Effectiveness of multicomponent home-based rehabilitation in older patients after hip fracture surgery: A systematic review and meta-analysis

BACKGROUND

Hip fracture is a major burden on health care systems worldwide and requires hospitalisation for a long period.

OBJECTIVE

The aim was to evaluate the effectiveness of multicomponent home-based rehabilitation compared with different control interventions (in-hospital rehabilitation, active control or usual care) in older patients after hip fracture surgery.

DESIGN

Systematic review and meta-analysis of randomised controlled studies.

DATA SOURCES

We searched three electronic databases, including Ovid-MEDLINE, Ovid-Embase, CINAHL and the Cochrane Library for relevant articles up to March 2020.

REVIEW METHODS

Two investigators independently extracted data and assessed study quality using the risk of bias. Data were analysed using Review Manager 5.3. The current review employs the PRISMA procedure.

RESULTS

Out of 2996 studies, 22 articles were relevant for this review and meta-analysis. Among them, five compared the multicomponent home-based rehabilitation with in-hospital rehabilitation, one compared it with active control, six with usual care and ten compared the home exercise only with usual care. There was no significant difference in activities of daily living (ADL) between multicomponent home-based rehabilitation and in-hospital rehabilitation, while multicomponent home-based rehabilitation significantly increased in ADL when compared to usual care. Home exercises also had significant effects on ADL, quality of life(QoL), balance, gait and muscle strength of the knee extensor compared with usual care (p < .05).

CONCLUSIONS

Multicomponent home-based rehabilitation is comparable to in-hospital rehabilitation regarding improvements in muscle strength, gait speed, balance, ADL and QoL.

RELEVANT TO CLINICAL PRACTICE

Multicomponent home-based rehabilitation is comparable to in-hospital rehabilitation regarding improvements in muscle strength, gait speed, balance, ADL and QoL. Also, high adherence to home exercise may be associated with better clinical outcomes. Therefore, more compliance-oriented multicomponent home-based rehabilitation programmes for older patients after hip fracture must be developed by health care professionals, including physical therapist, to ensure optimum home-based rehabilitation.

Effectiveness of Multicomponent Home-Based Rehabilitation in Elderly Patients after Hip Fracture Surgery: A Randomized Controlled Trial

This randomized controlled study aimed to assess the clinical effectiveness of an 8-week personalized multicomponent home-based rehabilitation (MHR) program by comparing it with a home exercise program after discharge. Forty patients (≥60 years old) who underwent hip surgery were randomly assigned to multicomponent home-based rehabilitation (MHR) and home exercise groups. The MHR program included strength, endurance, balance, and breathing exercises; modifications to the home environment; education on assistive device use; pressure ulcer care; nutrition management; and motivational counseling. The MHR group received 24 visits from rehabilitation staff for 8 weeks (3 times a week), while the home exercise group received home exercises focusing on strengthening described in the leaflet. The rehabilitation staff prescribed the intensity of exercise at the first visit, and the home exercise group exercised without supervision after that for 8 weeks. Both groups received a 10-min phone call once a week for overall counseling to ensure high adherence to home exercises. Among the 40 participants, 29 (72.5%) completed the trial. The primary outcomes were balance and mobility. Balance was assessed using the functional reach test (FRT), and the timed up-and-go test (TUG) was used to assess balance and mobility. Data were analyzed using the intention-to-treat principle. The MHR group showed significant improvement compared to the home exercise group for FRT (mean difference (MD) 4.4 cm; 95% confidence interval (CI) 1.0 to 7.8) and TUG (MD: −4.2 s; 95% CI −8.0 to −0.3) after 8 weeks of intervention. Subjective pain and physical components of general health-related quality of life also improved significantly in the MHR group. No serious adverse events related to the interventions were observed. The eight-week of MHR program can effectively improve balance and mobility.