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Adherence to Exercise Programs in Community-Dwelling Older Adults Postdischarge for Hip Fracture: A Systematic Review and Meta-analysis

  • Author Footnotes
    ⁎ Both Lucinda Yau and Kate Soutter contributed equally to this article and are joint first authors.
    Lucinda Yau
    Footnotes
    ⁎ Both Lucinda Yau and Kate Soutter contributed equally to this article and are joint first authors.
    Affiliations
    Physiotherapy Department, Alfred Health, Melbourne, Australia
    Search for articles by this author
  • Author Footnotes
    ⁎ Both Lucinda Yau and Kate Soutter contributed equally to this article and are joint first authors.
    Kate Soutter
    Footnotes
    ⁎ Both Lucinda Yau and Kate Soutter contributed equally to this article and are joint first authors.
    Affiliations
    Physiotherapy Department, Alfred Health, Melbourne, Australia
    Search for articles by this author
  • Christina Ekegren
    Affiliations
    Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
    Search for articles by this author
  • Keith D. Hill
    Affiliations
    Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
    Search for articles by this author
  • Maureen Ashe
    Affiliations
    Department of Family Practice, University of British Columbia, Vancouver, Canada
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  • Sze-Ee Soh
    Correspondence
    Corresponding author Sze-Ee Soh, PhD, 47-49 Moorooduc Highway Frankston, VIC 3199.
    Affiliations
    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Department of Physiotherapy, Monash University, Melbourne, Australia
    Search for articles by this author
  • Author Footnotes
    ⁎ Both Lucinda Yau and Kate Soutter contributed equally to this article and are joint first authors.
Published:February 07, 2022DOI:https://doi.org/10.1016/j.apmr.2022.01.145

      Abstract

      Objective

      To determine whether older adults adhere to exercise programs after discharge for hip fracture and how adherence relates to exercise program characteristics and intervention efficacy.

      Data Sources

      Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, Embase, Physiotherapy Evidence Database, Web of Science, SPORTDiscus, PsycINFO, PubMed, and Ovid MEDLINE were searched from inception to August 2020.

      Study Selection

      Randomized controlled trials of exercise interventions in adults older than 60 years with a surgically managed hip fracture that provided a measure of adherence were selected by 2 independent reviewers.

      Data Extraction

      Data were extracted independently by 1 reviewer and cross-checked by a second reviewer for accuracy. Risk of bias was assessed with 2 tools: a customized checklist was used to examine sources of bias and ambiguity for adherence data, and the Cochrane Risk of Bias tool was used to assess the interval validity of studies.

      Data Synthesis

      Seventeen trials with 1850 participants (mean age, 78.8 years) were included in the review. The pooled estimate of adherence to exercise programs post hip fracture was 0.88 (95% CI, 0.78-0.95). Programs that were more than 6 months in duration were associated with a decrease in adherence (odds ratio, 0.29; 95% CI, 0.11-0.77). However, increased adherence was not associated with improvements in functional outcomes. None of the other program characteristics were associated with improvements in functional outcomes.

      Conclusions

      Adherence to exercise programs after hip fracture appears to be high and may be related to program duration. However, there is a need for a standardized approach to measure and report adherence data in future studies to determine whether exercise adherence is associated with improvements in function for this population.

      Keywords

      List of abbreviations:

      OR (odds ratio), SMD (standardized mean difference), WHO (World Health Organization)
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