Effects of Geriatric Team Rehabilitation After Hip Fracture: Meta-Analysis of Randomized Controlled Trials

Peter Nordström; Karl-Gunnar Thorngren; Ami Hommel; Lena Ziden; Sten Anttila

doi:10.1016/j.jamda.2018.05.008

Effects of Geriatric Team Rehabilitation After Hip Fracture: Meta-Analysis of Randomized Controlled Trials

J Am Med Dir Assoc. 2018 Oct;19(10):840-845. doi: 10.1016/j.jamda.2018.05.008. Epub 2018 Jun 27.

Authors

Peter Nordström¹, Karl-Gunnar Thorngren², Ami Hommel², Lena Ziden³, Sten Anttila⁴

Affiliations

¹ Department of Community Medicine and Rehabilitation, Geriatrics, Umeå University, Umeå, Sweden. Electronic address: peter.nordstrom@germed.umu.se.
² Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden.
³ Department of Clinical Neuroscience and Rehabilitation, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
⁴ Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.

PMID: 29958818
DOI: 10.1016/j.jamda.2018.05.008

Abstract

Objective: Systematic rehabilitation by geriatric interdisciplinary teams has been associated with favorable outcomes in frail older patients. The aim of the present meta-analysis was to evaluate the effects of interdisciplinary geriatric team rehabilitation in older patients with hip fracture.

Design, setting, and participants: Randomized controlled trials involving participants sustaining hip fractures at the age of 65 years or older were included. Included trials evaluated effects of interdisciplinary geriatric team rehabilitation compared with usual postoperative care and reported on at least one of the following outcomes: activities of daily living (ADLs), physical function, mobility, depression, cognitive function, discharge to home, quality of life, influence on relatives, complications, and survival. Seven studies of at least moderate quality with a total of 1763 participants were included.

Measures: Data were combined using a random-effects model. The GRADE system (1-4, where 4 is highest level of evidence) was used to rate the quality of the estimates.

Results: Outcomes were grouped into 4 categories, each of which was reported on in at least 4 studies: ADL/physical function, mobility, living in one's own home, and survival. Interdisciplinary geriatric team rehabilitation increased ADL/physical function (standardized mean difference [SMD], 0.32; 95% confidence interval [CI], 0.17-0.47) and mobility (SMD, 0.32; 95% CI, 0.12-0.52) compared with conventional care. In contrast, interdisciplinary geriatric team rehabilitation did not increase the chance of living in one's own home after discharge (risk ratio [RR], 1.07; 95% CI, 0.99-1.16) or survival (RR, 1.02; 95% CI, 0.99-1.06) compared with conventional care. All results were rated as GRADE 3.

Conclusion: Systematic rehabilitation by geriatric interdisciplinary teams increases physical function and mobility significantly compared with conventional care in patients with hip fracture. In contrast, the chance of being discharged to one's own home and survival are not influenced.

Keywords: Meta-analysis; hip fracture; interdisciplinary geriatric team rehabilitation.

Publication types

Meta-Analysis
Review

MeSH terms

Aged
Hip Fractures / rehabilitation*
Humans
Patient Care Team*
Patient Outcome Assessment
Randomized Controlled Trials as Topic