Fifteen studies (n=2,154) were included in the review: 11 RCTs (n=1,281), 2 observational studies (n=588) and 2 case studies (n=285).
The majority of studies described their inclusion and exclusion criteria and defined hip fracture. Similarly, withdrawals and drop-outs were usually reported. However, a number of studies failed to report the reliability and validity of the outcome measures and also the use of blinded outcome assessors. Treatment interventions in a third of studies could not be replicated because of poor reporting. In terms of evidence levels, 6 studies were assessed as level I, six as level II, and three as level V.
Evidence from RCTs.
Data from the studies was often conflicting, as in the case of the assessment of multidisciplinary rehabilitation teams. One study (n=40) in women suggested that treadmill gait retraining was significantly better than standard gait retraining in terms of mobility. One study (n=243) showed a significant benefit for rehabilitation within a geriatric ward compared with standard care. However, one study (n=279) suggested that there were no differences between post-operative interdisciplinary care and normal care. Similarly, data from weight bearing studies were also conflicting with 2 studies (n=120 and n=40) suggesting an improvement in balance, functional ability and walking ability in comparison with non-weight bearing exercises. Another study (n=80) showed equivalent effects in weight bearing and non-weight bearing groups. One study (n=28) suggested that lower extremity progressive resistance training and function training improved strength and functional performance in comparison with control (not specified). One study (n=81) suggested that physical therapy was associated with better ambulation ability compared with institution-based rehabilitation. One study (n=243) concluded that patients with mild or moderate dementia can return to the community if they receive active geriatric rehabilitation and another (n=304) that a multicomponent rehabilitation programme was no more effective than usual care in promoting recovery. One study (n=66) showed similar outcomes in patients receiving home- and hospital-based rehabilitation.
Evidence from case series and observational studies.
One case series (n=70) suggested that the number of physical therapy visits showed a significant association with recovery to pre-fracture ambulation status. The other case series study (n=215) suggested that patients receiving standard physiotherapy had little chance of further recovery after 4 months. One observational study (n=443) suggested that physical therapy immediately after surgery was associated with significantly better ambulation; this observation was only present at 2 months and not at 6 months. The remaining observational study (n=145) compared patients supervised in in-patient rehabilitation in an orthopaedic hospital with in-patient rehabilitation in a geriatric hospital and patients discharged to home care. Hospital rehabilitation had no apparent significant advantage in terms of mortality and morbidity compared with patients discharged to home.