Effectiveness of community-based rehabilitation interventions incorporating outdoor mobility on ambulatory ability and falls-related self-efficacy after hip fracture: a systematic review and meta-analysis

Katie J Sheehan; Laura Fitzgerald; Kate Lambe; Finbarr C Martin; Sallie E Lamb; Catherine Sackley

doi:10.1007/s11657-021-00963-0

Effectiveness of community-based rehabilitation interventions incorporating outdoor mobility on ambulatory ability and falls-related self-efficacy after hip fracture: a systematic review and meta-analysis

Arch Osteoporos. 2021 Jun 19;16(1):99. doi: 10.1007/s11657-021-00963-0.

Authors

Katie J Sheehan¹, Laura Fitzgerald², Kate Lambe², Finbarr C Martin², Sallie E Lamb³, Catherine Sackley²

Affiliations

¹ Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, London, UK. katie.sheehan@kcl.ac.uk.
² Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, London, UK.
³ Institute of Health Research, University of Exeter, Devon, UK.

Abstract

There is limited evidence from 11 randomised controlled trials on the effect of rehabilitation interventions which incorporate outdoor mobility on ambulatory ability and/or self-efficacy after hip fracture. Outdoor mobility should be central (not peripheral) to future intervention studies targeting improvements in ambulatory ability.

Purpose: Determine the extent to which outdoor mobility is incorporated into rehabilitation interventions after hip fracture. Synthesise the evidence for the effectiveness of these interventions on ambulatory ability and falls-related self-efficacy.

Methods: Systematic search of MEDLINE, Embase, PsychInfo, CINAHL, PEDro and OpenGrey for published and unpublished randomised controlled trials (RCTs) of community-based rehabilitation interventions incorporating outdoor mobility after hip fracture from database inception to January 2021. Exclusion of protocols, pilot/feasibility studies, secondary analyses of RCTs, nonrandomised and non-English language studies. Duplicate screening for eligibility, risk of bias, and data extraction sample. Random effects meta-analysis. Statistical heterogeneity with inconsistency-value (I²).

Results: RCTs (n = 11) provided limited detail on target or achieved outdoor mobility intervention components. There was conflicting evidence from 2 RCTs for the effect on outdoor walking ability at 1-3 months (risk difference 0.19; 95% confidence intervals (CI): 0.21, 0.58; I² = 92%), no effect on walking endurance at intervention end (standardised mean difference 0.05; 95% CI: - 0.26, 0.35; I² = 36%); and suggestive (CI crosses null) of a small effect on self-efficacy at 1-3 months (standardised mean difference 0.25; 95% CI: - 0.29, 0.78; I² = 87%) compared with routine care/sham intervention.

Conclusion: It was not possible to attribute any benefit observed to an outdoor mobility intervention component due to poor reporting of target or achieved outdoor mobility and/or quality of the underlying evidence. Given the low proportion of patients recovering outdoor mobility after hip fracture, future research on interventions with outdoor mobility as a central component is warranted.

Trial registration: PROSPERO registration: CRD42021236541.

Keywords: Falls efficacy; Fracture neck of femur; Home-based; Physiotherapy; Walking.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Accidental Falls*
Hip Fractures*
Humans
Self Efficacy
Walking