Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis

Mitchell N Sarkies; Luke Testa; Ann Carrigan; Natalie Roberts; Rene Gray; Catherine Sherrington; Rebecca Mitchell; Jacqueline C T Close; Catherine McDougall; Katie Sheehan

doi:10.1093/ageing/afad154

Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis

Age Ageing. 2023 Aug 1;52(8):afad154. doi: 10.1093/ageing/afad154.

Authors

Mitchell N Sarkies¹, Luke Testa², Ann Carrigan², Natalie Roberts², Rene Gray³, Catherine Sherrington^{4

5}, Rebecca Mitchell², Jacqueline C T Close^{6

7}, Catherine McDougall^{8

9}, Katie Sheehan¹⁰

Affiliations

¹ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney NSW 2006, Australia.
² Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park NSW 2113, Australia.
³ James Paget University Hospital Foundation Trust, Norfolk NR31, UK.
⁴ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney NSW 2006, Australia.
⁵ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney NSW 2006, Australia.
⁶ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney NSW 2031, Australia.
⁷ Prince of Wales Clinical School, University of New South Wales, Sydney NSW 2052, Australia.
⁸ The University of Queensland, Brisbane 4072, Australia.
⁹ The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane 4032, Australia.
¹⁰ Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London WC2R, UK.

Abstract

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.

Keywords: analgesia; model of care; older people; post-operative; pre-operative; surgery; systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Aged, 80 and over
Bicycling
Dietary Supplements
Early Ambulation*
Hip Fractures* / rehabilitation
Hip Fractures* / surgery
Humans
Pain Management
Perioperative Care*