Multi-disciplinary rehabilitation after hip fracture is associated with improved outcome: A systematic review
Julie Halbert, Maria Crotty, Craig Whitehead, Ian Cameron, Susan Kurrle, Susan Graham, Helen Handoll, Terry Finnegan, Tim Jones, Amanda Foley and Michael Shanahan, the Hip Fracture Rehabilitation Trial Collaborative Group
Background: While hip fractures are an important cause of disability, dependency and death in older adults, the benefit of multi-disciplinary rehabilitation for people who have sustained hip fracture has not been demonstrated.
Methods: Systematic review of randomized controlled trials which compare co-ordinated multi-disciplinary rehabilitation with usual orthopaedic care in older people who had sustained a hip fracture. Outcome measures included: mortality, return home, “poor outcome”, total length of hospital stay, readmissions and level of function.
Results: We identified 11 trials including 2177 patients. Patients who received multi-disciplinary rehabilitation were at a lower risk (Risk Ratio 0.84, 95% CI 0.73–0.96) of a “poor outcome” – that is dying or admission to a nursing home at discharge from the programme, and showed a trend towards higher levels of return home (Risk Ratio 1.07, 95% CI 1.00–1.15). Pooled data for mortality did not demonstrate any difference between multi-disciplinary rehabilitation and usual orthopaedic care.
Conclusion: This is the first review of randomized trials to demonstrate a benefit from multi-disciplinary rehabilitation; a 16% reduction in the pooled outcome combining death or admission to a nursing home. This result supports the routine provision of organized care for patients following hip fracture, as is current practice for patients after stroke.