Advanced

Effects of Geriatric Team Rehabilitation After Hip Fracture : Meta-Analysis of Randomized Controlled Trials

Nordström, Peter; Thorngren, Karl Gunnar LU ; Hommel, Ami LU ; Ziden, Lena LU and Anttila, Sten (2018) In Journal of the American Medical Directors Association 19(10). p.840-845
Abstract

Objective: Systematic rehabilitation by geriatric interdisciplinary teams has been associated with favorable outcomes in frail older patients. The aim of the present meta-analysis was to evaluate the effects of interdisciplinary geriatric team rehabilitation in older patients with hip fracture. Design, setting, and participants: Randomized controlled trials involving participants sustaining hip fractures at the age of 65 years or older were included. Included trials evaluated effects of interdisciplinary geriatric team rehabilitation compared with usual postoperative care and reported on at least one of the following outcomes: activities of daily living (ADLs), physical function, mobility, depression, cognitive function, discharge to... (More)

Objective: Systematic rehabilitation by geriatric interdisciplinary teams has been associated with favorable outcomes in frail older patients. The aim of the present meta-analysis was to evaluate the effects of interdisciplinary geriatric team rehabilitation in older patients with hip fracture. Design, setting, and participants: Randomized controlled trials involving participants sustaining hip fractures at the age of 65 years or older were included. Included trials evaluated effects of interdisciplinary geriatric team rehabilitation compared with usual postoperative care and reported on at least one of the following outcomes: activities of daily living (ADLs), physical function, mobility, depression, cognitive function, discharge to home, quality of life, influence on relatives, complications, and survival. Seven studies of at least moderate quality with a total of 1763 participants were included. Measures: Data were combined using a random-effects model. The GRADE system (1–4, where 4 is highest level of evidence) was used to rate the quality of the estimates. Results: Outcomes were grouped into 4 categories, each of which was reported on in at least 4 studies: ADL/physical function, mobility, living in one's own home, and survival. Interdisciplinary geriatric team rehabilitation increased ADL/physical function (standardized mean difference [SMD], 0.32; 95% confidence interval [CI], 0.17–0.47) and mobility (SMD, 0.32; 95% CI, 0.12–0.52) compared with conventional care. In contrast, interdisciplinary geriatric team rehabilitation did not increase the chance of living in one's own home after discharge (risk ratio [RR], 1.07; 95% CI, 0.99–1.16) or survival (RR, 1.02; 95% CI, 0.99–1.06) compared with conventional care. All results were rated as GRADE 3. Conclusion: Systematic rehabilitation by geriatric interdisciplinary teams increases physical function and mobility significantly compared with conventional care in patients with hip fracture. In contrast, the chance of being discharged to one's own home and survival are not influenced.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hip fracture, interdisciplinary geriatric team rehabilitation, Meta-analysis
in
Journal of the American Medical Directors Association
volume
19
issue
10
pages
840 - 845
publisher
Elsevier
external identifiers
  • scopus:85048989630
ISSN
1525-8610
DOI
10.1016/j.jamda.2018.05.008
language
English
LU publication?
yes
id
8a47b4b3-5058-4185-a3dd-ecba13db4c64
date added to LUP
2018-07-06 14:23:16
date last changed
2019-10-08 03:32:32
@article{8a47b4b3-5058-4185-a3dd-ecba13db4c64,
  abstract     = {<p>Objective: Systematic rehabilitation by geriatric interdisciplinary teams has been associated with favorable outcomes in frail older patients. The aim of the present meta-analysis was to evaluate the effects of interdisciplinary geriatric team rehabilitation in older patients with hip fracture. Design, setting, and participants: Randomized controlled trials involving participants sustaining hip fractures at the age of 65 years or older were included. Included trials evaluated effects of interdisciplinary geriatric team rehabilitation compared with usual postoperative care and reported on at least one of the following outcomes: activities of daily living (ADLs), physical function, mobility, depression, cognitive function, discharge to home, quality of life, influence on relatives, complications, and survival. Seven studies of at least moderate quality with a total of 1763 participants were included. Measures: Data were combined using a random-effects model. The GRADE system (1–4, where 4 is highest level of evidence) was used to rate the quality of the estimates. Results: Outcomes were grouped into 4 categories, each of which was reported on in at least 4 studies: ADL/physical function, mobility, living in one's own home, and survival. Interdisciplinary geriatric team rehabilitation increased ADL/physical function (standardized mean difference [SMD], 0.32; 95% confidence interval [CI], 0.17–0.47) and mobility (SMD, 0.32; 95% CI, 0.12–0.52) compared with conventional care. In contrast, interdisciplinary geriatric team rehabilitation did not increase the chance of living in one's own home after discharge (risk ratio [RR], 1.07; 95% CI, 0.99–1.16) or survival (RR, 1.02; 95% CI, 0.99–1.06) compared with conventional care. All results were rated as GRADE 3. Conclusion: Systematic rehabilitation by geriatric interdisciplinary teams increases physical function and mobility significantly compared with conventional care in patients with hip fracture. In contrast, the chance of being discharged to one's own home and survival are not influenced.</p>},
  author       = {Nordström, Peter and Thorngren, Karl Gunnar and Hommel, Ami and Ziden, Lena and Anttila, Sten},
  issn         = {1525-8610},
  keyword      = {hip fracture,interdisciplinary geriatric team rehabilitation,Meta-analysis},
  language     = {eng},
  month        = {01},
  number       = {10},
  pages        = {840--845},
  publisher    = {Elsevier},
  series       = {Journal of the American Medical Directors Association},
  title        = {Effects of Geriatric Team Rehabilitation After Hip Fracture : Meta-Analysis of Randomized Controlled Trials},
  url          = {http://dx.doi.org/10.1016/j.jamda.2018.05.008},
  volume       = {19},
  year         = {2018},
}