Improving mobility outcomes after hip fracture is key to recovery. Mobility is the ability to move about, including standing up and walking and mobility strategies are treatments that aim to help people move better. This Cochrane systematic review aimed to evaluate the benefits and harms of interventions for improving mobility and physical functioning after hip fracture surgery in adults.
This Cochrane systematic review included randomised controlled trials or quasi-randomised controlled trials that assessed mobility strategies after hip fracture surgery. Eligible trials were identified from 8 electronic databases. Trials were included if they investigated the effect of strategies aimed to improve mobility. These could include care programmes, exercise (gait, balance, functional training, strength/resistance/endurance/flexibility training, three-dimensional exercise and general physical activity) or muscle stimulation. Interventions could be compared to usual care (both in-hospital), no intervention, sham exercise or social visits (post-hospital). Critical outcomes were mobility, walking speed, functioning, health-related quality of life, mortality, adverse effects, and return to living at pre-fracture residence.
Two reviewers identified and selected studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
The review included 40 randomised controlled trials (n = 4059 participants) from 17 countries. Patients were mostly elderly (average age 80 years) and female (80%). All trials had unclear or high risk of bias for one or more domains.
In the hospital setting, there is low certainty evidence that mobility strategies may lead to a moderate, clinically meaningful increase in mobility compared to usual care (standardised mean difference [SMD]: 0.53, 95% confidence interval [CI] 0.10 to 0.96; n = 360). Post-hospital, there is high certainty evidence that mobility strategies compared to usual care, no intervention, sham exercise or social visit led to a small, clinically meaningful increase in mobility (SMD: 0.32, 95% CI 0.11 to 0.54; n= 761). Adverse events were rarely measured by included trials so the safety of these programs in the hospital and out of hospital settings remains unknown.
Compared with conventional care, interventions that target improvement in mobility after hip fracture may improve mobility and walking speed, both in hospital and post-hospital settings. However, long term and economic outcomes have not yet been determined.
Fairhall NJ, Dyer SM, Mak JC, Diong J, Kwok WS, Sherrington C. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev. 2022 Sep 7;9(9):CD001704.