Mobilisation strategies after hip fracture surgery in adults

M J Parker, H H Handoll, Y Dynan
Cochrane Database of Systematic Reviews 2002, (2): CD001704

BACKGROUND: Post-operative care programmes after hip fracture surgery include strategies for mobilisation, such as early weight bearing, gait retraining and other physical therapy interventions.

OBJECTIVES: To evaluate the effects of different mobilisation strategies and programmes after hip fracture surgery.

SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (to February 2002), MEDLINE (1966 to February 2002), the National Research Register (Issue 2, 2001), Current Controlled Trials, conference proceedings and reference lists of articles.

SELECTION CRITERIA: All randomised or quasi-randomised trials comparing different mobilisation strategies/programmes after hip fracture surgery.

DATA COLLECTION AND ANALYSIS: The reviewers independently assessed trial quality, using a ten item scale, and extracted data. Wherever appropriate and possible, the data are presented graphically.

MAIN RESULTS: Our first update included one new study. Again, each of the now five included trials evaluated a different intervention. Most trials had poor and / or poorly reported trial methodology. One trial of 100 patients which compared twice daily with once daily physiotherapy reported a lack of demonstrable difference in recovery of the two patient groups at nine weeks follow-up. Only limited outcome data were available for checking this. One trial of 80 patients evaluated a quadriceps muscle strengthening exercise programme. Improved mobility, leg extension power and Barthel score were reported for the intervention group. A treadmill gait retraining programme was compared with a conventional gait retraining programme in 40 patients. More patients in the treadmill group had recovered their pre-fracture level of mobility by the time of hospital discharge, which tended to happen earlier than for the control group. Neither of these differences were statistically significant. One trial of 24 patients compared neuromuscular stimulation of the quadriceps muscle with placebo stimulation. No data were available to test the claims that neuromuscular stimulation improved the recovery of mobility, assessed up to 13 weeks. One trial involving 273 patients with a displaced intracapsular fracture treated by internal fixation compared weight bearing at two weeks after surgery with delayed weight bearing at 12 weeks after surgery. From the limited data available, there were no statistically significant differences between the two methods of treatment for the outcomes of non-union, mortality and overall unfavourable outcome at one year.

REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine the effects of more frequent physiotherapy, quadriceps strengthening exercises, treadmill gait retraining, or neuromuscular stimulation after hip fracture surgery. There is also insufficient evidence to determine the effects of early weight bearing after the internal fixation of an intracapsular proximal femoral fracture.

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