Perioperative interventions to improve early mobilisation and physical function after hip fracture : A systematic review and meta-analysis

Journal article

Sarkies, Mitchell N., Testa, Luke, Carrigan, Ann, Roberts, Natalie, Gray, Rene, Sherrington, Catherine, Mitchell, Rebecca, Close, Jacqueline C. T., Mcdougall, Catherine and Sheehan, Katie. (2023). Perioperative interventions to improve early mobilisation and physical function after hip fracture : A systematic review and meta-analysis. Age and Ageing. 52(8), p. Article afad154. https://doi.org/10.1093/ageing/afad154
AuthorsSarkies, Mitchell N., Testa, Luke, Carrigan, Ann, Roberts, Natalie, Gray, Rene, Sherrington, Catherine, Mitchell, Rebecca, Close, Jacqueline C. T., Mcdougall, Catherine and Sheehan, Katie
Abstract

Background
Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery.

Objective
Determine the effectiveness of perioperative interventions on early mobilisation and physical function after hip fracture.

Methods
Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science were searched from January 2000 to March 2022. English language experimental and quasi-experimental studies were included if patients were hospitalised for a fractured proximal femur with a mean age 65 years or older and reported measures of early mobilisation and physical function during the acute hospital admission. Data were pooled using a random effect meta-analysis.

Results
Twenty-eight studies were included from 1,327 citations. Studies were conducted in 26 countries on 8,192 participants with a mean age of 80 years. Pathways and models of care may provide a small increase in early mobilisation (standardised mean difference [SMD]: 0.20, 95% confidence interval [CI]: 0.01–0.39, I2 = 73%) and physical function (SMD: 0.07, 95% CI 0.00 to 0.15, I2 = 0%) and transcutaneous electrical nerve stimulation analgesia may provide a moderate improvement in function (SMD: 0.65, 95% CI: 0.24–1.05, I2 = 96%). The benefit of pre-operative mobilisation, multidisciplinary rehabilitation, recumbent cycling and clinical supervision on mobilisation and function remains uncertain. Evidence of no effect on mobilisation or function was identified for pre-emptive analgesia, intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, occupational therapy training or nutritional supplements.

Conclusions
Perioperative interventions may improve early mobilisation and physical function after hip fracture surgery. Future studies are needed to model the causal mechanisms of perioperative interventions on mobilisation and function after hip fracture.

Keywordssurgery; pre-operative; post-operative; model of care; analgesia; systematic review; older people
Year2023
JournalAge and Ageing
Journal citation52 (8), p. Article afad154
PublisherOxford University Press
ISSN0002-0729
Digital Object Identifier (DOI)https://doi.org/10.1093/ageing/afad154
PubMed ID37596922
Scopus EID2-s2.0-85168392625
PubMed Central IDPMC10439513
Open accessPublished as ‘gold’ (paid) open access
Page range1-11
FunderNational Health and Medical Research Council (NHMRC)
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online17 Aug 2023
Publication process dates
Deposited15 Jan 2025
Grant ID2007970
Additional information

This study received funding from an NHMRC Investigator Grant (CIA Sarkies 2007970).

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