Multidisciplinary rehabilitation for older people with hip fractures.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized and quasi-randomized trials
PubMed 34766330 · doi:10.1002/14651858.CD007125.pub3
What was done
This Cochrane systematic review update evaluated randomized and quasi-randomized trials of multidisciplinary rehabilitation (supervised by a geriatrician, rehabilitation physician, or other medical specialist) versus usual care in older adults (aged 65 or older) recovering from hip fracture surgery. Searches were conducted through October 2020. The primary outcome was a composite 'poor outcome' (mortality or decline in residential status requiring institutional care) at 6 to 12 months. Critical secondary outcomes included all-cause mortality, mobility, activities of daily living (ADL) dependency, health-related quality of life, and pain.
What was found
The review included 28 trials comprising 5,351 older adults (mean age 76.5 to 87 years, predominantly female). For inpatient rehabilitation (20 trials), multidisciplinary care probably reduced the composite 'poor outcome' at 6 to 12 months (RR 0.88, 95% CI 0.80 to 0.98; 13 studies, 3,036 participants; moderate-certainty evidence), corresponding to 41 fewer poor outcomes per 1,000 patients and a number needed to treat of 25 (95% CI 15 to 100). Multidisciplinary care also reduced poorer mobility at 6 to 12 months (RR 0.83, 95% CI 0.71 to 0.98; 5 studies, 1,085 participants; low certainty). Mortality effects were inconclusive both in-hospital (RR 0.77, 95% CI 0.58 to 1.04; 11 studies, 2,455 participants; low certainty) and at 4 to 12 months (RR 0.91, 95% CI 0.80 to 1.05; 18 studies, 3,973 participants; low certainty). Evidence for ADL dependence and quality of life was of very low certainty, and long-term pain was not reported. For ambulatory and supported home discharge settings (4 trials total), evidence was sparse and judged low- to very low-certainty across all reported endpoints.
Why it matters
Inpatient multidisciplinary care pathways led by specialists provide clear clinical benefit in preserving living independence and reducing overall poor outcomes after hip fracture surgery in older adults.
Limits
Most included trials carried unclear or high risk of performance and detection bias due to lack of blinding. There was substantial clinical heterogeneity across interventions and populations. Evidence for ambulatory models, quality of life, ADLs, and hip-related pain remains very low certainty or unmeasured.
Cited by
- context Approximately 50% of older individuals who suffer a hip fracture never regain full functional independence and die within two years.