Table 1 Intervention types and settings of selected RCTs to improve outcomes post hip fracture surgery
From: Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials
RCT intervention type (n) | RCT intervention focus area, intervention group setting | ||
|---|---|---|---|
Inpatient | Outpatient | Inpatient – Outpatient | |
Rehabilitation (n = 39) 56 articles | • Rehabilitation department / ward ○ Aerobic training [25] ○ Specialised physical rehabilitation [32] ○ Weight bearing exercise [27]* ○ Treadmill training [28, 29] * • Orthopaedics ward ○ Progressive strength training [23] * ○ Transcutaneous electrical nerve stimulation [19] • Geriatric ward ○ Specialised geriatric rehabilitation [32] ○ Progressive high intensity training [24] • Trauma unit ○ Intensive physiotherapy [22] • Non-specified ward ○ Neurostimulation [20] ○ Individualized occupational therapy [31] ○ Balance task-specific training [26] ○ Early ambulation [21] ○ Accelerated rehabilitation [30] * | • Indoor exercise facilities ○ Progressive resistance training [33, 34] / resistance training [35, 36, 143, 144] • Outpatient clinic ○ Strength training [37, 38] / resistance training [39] ○ Physical training and self-efficacy [40] ○ Intensive training [41] * • Home ○ Home physiotherapy [8, 42] / strength training [49,50,51] / high intensity exercises [52] / weight bearing [145, 146] ○ Self-efficacy based exercise [147] ○ Multicomponent home physiotherapy [54] * ○ Telerehabilitation [148] • Home / institutional care ○ Weight bearing exercise [53] | • Inpatient to home ○ Extended physical therapy plus supplementation [149, 150] ○ Electrical stimulation [55,56,57] * ○ Individualized occupational therapy [58, 59] ○ Higher dose, weight bearing [151,152,153] ○ Cognitive behavioural therapy with / without sensor monitoring [61, 62] • Inpatient to nursing home / home / day hospital ○ Accelerated rehabilitation [60] |
Medication, nutrition and supplementation (n = 30) 38 articles | • Non-specified ward ○ Nutritional support [63,64,65] ○ Dietetic assistants [70] ○ Growth hormone [71] • Rehabilitation / Orthopedic ward ○ Nutritional support [66,67,68,69] ○ Essential amino acid supplementation [73] ○ Anabolic steroids [72] * ○ Vitamin D [74] | • Home ○ Essential amino acid supplementation [76] ○ Vitamin D supplementation [77] | • Inpatient to home / nursing home / care facility ○ Growth hormone secretagogue mimetic [88] * ○ Essential amino acid supplementation [75] * ○ Nutritional support [91,92,93, 154,155,156] * ○ Nutritional support with dietetic counselling [83, 84] ○ Bone anabolic drug [85,86,87] ○ Vitamin D loading dose [94,95,96] * ○ Vitamin D and calcium [157] ○ Anabolic steroids [78,79,80,81] ○ Intranasal calcitonin [82] |
Optimizing clinical management (n = 9) 11 articles | • Non-specified ward ○ Physiotherapy education [97] ○ Management of pressure ulcers [105] * ○ Management of pain [158, 159] ○ Management of postoperative delirium [102] ○ Management of incontinence [103] * ○ Dislocation precautionary measures [104] * • Post-acute care unit ○ Enhanced medical rehabilitation [98] • Geriatric unit ○ Management of postoperative delirium [101] • Orthopedic unit | Nil | Nil |
Prevention of venous thromboembolism (VTE) (n = 8) 9 articles | • Non-specified ward ○ Factor inhibitors / antithrombotic [106, 160, 161] * ○ Antithrombotic, factor inhibitor [107, 162] * ○ Ancrod [108] | Nil | • Inpatient to home / outpatient ○ Fondaparinux Sodium [109, 110] ○ Antithrombotic [111] |
Multidisciplinary, multifactorial programme (n = 7) 13 articles | • Geriatric Unit ○ Geriatric vs. orthopedic care [112] * • Orthopedic rehabilitation ○ Orthopedic + Geriatric care [113, 114] • Interdisciplinary care ward ○ Interdisciplinary care [115] * | • Home ○ Multidisciplinary [118, 119] • Multidisciplinary clinic ○ Geriatrician, Physiotherapist, Occupational therapist [116, 117] * | • Inpatient to home ○ Intensive geriatric rehabilitation [120, 121] ○ Early discharge supported by Geriatric interdisciplinary team [122,123,124] |
Osteoporosis management / Fracture prevention post-discharge (n = 6) 15 articles | Nil | • Outpatient ○ Yearly bisphosphonates [163,164,165,166,167,168,169,170] ○ Vitamin D and / or calcium [129] * | • Inpatient to home ○ Primary care and patient empowerment [127] ○ Vitamin D and / or calcium [171, 172] • Inpatient to outpatient (clinic / primary care) ○ Osteoporosis management [128] |
Falls prevention (inpatient, post-discharge) (n = 4) 7 articles | • Post-acute Geriatric Rehabilitation Unit ○ Multicomponent cognitive behavioural intervention [173] | • Home ○ Follow up call [174] | • Inpatient and home ○ Home assessment visit pre-discharge [134] |
Post-operative Anaemia (n = 3) 3 articles | • Non-specified ward ○ Oral iron therapy [135] * | Nil | • Inpatient to home |
Supported discharge (n = 1) 1 article | Nil | Nil | • Inpatient to home ○ Gerontologic advanced practice nurse care [138] |
Others (group learning, motivational interviewing) (n = 2) 2 articles | Nil | • Unspecified outpatient setting ○ Group learning and exercise [139] • Home ○ Motivational interviewing [140] | Nil |
Total: | 109 studies (155 articles) | ||