To investigate the impact of rehabilitation on the physical, social and psychological
dimensions of community reintegration following hip fracture.
Electronic databases EMBASE, EMCARE, MEDLINE, PsycINFO, CINAHL and SPORTDiscus were
searched from the earliest date available to 2nd June 2021.
Searching identified 1844 potentially relevant articles. Twenty randomised controlled
trials evaluating physical retraining, cognitive retraining, and model of care interventions
on physical, social and psychological aspects of community reintegration for 3075
adults following hip fracture were included.
Data were extracted using pre-determined templates for participant characteristics,
intervention type and setting, and outcomes related to community reintegration. Methodological
quality was assessed using the PEDro scale, and the Grading of Recommendations, Assessment,
Development and Evaluations approach was applied to each meta-analysis.
Post intervention data were pooled to calculate risk ratios (RR), mean differences
(MD), standardised mean differences (SMD) and 95% confidence intervals (CI) using
inverse variance methods and a random effects model. When compared with usual care
or no rehabilitation, there was moderate quality evidence to suggest that physical
retraining interventions improved outdoor mobility (RR 1.45, 95%CI 1.09 to 1.91, I2 0%), and moderate quality evidence to suggest that physical retraining improved Nottingham
Extended Activities of Daily Living Scale scores (physical and social reintegration)
by a mean 3.5 units (95%CI 0.99 to 6.01, I2 0%). Meta-analyses showed no significant effect for cognitive retraining and model
of care interventions on any dimension of community reintegration.
Preliminary evidence suggests that physical rehabilitation following hip fracture
improves physical and social aspects of community reintegration. The impact of psychological
and home-based interventions on community reintegration is currently unclear. Further
research is needed to determine the impact of rehabilitation on community reintegration,
using interventions and measures that encompass all dimensions of community reintegration.