted in 26 countries on 8,192 participants with a mean age of 80 years. Pathways and models of care may provide a small increase in early mobilisation (standardised mean difference [SMD]: 0.20, 95% confidence interval [CI]: 0.01-0.39, I2 = 73%) and physical function (SMD: 0.07, 95% CI 0.00 to 0.15, I2 = 0%) and transcutaneous electrical nerve stimulation analgesia may provide a moderate improvement in function (SMD: 0.65, 95% CI: 0.24-1.05, I2 = 96%). The benefit of pre-operative mobilisation, multidisciplinary rehabilitation, recumbent cycling and clinical supervision on mobilisation and function remains uncertain. Evidence of no effect on mobilisation or function was identified for pre-emptive analgesia, intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, occupational therapy training or nutritional supplements. CONCLUSIONS: Perioperative interventions may improve early mobilisation and physical function after hip fracture surgery. Future studies are needed to model the causal mechanisms of perioperative interventions on mobilisation and function after hip fracture.
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Sarkies et al. (2023) conducted a meta-analysis in hip fracture (n=8,192). Perioperative interventions (pathways, models of care, TENS) was evaluated on early mobilisation (SMD 0.20, 95% CI 0.01-0.39). Perioperative pathways and models of care provided a small increase in early mobilisation (SMD 0.20; 95% CI 0.01-0.39) and physical function after hip fracture surgery.
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