This review aimed to determine whether strength training is effective in reducing impairment, activity and participation restriction in adults after fracture. The authors concluded that there is preliminary evidence that training programmes may increase muscle strength and activity levels. The authors' cautious conclusions are likely to be reliable.

To determine: (i) the extent to which progressive resistance strength training has been applied to fracture rehabilitation; and (ii) whether training can be effective in reducing impairment, activity limitation and participation restriction in adults after fracture. Only (ii) will be covered by this abstract.

AMI, CINAHL, DARE, the Cochrane Library, EMBASE, MEDLINE, PEDro, PubMed and SPORTDiscus were searched for full articles written in English going back to 1966; the search terms were reported. The reference lists of relevant articles were also checked.

Studies of progressive resistance strength-training programmes, measuring a change in strength or other body function, activity limitation, or societal participation, in adults aged 19 years or older and recovering from a fracture, were eligible for inclusion.

All the included studies were of patients with lower limb fractures. The mean age ranged from 35 to 81.3 years. One study featured women only. The interval between fracture and strength training ranged from 15 days to 10 weeks. The programmes were 6 to 12 weeks in length, and a broad range of outcomes was used. Adverse events were reported.

Two reviewers independently selected studies for inclusion.

Trial quality was scored using the PEDro scale, which assesses: eligibility criteria; random allocation; concealed allocation; baseline prognostic similarity between the groups; blinding of the participant, therapist and outcome assessor; more than 85% follow-up for at least one primary outcome; intention-to-treat analysis; between- or within-group statistical analysis for at least one primary outcome; and point estimates of variability for at least one primary outcome. A score out of 10 was obtained by using all but the eligibility criteria.

Two reviewers independently rated the quality of the trials, with any disagreements resolved by consensus.

Effect sizes and 95% confidence intervals were calculated using group means and standard deviations (SD). An approximation of the SD was calculated by relating the SD of the difference scores to the correlation between the two sets of data.

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.

A meta-analysis was not performed because of between-study heterogeneity, and study results were instead pooled in a narrative synthesis. Details of the studies were tabulated and differences between the studies discussed in the text.

Three studies (n=118) were included in the review: two randomised controlled trials (n=108) and one pre-test post-test clinical trial (n=10). The follow-up period after the end of the intervention ranged from 0 to 12 weeks.

PEDro scores for quality ranged from 4 to 6.

All studies reported improvements in muscle strength with strength training, although the two studies which conducted post-intervention follow-up revealed a subsequent loss of strength. Strength training also significantly improved several activities such as walking speed, movement on stairs and rising from a chair, although, again, follow-up revealed a subsequent loss of activity for most outcomes. Further analyses were reported.

Adults recovering from fracture may benefit from participating in a progressive resistance strength-training programme by increasing muscle strength and activity levels.

This review addressed a clear question and was supported by appropriate inclusion criteria. Although several electronic databases were searched, the inclusion of only English language papers might have resulted in the omission of some relevant studies. Further studies may also have been missed since the authors did not report attempts to identify unpublished studies. Methods to reduce reviewer bias and error in the study selection and validity assessment processes, but not the data extraction, were reported. Sufficient study details were provided and an appropriate narrative synthesis of the data was undertaken. Study quality was assessed, but the authors did not discuss the (low) validity scores when interpreting the study results. However, the authors did state that further research is required to replicate the findings. The authors' cautious conclusions accurately reflect the poor quality of the included studies but this, together with some methodological limitations of the review, means they are rightly regarded as preliminary.

Practice: The authors stated that physical therapists should consider strength training as a rehabilitation option, and that the study results have important clinical implications for the functioning of older people.

Research: The authors stated that further studies are required to replicate findings, and to evaluate the impact of a progressive resistance strength-training programme on recovery after fractures of other bones in the body. They also stated that research needs to determine whether training is feasible and beneficial if conducted in the home environment, with lower supervision from a physical therapist.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.