Effectiveness of community-based rehabilitation interventions incorporating outdoor mobility on ambulatory ability and falls-related self-efficacy after hip fracture: a systematic review and meta-analysis
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Abstract Summary There is limited evidence from 11 randomised controlled trials on the effect of rehabilitation interventions which incorporate outdoor mobility on ambulatory ability and/or self-efficacy after hip fracture. Outdoor mobility should be central (not peripheral) to future intervention studies targeting improvements in ambulatory ability. Purpose Determine the extent to which outdoor mobility is incorporated into rehabilitation interventions after hip fracture. Synthesise the evidence for the effectiveness of these interventions on ambulatory ability and falls-related self-efficacy. Methods Systematic search of MEDLINE, Embase, PsychInfo, CINAHL, PEDro and OpenGrey for published and unpublished randomised controlled trials (RCTs) of community-based rehabilitation interventions incorporating outdoor mobility after hip fracture from database inception to January 2021. Exclusion of protocols, pilot/feasibility studies, secondary analyses of RCTs, nonrandomised and non-English language studies. Duplicate screening for eligibility, risk of bias, and data extraction sample. Random effects meta-analysis. Statistical heterogeneity with inconsistency-value (I2). Results RCTs (n = 11) provided limited detail on target or achieved outdoor mobility intervention components. There was conflicting evidence from 2 RCTs for the effect on outdoor walking ability at 1–3 months (risk difference 0.19; 95% confidence intervals (CI): 0.21, 0.58; I2 = 92%), no effect on walking endurance at intervention end (standardised mean difference 0.05; 95% CI: − 0.26, 0.35; I2 = 36%); and suggestive (CI crosses null) of a small effect on self-efficacy at 1–3 months (standardised mean difference 0.25; 95% CI: − 0.29, 0.78; I2 = 87%) compared with routine care/sham intervention. Conclusion It was not possible to attribute any benefit observed to an outdoor mobility intervention component due to poor reporting of target or achieved outdoor mobility and/or quality of the underlying evidence. Given the low proportion of patients recovering outdoor mobility after hip fracture, future research on interventions with outdoor mobility as a central component is warranted. Trial registration PROSPERO registration: CRD42021236541
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Several reviews described physiotherapists, occupational therapists, trained non-professionals, exercise scientists, personal trainers, nurses and chiropractors facilitating the interventions.
“However, several described physiotherapists, occupational therapists, trained non-professionals, exercise scientists, personal trainers, nurses and chiropractors facilitating the interventions.85 86 88”
From Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: A scoping review of systematic reviews (2024) · cites this paper as [88]
In Results, 'Characteristics of included RCTs' (Table 2; page not provided), the review lists physiotherapists, an occupational therapist and trained non-professionals as intervention providers. It also lists a sports therapist, but the available passages do not identify exercise scientists, personal trainers, nurses or chiropractors as intervention facilitators. (LLM, conf=0.87)
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Cites
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,406 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
Interrater reliability: The kappa statistic
McHugh, M. L. (2012) · Biochemia Medica · doi:10.11613/bm.2012.031 · Cited by 19,877 · see citing works
Meta-analysis: Excess Mortality After Hip Fracture Among Older Women and Men
Haentjens, P., Magaziner, J., Colon-Emeric, C. S., Vanderschueren, D., Milisen, K., Velkeniers, B., & Boonen, S. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-152-6-201003160-00008 · Cited by 1,420 · see citing works
Bohannon, R. W., & Crouch, R. (2017) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12629 · Cited by 715 · see citing works
Leibson, C. L., Tosteson, A. N. A., Gabriel, S. E., Ransom, J. E., & Melton, L. J. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50455.x · Cited by 693 · see citing works
Zubala, A., MacGillivray, S. A., Frost, H., Kroll, T., Skelton, D. A., Gavine, A. J., Gray, N. M., Toma, M., & Morris, J. H. (2017) · PLoS ONE · doi:10.1371/journal.pone.0180902 · Cited by 410 · see citing works
Intensive physical training in geriatric patients after severe falls and hip surgery
Hauer, K. A. (2002) · Age and Ageing · doi:10.1093/ageing/31.1.49 · Cited by 252 · see citing works
The Taxonomy Investigators, Lamb, S. E., Becker, C., Gillespie, L. D., Smith, J. L., Finnegan, S., Potter, R. C., & Pfeiffer, K. (2011) · Trials · doi:10.1186/1745-6215-12-125 · Cited by 226 · see citing works
Self-citationPhysical Therapy Management of Older Adults With Hip Fracture
McDonough, C. M., Harris‐Hayes, M., Kristensen, M. T., Overgaard, J. A., Herring, T. B., Kenny, A. M., & Mangione, K. K. (2021) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2021.0301 · Cited by 217 · see citing works
Crotty, M., Whitehead, C. H., Gray, S., & Finucane, P. M. (2002) · Clinical Rehabilitation · doi:10.1191/0269215502cr518oa · Cited by 180 · see citing works
Tang, V., Sudore, R. L., Cenzer, I. S., et al. (2016) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3848-2 · Cited by 157 · see citing works
Crotty, M., Unroe, K. T., Cameron, I. D., Miller, M., Ramı́rez, G., & Couzner, L. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007624.pub3 · Cited by 153 · see citing works
A global call to action to improve the care of people with fragility fractures
Dreinhöfer, K., Mitchell, P., Bégué, T., et al. (2018) · Injury · doi:10.1016/j.injury.2018.06.032 · Cited by 153 · see citing works
Zidén, L., Frändin, K., & Kreuter, M. (2008) · Clinical Rehabilitation · doi:10.1177/0269215508096183 · Cited by 146 · see citing works
Visschedijk, J. H. M., Achterberg, W. P., van Balen, R., & Hertogh, C. M. P. M. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.03036.x · Cited by 144 · see citing works
Griffiths, F. E., Mason, V. L., Boardman, F., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-005406 · Cited by 116 · see citing works
Mangione, K. K., Craik, R. L., Tomlinson, S. S., & Palombaro, K. M. (2005) · Physical Therapy · doi:10.1093/ptj/85.8.727 · Cited by 111 · see citing works
Zidén, L., Kreuter, M., & Frändin, K. (2009) · Disability and Rehabilitation · doi:10.3109/09638280902980910 · Cited by 110 · see citing works
Salpakoski, A., Törmäkangas, T., Edgren, J., Kallinen, M., Sihvonen, S. E., Pesola, M., Vanhatalo, J., Arkela-Kautiainen, M., Rantanen, T., & Sipilä, S. (2014) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.12.083 · Cited by 92 · see citing works
Delivery and Outcomes of a Yearlong Home Exercise Program After Hip Fracture
Orwig, D., Hochberg, M. C., Yu-Yahiro, J. A., Resnick, B. M., Hawkes, W., Shardell, M. D., Hebel, J. R., Colvin, P. L., Miller, R. R., Golden, J., et al. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.15 · Cited by 92 · see citing works
Testing the effectiveness of the exercise plus program in older women post-hip fracture
Resnick, B. M., Orwig, D., Yu-Yahiro, J. A., Hawkes, W., Shardell, M. D., Hebel, J. R., Zimmerman, S. I., Golden, J., Werner, M., & Magaziner, J. S. (2007) · Annals of Behavioral Medicine · doi:10.1007/bf02879922 · Cited by 87 · see citing works
Magaziner, J., Mangione, K. K., Orwig, D., Baumgarten, M., Magder, L. S., Terrin, M. L., Fortinsky, R. H., Gruber‐Baldini, A. L., Beamer, B. A., Tosteson, A. N. A., et al. (2019) · JAMA · doi:10.1001/jama.2019.12964 · Cited by 82 · see citing works
Karlsson, Å., Berggren, M., Gustafson, Y., Olofsson, B., Lindelöf, N., & Stenvall, M. (2016) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.02.001 · Cited by 81 · see citing works
Karlsson, Å., Lindelöf, N., Olofsson, B., Berggren, M., Gustafson, Y., Nordström, P., & Stenvall, M. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2019.12.007 · Cited by 76 · see citing works
Mundi, S., Chaudhry, H., & Bhandari, M. (2014) · Canadian Journal of Surgery · doi:10.1503/cjs.023413 · Cited by 72 · see citing works
Heldmann, P., Werner, C., Belala, N., Bauer, J. M., & Hauer, K. A. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1201-4 · Cited by 72 · see citing works
Edgren, J., Salpakoski, A., Sihvonen, S. E., et al. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2014.12.015 · Cited by 71 · see citing works
Community ambulation before and after hip fracture: a qualitative analysis
Taylor, N. F., Barelli, C., & Harding, K. E. (2010) · Disability and Rehabilitation · doi:10.3109/09638280903483869 · Cited by 67 · see citing works
The 30-day survival and recovery after hip fracture by timing of mobilization and dementia
Goubar, A., Martin, F. C., Potter, C., Jones, G., Sackley, C. M., Ayis, S. A., & Sheehan, K. J. (2021) · The Bone & Joint Journal · doi:10.1302/0301-620x.103b7.bjj-2020-2349.r1 · Cited by 64 · see citing works
Self-citationPfeiffer, K., Kampe, K., Klenk, J., Rapp, K., Kohler, M., Albrecht, D., Büchele, G., Hautzinger, M., Taraldsen, K., & Becker, C. (2020) · Age and Ageing · doi:10.1093/ageing/afaa050 · Cited by 60 · see citing works
Incidence of Hip Fracture in U.S. Nursing Homes
Berry, S. D., Lee, Y., Zullo, A. R., Kiel, D. P., Dosa, D. M., & Mor, V. (2016) · The Journals of Gerontology Series A · doi:10.1093/gerona/glw034 · Cited by 59 · see citing works
Wu, D., Zhu, X., & Zhang, S. (2018) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2328 · Cited by 53 · see citing works
Pol, M., ter Riet, G., van Hartingsveldt, M., et al. (2019) · Age and Ageing · doi:10.1093/ageing/afz074 · Cited by 53 · see citing works
Inequity in rehabilitation interventions after hip fracture: a systematic review
Sheehan, K. J., Fitzgerald, L., Hatherley, S., et al. (2019) · Age and Ageing · doi:10.1093/ageing/afz031 · Cited by 51 · see citing works
Self-citationCrotty, M., Killington, M., Liu, E., Cameron, I. D., Kurrle, S. E., Kaambwa, B., Davies, O., Miller, M., Chehade, M. J., & Ratcliffe, J. (2019) · Age and Ageing · doi:10.1093/ageing/afz005 · Cited by 50 · see citing works
Predictors of change in ‘discharge destination’ following treatment for fracture neck of femur
Nanjayan, S. K., John, J., Swamy, G. N., et al. (2014) · Injury · doi:10.1016/j.injury.2014.02.005 · Cited by 43 · see citing works
Turunen, K. M., Salpakoski, A., Edgren, J., Törmäkangas, T., Arkela-Kautiainen, M., Kallinen, M., Pesola, M., Hartikainen, S. A., Nikander, R., & Sipilä, S. (2017) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2017.01.004 · Cited by 43 · see citing works
Logan, P., Armstrong, S., Avery, T., Barer, D., Barton, G., Darby, J., Gladman, J., Horne, J., Leach, S., Lincoln, N., et al. (2014) · Health Technology Assessment · doi:10.3310/hta18290 · Cited by 40 · see citing works
McCluskey, A., & Middleton, S. (2010) · Implementation Science · doi:10.1186/1748-5908-5-59 · Cited by 16 · see citing works
Suwanpasu, S., Aungsuroch, Y., & Jitapanya, C. (2014) · Asian Biomedicine · doi:10.5372/1905-7415.0804.323 · Cited by 14 · see citing works
Kahlert, D., & Ehrhardt, N. (2020) · Journal of Population Ageing · doi:10.1007/s12062-020-09278-3 · Cited by 12 · see citing works
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Sim, A., McNeilage, A. G., Gholamrezaei, A., Rebbeck, T., & Ashton-James, C. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-085778 · Cited by 8 · see citing works
- Authors
- Sheehan, K. J., Fitzgerald, L., Lambe, K., Martin, F. C., Lamb, S. E., & Sackley, C.
- Affiliations
- King's College London (GB)
- Corresponding author
- Sheehan, Katie J.
- Venue
- Archives of Osteoporosis
- Published
- 2021-06-19
- Volume
- 16
- Issue
- 1
- Pages
- 99-99
- ISSN
- 1862-3514 (ISSN-L)
- 1862-3522
- PMC
- PMC8214580
- OpenAlex
- W3175946340
- Cited by
- 15
- References
- 44
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 2 · 2022: 3
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Archives of Osteoporosis (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Keywords
- hip fracture, community-based rehabilitation, outdoor mobility, ambulatory ability, outdoor walking, walking endurance, fracture rehabilitation, intervention effectiveness
- MeSH terms
- Accidental Falls, Hip Fractures, Humans, Walking, Self Efficacy
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