Objective: Delirium is one of the most common complications following hip fracture surgery in older people. This study identified pre-and peri-operative factors associated with the development of post-operative delirium following hip fracture surgery. Methods:Published and unpublished literature were searched to identify all evidence reporting variables on patient characteristics, on-admission, intra-operative and post-operative management assessing incident delirium in older people following hip fracture surgery. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. Evidence was assessed using the Downs and Black appraisal tool and interpreted using the GRADE approach.Results: 6704 people (2090 people with post-operative delirium) from 32 studies were analysed.There was moderate evidence of nearly a two-times greater probability of post-operative delirium for those aged 80 years and over (OR: 1.77; 95% CI: 1.09, 2.87), whether patients lived in a care institution pre-admission (OR: 2.65; 95% CI: 1.79, 3.92), and a six-times greater probability of developing post-operative delirium with a pre-admission diagnosis of dementia (OR: 6.07, 95% CI: 4.84, 7.62). There was no association with intra-operative variables and probability of delirium. Conclusion:Clinicians treating people with a hip fracture should be vigilant towards postoperative delirium if their patients are older, have pre-existing cognitive impairment and poorer overall general health. This is also the case for those who experience post-operative complications such as pneumonia or a urinary tract infection.

These results indicate the NPI score to be a valid tool to assess patellar instability for individuals following patellar dislocation. Further study is now required in order to assess the reliability and responsiveness of this new outcome measure.

Analysis 1.4. Comparison 1 Interdisciplinary geriatric rehabilitation (inpatient and community rehabilitation) versus conventional rehabilitation, Outcome 4 Number of participants in institutionalised care (hospital or nursing home) at 12 months post-hip fracture.

Objectives To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and consider whether the evidence is generalizable to patients with COVID-19. Methods The authors undertook a rapid systematic review. Medline (via OvidSP), CINAHL Complete (via EBSCOhost), Cochrane Library, Cochrane Database of Systematic Reviews and CENTRAL (via Wiley), Epistemonikos (via Epistemonikos.org), PEDro (via pedro.org.au) and OTseeker (via otseeker.com) searched to 7 May 2020. The authors included systematic reviews, RCTs and qualitative studies involving adults with respiratory illness requiring intensive care who received rehabilitation to enhance or restore resulting physical impairments or function. Data were extracted by one author and checked by a second. TIDier was used to guide intervention descriptions. Study quality was assessed using Critical Skills Appraisal Programme (CASP) tools. Results Six thousand nine hundred and three titles and abstracts were screened; 24 systematic reviews, 11 RCTs and eight qualitative studies were included. Progressive exercise programmes, early mobilisation and multicomponent interventions delivered in ICU can improve functional independence. Nutritional supplementation in addition to rehabilitation in post-ICU hospital settings may improve performance of activities of daily living. The evidence for rehabilitation after discharge from hospital following an ICU admission is inconclusive. Those receiving rehabilitation valued it, engendering hope and confidence. Conclusions Exercise, early mobilisation and multicomponent programmes may improve recovery following ICU admission for severe respiratory illness that could be generalizable to those with COVID-19. Rehabilitation interventions can bring hope and confidence to individuals but there is a need for an individualised approach and the use of behaviour change strategies. Further research is needed in post-ICU settings and with those who have COVID-19. Registration: Open Science Framework https://osf.io/prc2y

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Purpose: Define whether distal vastus medialis (VM) muscle strengthening improves functional outcomes compared to general quadriceps muscles strengthening following first-time patellar dislocation (FTPD).Methods: Fifty patients post-FTPD were randomised to either a general quadriceps exercise or rehabilitation programme (n=25) or to a specific-VM exercise and rehabilitation regime (n=25).Primary outcome was the Lysholm Knee Score, secondary outcomes included the Tegner Level of Activity Scale, the Norwich Patellar Instability (NPI) Score, and isometric knee extensions strength at various knee flexion ranges of motion. Outcomes were assessed at baseline, six weeks, six months and 12 months.Results: There were statistically significant differences in functional outcome and activity levels through the Lysholm Knee Score and Tegner Level of Activity Scale at 12 months in the general quadriceps exercise group compared to the VM group (p=0.05; 95% CI: -14.0 to 0.0/p=0.04; 95% CI: -3.0 to 0.0). This did not reach a clinically important difference. There was no statistically significant difference between the groups for the NPI Score and isometric strength at any followup interval. The trial experienced substantial participant attrition (52% at 12 months). Conclusions:Whilst there was a statistical difference in Lysholm Knee Score and Tegner Level of Activity Score between general quadriceps and VM exercise groups at 12 months, this may not have necessarily been clinically important. This trial highlights that the recruitment and retention of participants from this population is a challenge and should be considered during the design of future trials in this population. Dislocation -Smith et al (2015) 3 Level of evidence: Therapeutic study, Level I Keywords: Quadriceps; vastus medialis oblique; exercise; patellar dislocation; trial VM versus General Quadriceps following Patellar Dislocation -Smith et al (2015) 4 VM versus General Quadriceps following Patellar IntroductionPatellar dislocation is a disabling musculoskeletal disorder which predominantly affects younger people who are engaged in multi-directional physically active pursuits [1]. The estimated incidence of patellar dislocation is between 7 [2] to 77 per 100,000 people per year [3], with a marginally greater incidence in females [2,4]. The term first-time patellar dislocation (FTPD) represents the first episode that the patella disengages completely from the femoral trochlear. It is sometimes termed primary patellar dislocation [5].Conservative (non-operative) treatment is the treatment of choice for FTPD. Quadriceps strengthening exercises are considered one of the principal management for people following FTPD [6,7]. A United Kingdom (UK) survey of physiotherapy practice has shown that quadriceps strengthening and specific-vastus medialis obliquus (VMO) or distal vastus medialis (VM) muscle strengthening or recruitment exercises were two of the most frequently used interventions for this population [1]. However, there remains controversy rega...

Background Hip fracture is a major injury that causes significant problems for a ected individuals and their family and carers. Over 40% of people with hip fracture have dementia or cognitive impairment. The outcomes of these individuals a er surgery are poorer than for those without dementia. It is unclear which care and rehabilitation interventions achieve the best outcomes for these people. This is an update of a Cochrane Review first published in 2013. Objectives (a) To assess the e ectiveness of models of care including enhanced rehabilitation strategies designed specifically for people with dementia following hip fracture surgery compared to usual care. (b) To assess for people with dementia the e ectiveness of models of care including enhanced rehabilitation strategies that are designed for all older people, regardless of cognitive status, following hip fracture surgery, compared to usual care. Search methods We searched ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group Specialised Register, MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 16 October 2019. Selection criteria We included randomised and quasi-randomised controlled trials evaluating the e ectiveness of any model of enhanced care and rehabilitation for people with dementia a er hip fracture surgery compared to usual care. Data collection and analysis Two review authors independently selected trials for inclusion and extracted data. We assessed risk of bias of the included trials. We synthesised data only if we considered the trials to be su iciently homogeneous in terms of participants, interventions, and outcomes. We used the GRADE approach to rate the overall certainty of evidence for each outcome. Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery (Review)

CommentaryDementia is a debilitating condition characterised by global loss of cognitive and intellectual functioning, which gradually interferes with social and occupational performance. It is a common worldwide condition with a significant impact on society. There are currently 36 million people worldwide with Alzheimer's disease (AD) and other dementias [1]. This is expected to more than double by 2030 (65 million) and reach 115 million in 2050, unless a major breakthrough is made. The worldwide societal costs were estimated at USD 604 billion in 2010 and rising [2].To date research on the specific physical healthcare needs of people with dementia has been neglected. Yet, physical comorbidities are reported as common in people with dementia [3] and have been shown to lead to increased disability and reduced quality of life for the affected person and their carer [4].Dementia is most frequently associated with older people who often present with other medical conditions, known as co-morbidities. Such co-morbidities include diabetes, chronic obstructive pulmonary disorder, musculoskeletal disorders and chronic cardiac failure and are common, 61% of people with dementia are estimated to have three or more comorbid diagnoses [5]. Musculoskeletal, genitourinary, and ear, nose and throat disorders have been reported as highly prevalent, affecting nearly half of people with dementia [6]. Physical comorbidities are often treatable and some may be reversible. Epilepsy, delirium, falls, oral disease, malnutrition, frailty, incontinence, sleep disorders and visual dysfunction are found to occur more frequently in dementia sufferers and untreated can lead to more severe health problems, pain and distress as well as worsening the symptoms of dementia itself [6]. As the severity of the dementia increases, so does the rate of comorbid conditions such as genitourinary disorders [6]. Pneumonia, urinary tract infection and congestive cardiac failure accounted for two-thirds of preventable admissions in dementia with dehydration and duodenal ulcer the next most important [7]. Healthcare costs for treating these problems are high, estimated at being 34% more costly than in age-matched, non-dementia cases [8]. The annual admission rate is double that of patients without dementia [7].In the UK, NICE guidelines for the treatment of dementia assert that the promotion and maintenance of independence and everyday functioning is a key treatment for those diagnosed with dementia [9]. At the core of this should be a comprehensive assessment of needs, difficulties and possible co-morbid symptoms. Timely identification of physical symptoms in those with dementia has been linked to decreased risk of hospitalisation [10], reduced healthcare costs [11] and the maintenance of physical comfort and quality of life [12,13].In addition the diagnosis and management of co-morbid conditions is recognised as being poor, as dementia dominates clinical encounters and shifts attention away from the co-morbidity [14] which can lead to increased morbidity ...