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Targeting mobility after hip fracture surgery
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Targeting mobility after hip fracture surgery
What are the benefits and harms of interventions aimed at improving mobility and physical functioning after hip fracture surgery?
The evidence for the use of additional mobility strategies to improve outcomes after hip fracture surgery has greater certainty in the post‐hospital setting than for the in‐hospital setting.
In the post‐hospital setting, there is high‐certainty evidence that mobility strategies lead to small, clinically meaningful improvements in mobility and walking speed compared with control. Mobility strategies also lead to a small, non‐clinically meaningful improvement in functioning (high‐certainty evidence) and probably a slight increase in health‐related quality of life that may not be meaningful (moderate‐certainty evidence).
Such strategies probably make little or no difference to short‐term mortality compared with control (moderate‐certainty evidence) and may make little or no difference to long‐term mortality or hospital re‐admission (low‐certainty evidence).
It is unclear whether mobilisation strategies affect re‐operation, pain or the number of people who fall (low and very-low‐certainty evidence). However, there is moderate‐certainty evidence that the number of falls is probably reduced by 21% compared with control.
Mobility strategies included exercises, physical training and muscle stimulation, and were used at various stages in rehabilitation. In the post-hospital setting, interventions that included gait, balance and functional tasks had high‐certainty evidence for effectiveness at increasing mobility.
Most trials excluded older people who were cognitively impaired (70%) or had a history of immobility, medical conditions affecting mobility, or both (72%). Therefore, the results of this review may not be applicable to these high‐risk groups. Of the 22 post‐hospital trials included in this review, 9 reported follow-up at 1–3 months, 6 at 4–6 months, 1 at 9 months, and 6 at 12 months.
Most hip fractures occur in older people. Females predominate over males, and the injury is usually the result of a simple fall. People experiencing a hip fracture frequently have other medical and physical problems associated with ageing, including impaired mobility and frailty.
Mobilisation is a major component of postoperative care and rehabilitation. Various mobilisation strategies are in use, such as exercise and electrical stimulation of muscles. Exercise programmes may include one or more types of exercise.
Fairhall NJ, et al. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2022;9:CD001704. This review contains 40 trials with a total of 4059 participants.