Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
Osteoporos Int. 2011 May;22(5):1289-322. doi: 10.1007/s00198-010-1408-x. Epub 2010 Oct 22.
The purpose of this study is to identify and chart research literature on safety, efficacy, or effectiveness of exercise prescription following fracture in older adults. We conducted a systematic, research-user-informed, scoping review. The population of interest was adults aged ≥45 years with any fracture. "Exercise prescription" included post-fracture therapeutic exercise, physical activity, or rehabilitation interventions. Eligible designs included knowledge synthesis studies, primary interventional studies, and observational studies. Trained reviewers independently evaluated citations for inclusion. A total of 9,415 citations were reviewed with 134 citations (119 unique studies) identified: 13 knowledge syntheses, 95 randomized or controlled clinical trials, and 11 "other" designs, representing 74 articles on lower extremity fractures, 34 on upper extremity, eight on vertebral, and three on mixed body region fractures. Exercise prescription characteristics were often missing or poorly described. Six general categories emerged describing exercise prescription characteristics: timing post-fracture, person prescribing, program design, functional focus, exercise script parameters, and co-interventions. Upper extremity and ankle fracture studies focused on fracture healing or structural impairment outcomes, whereas hip fracture studies focused more on activity limitation outcomes. The variety of different outcome measures used made pooling or comparison of outcomes difficult. There was insufficient information to identify evidence-informed parameters for safe and effective exercise prescription for older adults following fracture. Key gaps in the literature include limited numbers of studies on exercise prescription following vertebral fracture, poor delineation of effectiveness of different strategies for early post-fracture mobilization following upper extremity fracture, and inconsistent details of exercise prescription characteristics after lower extremity fracture.
本研究旨在确定和绘制有关老年人骨折后运动处方安全性、有效性或效果的研究文献。我们进行了一项系统的、以研究用户为导向的、范围广泛的综述。研究对象为年龄≥45 岁、有任何骨折的成年人。“运动处方”包括骨折后治疗性运动、身体活动或康复干预。合格的设计包括知识综合研究、初级干预研究和观察性研究。经过培训的审查员独立评估引文是否符合纳入标准。共审查了 9415 条引文，确定了 134 条引文（119 项独立研究）：13 项知识综合研究、95 项随机或对照临床试验和 11 项“其他”设计，涉及 74 篇关于下肢骨折的文章，34 篇关于上肢骨折，8 篇关于脊柱骨折，3 篇关于混合身体区域骨折。运动处方的特点往往缺失或描述不当。出现了六个描述运动处方特点的一般类别：骨折后时机、开处方的人、方案设计、功能重点、运动脚本参数和共同干预。上肢和踝关节骨折研究主要关注骨折愈合或结构损伤的结果，而髋关节骨折研究则更关注活动受限的结果。使用的不同结果测量方法种类繁多，使得难以对结果进行汇总或比较。没有足够的信息来确定针对老年人骨折后安全有效的运动处方的循证参数。文献中的关键空白包括关于脊柱骨折后运动处方的研究数量有限、早期上肢骨折后不同策略对促进早期活动的效果缺乏明确界定，以及下肢骨折后运动处方特点的细节不一致。
