Cameron I D, Finnegan T P, Madhok R, Langhorne P, Handoll H H
Rehabilitation Studies Unit, University of Sydney, PO Box 6, Ryde, New South Wales, Australia, NSW 1680.
Cochrane Database Syst Rev. 2000(2):CD000106. doi: 10.1002/14651858.CD000106.
Hip fracture is a major cause of morbidity in older people and its impact, both on the individual and to society, is substantial.
To examine the effects of co-ordinated multidisciplinary inpatient rehabilitation, compared with usual orthopaedic care, for older patients with hip fracture.
We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline (up to April 1998), and reference lists of published papers and books. We also contacted colleagues and trialists.
Randomised and quasi-randomised trials of postsurgical care using specialised rehabilitation of mainly older patients (aged 65 years or over) with hip fracture.
Trial assignment to included, excluded and awaiting assessment categories, was by consensus. Two reviewers independently assessed trial quality and extracted data. Limited additional information was sought from most trialists. As well as pooling of data from primary outcomes, supplementary analyses were performed to combine clinically relevant outcomes and investigate possible explanatory factors.
In this minor update, one new trial is identified and has been placed in "studies awaiting assessment". Of another three trials previously pending assessment, one has now been excluded. The five included trials involved 1068 patients. The combined outcomes of death or requiring institutional care at final follow-up showed no significant difference between intervention and control groups (Peto odds ratio 0.92; 95% confidence interval 0.71 to 1.18). There was considerable heterogeneity in length of stay and cost data. Using death and deterioration in function as a further combined outcome variable yielded a Peto odds ratio of 0.83 (95% confidence interval 0.64 to 1. 07). This should be interpreted with caution due to heterogeneity. No quality of life measures were reported and the two trials investigating carer burden showed no detrimental effect from the intervention. The review update did not result in any new data for these outcomes.
REVIEWER'S CONCLUSIONS: The trials reviewed had different aims, interventions and outcomes. As a consequence, results were heterogeneous and the question of effectiveness of different types of co-ordinated inpatient rehabilitation after hip fracture cannot be answered conclusively. There is a trend to effectiveness when combined outcome variables (death and institutional care, death and deterioration in function) are considered. Future trials of postsurgical care involving inpatient rehabilitation, or other models such as 'early supported discharge' and 'hospital at home' schemes, should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than attempt to evaluate its components.
髋部骨折是老年人发病的主要原因，其对个人和社会的影响都很大。
研究与常规骨科护理相比，多学科协调住院康复对老年髋部骨折患者的效果。
我们检索了Cochrane肌肉骨骼损伤组试验注册库、Medline（截至1998年4月）以及已发表论文和书籍的参考文献列表。我们还联系了同事和试验者。
主要针对老年髋部骨折患者（65岁及以上）进行专门康复的术后护理的随机和半随机试验。
通过共识将试验分配到纳入、排除和待评估类别。两名评审员独立评估试验质量并提取数据。从大多数试验者那里获取了有限的补充信息。除了汇总主要结局的数据外，还进行了补充分析，以合并临床相关结局并调查可能的解释因素。
在本次小更新中，确定了一项新试验并将其置于“待评估研究”中。之前待评估的另外三项试验中，有一项现已被排除。纳入的五项试验涉及1068名患者。最终随访时死亡或需要机构护理的综合结局在干预组和对照组之间无显著差异（Peto比值比0.92；95%置信区间0.71至1.18）。住院时间和成本数据存在相当大的异质性。将死亡和功能恶化作为进一步的综合结局变量得出Peto比值比为0.83（95%置信区间0.64至1.07）。由于存在异质性，对此应谨慎解释。未报告生活质量测量结果，两项调查照顾者负担的试验显示干预没有不利影响。本次综述更新未得出这些结局的任何新数据。
所综述的试验有不同的目的、干预措施和结局。因此，结果存在异质性，髋部骨折后不同类型的多学科协调住院康复的有效性问题无法得出确凿答案。在考虑综合结局变量（死亡和机构护理、死亡和功能恶化）时存在有效性趋势。未来涉及住院康复的术后护理试验，或其他模式，如“早期支持出院”和“居家医院”计划，应旨在确定多学科康复总体的有效性和成本效益，而不是试图评估其各个组成部分。
