Mobilisation strategies after hip fracture surgery in adults.

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 August 2002), MEDLINE (1966 to August week 5 2002), the National Research Register (Issue 2, 2002), 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 10 item scale, and extracted data. Wherever appropriate and possible, the data are presented graphically.

MAIN RESULTS: Our second update included one new study. Only two of the six included trials involved a similar comparison. All trials had methodological limitations, including inadequate follow-up. Two trials, involving a total of 188 patients, compared a more intensive with a less intensive regimen of physiotherapy. One reported a lack of demonstrable difference in recovery of the two patient groups at nine weeks follow-up. The other found a higher level of drop-out in the more intensive group with no difference in length of hospital stay. Only limited outcome data were available for both trials. 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 27 patients compared neuromuscular stimulation of the quadriceps muscle with placebo stimulation. More patients in the stimulation group had recovered their pre-fracture mobility at 13 weeks follow-up. 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 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 or a more intensive programme of 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.