Abstract
SummaryThere 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.PurposeDetermine 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self-efficacy.MethodsSystematic search of MEDLINE, Embase, PsychInfo, CINAHL, PEDro and OpenGrey for published and unpublished randomised controlled trials (RCTs) of community-based rehabilitation interventions incorporating outdoor mobility after hip fracture from database inception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).ResultsRCTs (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.ConclusionIt 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 registrationPROSPERO registration: CRD42021236541
Highlights
Each year, United Kingdom (UK) hospitals admit 70,000 older adults with hip fracture [1]
We excluded 99 on full-text screening for nonrandomised study design (n = 31), population (n = 10), intervention (n = 55), language (n = 2), no response from author for additional data related to eligibility (n = 2) and leaving 12 papers reporting 11 randomised controlled trials (RCTs) (Fig. 1)
Most RCTs were at low risk of bias for random sequence generation (n = 10), blinding of outcome assessor (n = 8), incomplete outcome data (n = 8) or selective reporting (n = 11) (Fig. 2)
Summary
Each year, United Kingdom (UK) hospitals admit 70,000 older adults with hip fracture [1]. There is a fivefold to eightfold increased risk for all-cause mortality in the first 3 months after hip fracture [2]. Only 34% regain their pre-fracture mobility (ability to move from and between different postures, e.g. sitting, standing, and walking) by 6-month post-fracture [3]. This may contribute to the reported high rates of transition from independent living to nursing homes among persons with hip fracture [4, 5]. Up to 65% of older adults report low falls-related selfefficacy after hip fracture [9], and a recent analysis of 24,492 patients indicated a weighted probability of up to 10% for recovery of mobility at 30 days among those able to walk outdoors pre-fracture [10]
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