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

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Effects of Geriatric Team Rehabilitation After Hip Fracture : Meta-Analysis of Randomized Controlled Trials. / Nordström, Peter; Thorngren, Karl Gunnar; Hommel, Ami; Ziden, Lena; Anttila, Sten.

I: Journal of the American Medical Directors Association, Vol. 19, Nr. 10, 01.2018, s. 840-845.

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

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TY - JOUR

T1 - Effects of Geriatric Team Rehabilitation After Hip Fracture

T2 - Journal of the American Medical Directors Association

AU - Nordström, Peter

AU - Thorngren, Karl Gunnar

AU - Hommel, Ami

AU - Ziden, Lena

AU - Anttila, Sten

PY - 2018/1

Y1 - 2018/1

N2 - 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.

AB - 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.

KW - hip fracture

KW - interdisciplinary geriatric team rehabilitation

KW - Meta-analysis

UR - http://www.scopus.com/inward/record.url?scp=85048989630&partnerID=8YFLogxK

U2 - 10.1016/j.jamda.2018.05.008

DO - 10.1016/j.jamda.2018.05.008

M3 - Article

VL - 19

SP - 840

EP - 845

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 10

ER -