Effectiveness of supervised home-based exercise therapy compared to a control intervention on functions, activities and participation in older patients after hip fracture: a systematic review and meta-analysis

Publication date: Available online 7 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Isolde A.R. Kuijlaars, Lieke Sweerts, Maria W.G. Nijhuis-van der Sanden, Romke van Balen, J. Bart Staal, Nico L.U. van Meeteren, Thomas J. Hoogeboom
ObjectiveThe aim of this review was to investigate whether supervised home-based exercise therapy after hospitalization is more effective on improving functions, activities and participation in older patients after hip fracture as compared with a control intervention (including usual care). Furthermore, we aimed to account the body of evidence for therapeutic validity.Data sourcesSystematic searches of Medline, Embase and CINAHL databases up to 30 June 2016.Study selectionRandomized controlled trials studying supervised home-based exercise therapy after hospitalization in older patients (≥65 years) after hip fracture.Data extractionTwo reviewers assessed methodological quality (PEDro) and therapeutic validity (CONTENT). Data were primary analysed using a best evidence synthesis on methodological quality and meta-analyses.Data synthesisNine articles were included (six trials; 602 patients). Methodological quality was high in 4/6 studies. One study had high therapeutic validity. We found limited evidence in favour of home-based exercise therapy for short- (≤four months) and long-term (>four months) performance-based activities of daily living and effects at long-term for gait (fast) and endurance. Evidence of no effectiveness was found for short- and long-term effects on gait and self-reported (instrumental) activities of daily living and short-term effects on balance, endurance and mobility. Conflicting evidence was found for strength, long-term balance, short-term gait (comfortable), long-term self-reported activities of daily living and long-term mobility.ConclusionsResearch findings show no evidence in favour of home-based exercise therapy after hip fracture for most outcomes of functions, activities and participation. However, trials in this field have low therapeutic validity (absence of rationale for content and intensity and reporting of adherence) which results in interventions which do not fit patients limitations and goals.



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