Cameron Ian D, Handoll Helen Hg, Finnegan Terence P, Madhok Rajan, Langhorne Peter
Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, PO Box 6, Ryde, NSW, Australia, 1680.
Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD000106. doi: 10.1002/14651858.CD000106.pub2.
Hip fracture is a major cause of morbidity and mortality 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 Bone, Joint and Muscle Trauma Group specialised register (December 2002), MEDLINE (1966 to December 2002), conference proceedings and reference lists of articles and books. We also contacted colleagues and trialists.
Randomised and quasi-randomised trials of post-surgical 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 data from primary outcomes, supplementary analyses were performed to combine clinically relevant outcomes and investigate possible explanatory factors.
In this minor update, new data for two already included trials have been incorporated, resulting in only slight changes to the pooled results.The nine included trials involved 1887 patients. The combined outcomes of death or requiring institutional care showed no significant difference between intervention and control groups (relative risk 0.93; 95% confidence interval 0.83 to 1.05). 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 relative risk of 0.91 (95% confidence interval 0.83 to 1.01). 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 evidence of detrimental effect from the intervention. The review update did not result in any new data for these outcomes.
AUTHORS' CONCLUSIONS: The available trials reviewed had different aims, interventions and outcomes. Combined outcome measures (e.g. death or institutional care) tended to be better for patients receiving co-ordinated inpatient rehabilitation, but the results were heterogeneous and not statistically significant.Future trials of post-surgical 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和死亡的主要原因，其对个人和社会的影响都很大。
比较多学科协作的住院康复治疗与常规（骨科）护理对老年髋部骨折患者的效果。
我们检索了Cochrane骨、关节与肌肉创伤组专业注册库（2002年12月）、MEDLINE（1966年至2002年12月）、会议论文集以及文章和书籍的参考文献列表。我们还联系了同事和试验研究者。
主要针对老年（65岁及以上）髋部骨折患者进行专业康复治疗的术后护理随机和半随机试验。
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。从大多数试验研究者处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，纳入了两项已纳入试验的新数据，仅使汇总结果有轻微变化。纳入的9项试验涉及1887例患者。干预组和对照组在死亡或需要机构护理的综合结局方面无显著差异（相对风险0.93；95%置信区间0.83至1.05）。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相对风险为0.91（95%置信区间0.83至1.01）。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未显示干预有不利影响的证据。本次综述更新未得出这些结局的任何新数据。
所综述的现有试验有不同的目标、干预措施和结局。综合结局指标（如死亡或机构护理）对接受多学科协作住院康复治疗的患者往往更好，但结果存在异质性且无统计学意义。未来涉及住院康复或其他模式（如“早期支持出院”和“居家医院”方案）的术后护理试验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。
