Handoll Helen Hg, Cameron Ian D, Mak Jenson Cs, Finnegan Terence P
Centre for Rehabilitation Sciences (CRS), Research Institute for Health Sciences and Social Care, University of Teesside, School of Health and Social Care, Middlesborough, Tees Valley, UK, TS1 3BA.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD007125. doi: 10.1002/14651858.CD007125.pub2.
Hip fracture is a major cause of morbidity and mortality in older people and its impact on society is substantial.
To examine the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older patients with hip fracture.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2009), The Cochrane Library (2009, Issue 2), MEDLINE and EMBASE (both to April 2009).
Randomised and quasi-randomised trials of post-surgical care using multidisciplinary rehabilitation of older patients (aged 65 years or over) with hip fracture. The primary outcome, 'poor outcome' was a composite of mortality and decline in residential status at long-term (generally one year) follow-up.
Trial selection was by consensus. Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate.
The 13 included trials involved 2498 older, usually female, patients who had undergone hip fracture surgery. Though generally well conducted, some trials were at risk of bias such as from imbalances in key baseline characteristics.There was substantial clinical heterogeneity in the trial interventions and populations. Multidisciplinary rehabilitation was provided primarily in an inpatient setting in 11 trials. Pooled results showed no statistically significant difference between intervention and control groups for poor outcome (risk ratio 0.89; 95% confidence interval 0.78 to 1.01), mortality (risk ratio 0.90, 95% confidence interval 0.76 to 1.07) or hospital readmission. Individual trials found better results, often short-term only, in the intervention group for activities of daily living and mobility. There was considerable heterogeneity in length of stay and cost data. Three trials reporting carer burden showed no evidence of detrimental effect from the intervention. Overall, the evidence indicates that multidisciplinary rehabilitation is not harmful.The trial comparing primarily home-based multidisciplinary rehabilitation with usual inpatient care found marginally improved function and a clinically significantly lower burden for carers in the intervention group. Participants of this group had shorter hospital stays, but longer periods of rehabilitation. One trial found no significant effect from doubling the number of weekly contacts at the patient's home from a multidisciplinary rehabilitation team.
AUTHORS' CONCLUSIONS: While there was a tendency to a better overall result in patients receiving multidisciplinary inpatient rehabilitation, these results were not statistically significant.Future trials of multidisciplinary rehabilitation should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than evaluate its components.
髋部骨折是老年人发病和死亡的主要原因，对社会的影响巨大。
研究多学科康复在住院或门诊护理环境中对老年髋部骨折患者的效果。
我们检索了Cochrane骨、关节和肌肉创伤小组专业注册库（2009年4月）、Cochrane图书馆（2009年第2期）、MEDLINE和EMBASE（均截至2009年4月）。
对年龄在65岁及以上的老年髋部骨折患者进行多学科康复的术后护理随机和半随机试验。主要结局“不良结局”是长期（一般为一年）随访时死亡率和居住状况下降的综合指标。
通过共识进行试验选择。两位综述作者独立评估试验质量并提取数据。在适当情况下合并数据。
纳入的13项试验涉及2498名通常为女性的老年髋部骨折手术患者。尽管试验总体开展良好，但一些试验存在偏倚风险，如关键基线特征不平衡。试验干预措施和人群存在很大的临床异质性。11项试验主要在住院环境中提供多学科康复。合并结果显示，干预组和对照组在不良结局（风险比0.89；95%置信区间0.78至1.01）、死亡率（风险比0.90，95%置信区间0.76至1.07）或再次入院方面无统计学显著差异。个别试验发现，干预组在日常生活活动和活动能力方面有更好的结果，通常仅为短期。住院时间和成本数据存在相当大的异质性。三项报告照顾者负担的试验未显示干预有有害影响的证据。总体而言，证据表明多学科康复无害。主要比较以家庭为基础的多学科康复与常规住院护理的试验发现，干预组功能略有改善，照顾者负担在临床上显著降低。该组参与者住院时间较短，但康复时间较长。一项试验发现，多学科康复团队将患者家中每周联系次数增加一倍没有显著效果。
虽然接受多学科住院康复的患者总体结果有改善趋势，但这些结果无统计学显著性。未来多学科康复试验应旨在确定多学科康复的总体有效性和成本效益，而非评估其各个组成部分。
