A total of 11 studies were included in this review, one RCT (n=243 patients) and 10 non-randomised prospective cohort studies (n=1,186 patients). The quality score for the RCT was 19/32 and the average quality score for the other studies was 14.7 (range 10 to 19); overall quality was described as fair to poor.
Cognitive impairment: Although all 11 studies reported cognitive assessment, the differing scales and thresholds made it difficult to summarise these data. Only three studies re-evaluated cognitive status post rehabilitation, but comparative pre- and post-data were not reported.
Functional activity (10 studies): Seven studies reported that patients with cognitive impairments were able to make functional gains following inpatient rehabilitation. Where studies reported relative gain, it appeared that patients with cognitive impairments gained less functioning than patients without impairments, but absolute gain was broadly similar between the two groups.
Length of stay (four studies): Three studies found no significant differences between impaired and intact groups in acute hospital stay. The average duration of acute hospital stay varied from 6.6 days, 16 days and 84.5 days across each of the studies. The RCT compared intervention and non-intervention groups, finding a statistically significant decrease in length of stay for mild to moderately cognitively impaired patients who received the intervention. Results were conflicting for the two studies which followed a case-series of patients. Discharge criteria were poorly described and not standardised, so results were not directly comparable across all studies.
Discharge destination: Place of residence on discharge was reported in three studies, but only one (RCT) also reported residence prior to the fracture occurring. In the RCT, a greater percentage of the cognitively impaired patients receiving the intervention returned to community living (91%) than those not receiving the intervention (63%).