Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Physiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
BMC Musculoskelet Disord. 2020 Jul 4;21(1):435. doi: 10.1186/s12891-020-03361-8.
To aid design of exercise trials for people with pelvic and lower limb fragility fractures a systematic review was conducted to identify what types of exercise interventions and mobility outcomes have been assessed, investigate intervention reporting quality, and evaluate risk of bias in published trials.
Systematic searches of electronic databases (CENTRAL, MEDLINE, EMBASE, PEDro) 1996-2019 were conducted to identify randomised controlled trials of exercise for pelvic or lower limb fragility fractures. Two reviewers independently screened titles and abstracts. One reviewer extracted data, a second verified. Two reviewers independently assessed risk of bias. Intervention reporting quality was based on TIDieR, assessed by one reviewer and verified by a second. Narrative synthesis was undertaken. Registration: PROSPERO CRD42017060905.
Searches identified 37 trials including 3564 participants, median sample size 81 (IQR 48-124), participants aged 81 years (IQR 79-82) and 76% (2536/3356) female. All trials focussed on people with hip fracture except one on ankle fracture. Exercise types focussed on resistance exercise in 14 trials, weight bearing exercise in 5 trials, 13 varied dose of sessions with health professionals, and 2 trials each focussed on treadmill gait training, timing of weight bearing or aerobic exercise. 30/37 (81%) of trials reported adequate sequence generation, 25/37 (68%) sufficient allocation concealment. 10/37 (27%) trials lacked outcome assessor blinding. Of 65 exercise interventions, reporting was clear for 33 (51%) in terms of when started, 61 (94%) for where delivered, 49 (75%) for who delivered, 47 (72%) for group or individual, 29 (45%) for duration, 46 (71%) for session frequency, 8 (12%) for full prescription details to enable the exercises to be reproduced, 32 (49%) clearly reported tailoring or modification, and 23 (35%) reported exercise adherence. Subjectively assessed mobility was assessed in 22/37 (59%) studies and 29/37 (78%) used an objective measure.
All trials focussed on hip fracture, apart from one ankle fracture trial. Research into pelvic and other lower limb fragility fractures is indicated. A range of exercise types were investigated but to date deficiencies in intervention reporting hamper reproducibility. Adoption of TIDieR and CERT guidelines should improve intervention reporting as use increases. Trials would be improved by consistent blinded outcome assessor use and with consensus on which mobility outcomes should be assessed.
为了帮助设计针对骨盆和下肢脆弱性骨折患者的运动试验，我们进行了一项系统评价，以确定评估了哪些类型的运动干预措施和活动能力结果，调查干预措施报告质量，并评估已发表试验的偏倚风险。
系统检索电子数据库（CENTRAL、MEDLINE、EMBASE、PEDro）1996-2019 年，以确定针对骨盆或下肢脆弱性骨折的运动随机对照试验。两名评审员独立筛选标题和摘要。一名评审员提取数据，另一名评审员进行验证。两名评审员独立评估偏倚风险。干预措施报告质量基于 TIDieR，由一名评审员评估，由另一名评审员验证。采用叙述性综合法。注册：PROSPERO CRD42017060905。
检索确定了 37 项试验，包括 3564 名参与者，中位数样本量为 81（IQR 48-124），参与者年龄为 81 岁（IQR 79-82），76%（2536/3356）为女性。所有试验均聚焦于髋部骨折患者，除 1 项踝关节骨折试验外。运动类型主要集中在 14 项抗阻运动、5 项负重运动、13 项由健康专业人员进行的不同剂量治疗、2 项分别聚焦于跑步机步态训练、负重时间或有氧运动的试验。37 项试验中有 30/37（81%）报告了充分的随机序列生成，25/37（68%）报告了充分的分配隐藏。10/37（27%）的试验缺乏结局评估者盲法。65 项运动干预措施中，有 33 项（51%）在开始时间方面报告明确，61 项（94%）在治疗地点方面报告明确，49 项（75%）在治疗人员方面报告明确，47 项（72%）在小组或个人方面报告明确，29 项（45%）在治疗持续时间方面报告明确，46 项（71%）在治疗频率方面报告明确，8 项（12%）报告了完整的处方详细信息，使运动能够重现，32 项（49%）明确报告了调整或修改，23 项（35%）报告了运动依从性。22/37（59%）项研究主观评估了活动能力，29/37（78%）项研究使用了客观测量。
所有试验均聚焦于髋部骨折，除 1 项踝关节骨折试验外。需要研究骨盆和其他下肢脆弱性骨折。已经研究了多种运动类型，但迄今为止，干预措施报告中的不足阻碍了其可重复性。随着 TIDieR 和 CERT 指南的采用，干预措施报告的质量将会提高。如果能够一致使用盲法结局评估者，并就应评估哪些活动能力结果达成共识，试验将会得到改善。
