Extended Exercise Rehabilitation After Hip Fracture Improves Patients' Physical Function: A Systematic Review and Meta-Analysis

Background. Although the principal goal of hip fracture management is a return to the pre-event functional level, most survivors fail to regain their former levels of autonomy. One of the most effective strategies to mitigate the fracture's consequences is therapeutic exercise. Purpose. The purpose of this study was to review and quantify the reported effects of an extended exercise rehabilitation program offered beyond the regular rehabilitation period on improving physical functioning for patients with hip fractures. Sources. The Cochrane libraries, PubMed, CINAHL, PEDro, and EMBASE were searched to April 2012. Study Selection. All randomized controlled trials comparing extended exercise programs with usual care for community-dwelling people after hip fracture were included in the review. Data Extraction and Synthesis. Two reviewers conducted each step independently. The data from the included studies were summarized, and pooled estimates were calculated for 11 functional outcomes. Results. Thirteen trials were included in the review and 11 in the meta-analysis. The extended exercise program showed modest effect sizes (ESs), which reached significance, under random theory, for knee extension strength for the affected and nonaffected sides (ES=0.47, 95% confidence interval [CI]=0.27-0.66, and ES=0.45, 95% CI=0.16-0.74, respectively), balance (ES=0.32, 95% CI=0.15-0.49), physical performance-based tests (ES=0.53, 95% CI=0.27-0.78), Timed "Up & Go" Test (ES=0.83, 95% CI=0.28-1.4), and fast gait speed (ES=0.42, 95% CI=0.11-0.73). Effects on normal gait speed, Six-Minute Walk Test, activities of daily living and instrumental activities of daily living, and physical function subscale of the 36-Item Short-Form Health Survey (SF-36-PF) did not reach significance. Community-based programs had larger ESs compared with home-based programs. Conclusions. To the authors' knowledge, this is the first meta-analysis to provide evidence that an extended exercise rehabilitation program for patients with hip fractures has a significant impact on various functional abilities. The focus of future research should go beyond just effectiveness and study the cost-effectiveness of extended programs.