Multidisciplinary rehabilitation for older people with hip fractures

Handoll, Helen; Cameron, Ian D.; Mak, Jenson; Panagoda, Claire E; Finnegan, Terence P

doi:10.1002/14651858.cd007125.pub3

Cited by 56 publications

(62 citation statements)

References 185 publications

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“…Hip fractures are a serious public health problem, mainly in the elderly ( 1 ). It is estimated that the number of hip fractures worldwide will be 4.5 million by 2050 ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

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Effects of Frailty on Outcomes Following Surgery Among Patients With Hip Fractures: A Systematic Review and Meta-Analysis

Wang

Lou

et al. 2022

Front. Med.

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BackgroundFrailty is a syndrome of multisystem dysfunction in the elderly. The association between preoperative frailty and postoperative outcomes in patients with hip fractures is unclear. To address this issue, we performed a meta-analysis to determine the association of frailty with postoperative mortality, complications, and readmission in patients with hip fractures.MethodsWe searched PubMed, Web of Science, Embase, and The Cochrane Library for cohort studies of frailty associated with postoperative adverse events in patients with hip fractures from inception to November 6, 2021. The Newcastle-Ottawa Scale was used to evaluate the quality of the included literature. Statistical analysis of meta-analysis was performed using Review Manager 5.3.ResultsTwelve retrospective cohort studies and seven prospective cohort studies involving a total of 62,132 patients met the inclusion criteria for this meta-analysis. Compared with non-frail patients, the pooled results showed that frailty was associated with patient in-hospital mortality (relative risk [RR] = 2.93; 95% confidence intervals [CI]: 2.56–3.34), 30-day mortality (RR = 2.85, 95%CI: 1.67–4.85) and total complications (RR = 1.79, 95%CI: 1.50–2.15). Subgroup analysis showed that the type of study design and frailty assessment tool had no significant effect on the results. Sensitivity analysis showed that the polled results of frailty predicted one-year mortality and 30-day readmission was unstable.ConclusionsIn this meta-analysis, we found that preoperative frailty may be associated with postoperative adverse events in patients with hip fractures, including in-hospital mortality, 30-day mortality, and postoperative complications.Systematic Review Registration: PROSPERO, identifier: CRD42021287739.

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“…Hip fractures are a serious public health problem, mainly in the elderly ( 1 ). It is estimated that the number of hip fractures worldwide will be 4.5 million by 2050 ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…In Italy, the number of elderly people with hip fractures has increased by 28.62 percent in 15 years ( 3 ). Hip fracture severely affects patients' postoperative life and has a high mortality ( 1 , 4 ). Mortality was 13.3% during hospitalization or within 30 days, and 8.4–36% within 1 year after surgery ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of Frailty on Outcomes Following Surgery Among Patients With Hip Fractures: A Systematic Review and Meta-Analysis

Wang

Lou

et al. 2022

Front. Med.

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“…Briefly, the reviews included meta-analyses of the effectiveness of PT interventions in different areas. The majority of the reviews were in the musculoskeletal area (22 reviews), 37–58 followed by cardiorespiratory (9 reviews), 59–67 neurological (6 reviews), 68–73 and other areas of PT (6 reviews) 74–79 . The characteristics of these reviews have been described previously 80 and can be seen in Supplementary Table S2 (Appendix 2, Supplemental Digital Content 2, http://links.lww.com/PHM/B345).…”

Section: Resultsmentioning

confidence: 99%

Are Biases Related to Attrition, Missing Data, and the Use of Intention to Treat Related to the Magnitude of Treatment Effects in Physical Therapy Trials?

Armijo‐Olivo

Costa

Ha³

et al. 2021

Am J Phys Med Rehabil

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The objective of this study was to determine the association between biases related to attrition, missing data, and the use of intention to treat and changes in effect size estimates in physical therapy randomized trials. A meta-epidemiological study was conducted. A random sample of randomized controlled trials included in meta-analyses in the physical therapy discipline were identified. Data extraction including assessments of the use of intention to treat principle, attrition-related bias, and missing data was conducted independently by two reviewers. To determine the association between these methodological issues and effect sizes, a two-level analysis was conducted using a meta-meta-analytic approach. Three hundred ninety-three trials included in 43 meta-analyses, analyzing 44,622 patients contributed to this study. Trials that did not use the intention-to-treat principle (effect size = −0.13, 95% confidence interval = −0.26 to 0.01) or that were assessed as having inappropriate control of incomplete outcome data tended to underestimate the treatment effect when compared with trials with adequate use of intention to treat and control of incomplete outcome data (effect size = −0.18, 95% confidence interval = −0.29 to −0.08).Researchers and clinicians should pay attention to these methodological issues because they could provide inaccurate effect estimates. Authors and editors should make sure that intention-to-treat and missing data are properly reported in trial reports.

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“…Early and stable fixation in a single-stage and adequate multimodal analgesia aim to achieve quicker mobilization and fully weight-bearing in the immediate postoperative period to restore the patient's functional capacity and avoid complications related to immobility, such as pressure ulcers, physical deconditioning syndrome, deep vein thrombosis, pulmonary embolism, myocardial infarction, pneumonia, and mortality. 45 Likewise, the load on the affected limb stimulates callus formation through mechanotransduction and muscle-mass strengthening. Ambulation should be initiated as early as the first postoperative day if allowed by the medical situation because it has been shown that functional recovery and length of hospital stay are delayed in patients who remain in bed on the second day after surgery.…”

Section: Postoperative Recommendationsmentioning

confidence: 99%

Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly

Galán-Olleros

Rodríguez-Zamorano

García-Coiradas

et al. 2022

Current Orthopaedic Practice

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Currently, there is a wide awareness of the high degree of functional impairment and morbimortality associated with hip fractures in the elderly, and efforts are being made to improve outcomes. As age rises, physiological reserves decline, and more severe complications occur. Simultaneous bilateral extracapsular hip fractures in the setting of low-energy trauma in the elderly are rare but deserve special attention with treatment strategies that are in between those for unilateral hip fractures and elderly patients with multiple injuries. Adequate initial assessment, a multidisciplinary approach to trauma care, and the integration of medical and orthopaedic surgical attention are paramount. Furthermore, there is a need for early single-stage surgical fixation in medically stable patients and optimization of patients who are unfit. Despite some variations from unilateral cases, the main objective remains to achieve painless hips and stable fixation for early mobilization with the lowest morbidity and mortality rates. General anesthesia for intramedullary nailing using short nonreamed nails for stable fracture patterns and minimal reaming when long nails are used may be regarded as the best option. Physicians should be cautious of the higher risk of complications such as blood loss, fat embolism syndrome, and adult respiratory distress syndrome. Orthogeriatric management and multidisciplinary teams may also improve outcomes, as demonstrated for unilateral hip fractures. Secondary prevention of fractures is promoted through the prescription of antiosteoporotic treatment, nutritional assessment, and skills training. This literature review aims to help optimize the management of patients with simultaneous bilateral extracapsular hip fractures, outlining the differential concerns with respect to unilateral cases.

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Multidisciplinary rehabilitation for older people with hip fractures

Cited by 56 publications

References 185 publications

Effects of Frailty on Outcomes Following Surgery Among Patients With Hip Fractures: A Systematic Review and Meta-Analysis

Effects of Frailty on Outcomes Following Surgery Among Patients With Hip Fractures: A Systematic Review and Meta-Analysis

Are Biases Related to Attrition, Missing Data, and the Use of Intention to Treat Related to the Magnitude of Treatment Effects in Physical Therapy Trials?

Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly

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