Exercise prescription after fragility fracture in older adults: a scoping review

Abstract

Purpose-To identify and chart research literature on safety, efficacy or effectiveness of exercise prescription following fracture in older adults.Methods-We conducted a systematic, research-user-informed, scoping review. The population of interest was adults aged ≥ 45 years with any fracture. 'Exercise prescription' included postfracture therapeutic exercise, physical activity or rehabilitation interventions. Eligible designs included knowledge synthesis studies, primary interventional studies and observational studies. Trained reviewers independently evaluated citations for inclusion.Results-A total of 9415 citations were reviewed with 134 citations (119 unique studies) identified: 13 knowledge syntheses, 95 randomized or controlled clinical trials, and 11 'other' designs, representing 74 articles on lower extremity fractures, 34 on upper extremity, eight on vertebral, and three on mixed body region fractures. Exercise prescription characteristics were often missing or poorly described. Six general categories emerged describing exercise prescription characteristics: timing post-fracture, person prescribing, program design, functional focus, exercise script parameters and co-interventions. Upper extremity and ankle fracture studies focused on fracture healing or structural impairment outcomes, whereas hip fracture studies focused more on activity limitation outcomes. The variety of different outcome measures used made pooling or comparison of outcomes difficult. CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusions-There was insufficient information to identify evidence-informed parameters for safe and effective exercise prescription for older adults following fracture. Key gaps in the literature include limited numbers of studies on exercise prescription following vertebral fracture, poor delineation of effectiveness of different strategies for early post-fracture mobilization following upper extremity fracture, and inconsistent details of exercise prescription characteristics after lower extremity fracture.

A scoping review of scoping reviews: advancing the approach and enhancing the consistency

“…The lack of critical appraisal of included studies was reported as a study limitation in 16.0% (55/344) of reviews. One review commented that this was the primary limitation of scoping reviews (Feehan et al , ), and others noted that without this step, scoping reviews cannot identify gaps in the literature related to low quality of research (Hand and Letts, ; Brien et al , ). Additionally, two reviews reported that their results could not be used to make recommendations for policy or practice because they did not assess the quality of included studies (Bostrom et al , ; Churchill et al , ).…”

“…However, there was some divergence in how study authors characterized the rigor of the scoping review methodology. The terms 'systematic', 'rigorous', 'replicable', and 'transparent' were frequently used to describe the methodology, and several authors described scoping reviews to be comparable in rigor to systematic reviews (Gagliardi et al, 2009;Liu et al, 2010;Ravenek et al, 2010;Feehan et al, 2011;Heller et al, 2011). In contrast, some studies described the methodology as less rigorous or systematic than a systematic review (Cameron et al, 2008;Levac et al, 2009;Campbell et al, 2011).…”

A scoping review of the proximal humerus fracture literature

“…Feehan et al [12] performed a comprehensive scoping review of exercise prescription for older adults following a fragility fracture. A similar process of integrated knowledge translation was employed and a large group of academic researchers, physiotherapists, and consumer collaborators were involved in each step of the study.…”

“…Although scoping reviews are not common in the orthopaedic surgery literature, their use has been promoted by several government funding agencies and have been successfully employed in many other areas of medicine. Feehan et al [ 12 ] performed a comprehensive scoping review of exercise prescription for older adults following a fragility fracture. A similar process of integrated knowledge translation was employed and a large group of academic researchers, physiotherapists, and consumer collaborators were involved in each step of the study.…”

Widening the perspectives of fracture prevention in osteoporosis by identifying subgroups based upon psychological aspects and health behaviour

“…Moreover, this health-resilient group would promote fall prevention further by exchanging part of weekly walking for activities designed to improve muscle strength and specific balance training [38,52,54]. A review of post fracture exercise reported that only 4% of the exercise prescriptions to people 45 years or older, contributed to fracture prevention, and in relation to forearm fractures no preventive prescription was found [58]. One underlying dimension of successful multifactorial fall prevention programmes [54] might according to these results be programmes that support psychologycal aspects of empowerment [59].…”