Department of Physiotherapy, Peninsula Health, Frankston; Department of Physiotherapy, Monash University, Melbourne.
Department of Physiotherapy, La Trobe University, Bundoora.
Arch Phys Med Rehabil. 2022 Aug;103(8):1638-1650.e7. doi: 10.1016/j.apmr.2021.12.007. Epub 2021 Dec 31.
To investigate the effect of rehabilitation on the physical, social, and psychological dimensions of community reintegration after hip fracture.
Electronic databases Embase, EMCare, MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health, and SPORTDiscus were searched from the earliest date available to second June 2021.
Searching identified 1844 potentially relevant articles. Twenty randomized controlled trials evaluating physical retraining, cognitive retraining, and model of care interventions on physical, social and psychological aspects of community reintegration for 3075 adults after hip fracture were included.
Data were extracted using predetermined templates for participant characteristics, intervention type and setting, and outcomes related to community reintegration. Methodological quality was assessed using the Physiotherapy Evidence Database scale, and the Grading of Recommendations, Assessment, Development, and Evaluations approach was applied to each meta-analysis.
Post intervention data were pooled to calculate risk ratios (RRs), mean differences, standardized mean differences, and 95% confidence intervals (CIs) using inverse variance methods and a random-effects model. Compared with usual care or no rehabilitation, there was moderate-quality evidence to suggest that physical retraining interventions improved outdoor mobility (RR, 1.45; 95% CI, 1.09-1.91; I=0%) and moderate-quality evidence to suggest that physical retraining improved Nottingham Extended Activities of Daily Living Scale scores (physical and social reintegration) by a mean 3.5 units (95% CI, 0.99-6.01; I=0%). Meta-analyses showed no significant effect for cognitive retraining and model of care interventions on any dimension of community reintegration.
Preliminary evidence suggests that physical rehabilitation after hip fracture improves physical and social aspects of community reintegration. The effect of psychological and home-based interventions on community reintegration is currently unclear. Further research is needed to determine the effect of rehabilitation on community reintegration, using interventions and measures that encompass all dimensions of community reintegration.
调查康复对髋部骨折后社区再融入的身体、社会和心理维度的影响。
从最早可获得的时间到 2021 年 6 月 2 日，电子数据库 Embase、EMCare、MEDLINE、PsycINFO、护理和联合健康累积索引以及 SPORTDiscus 进行了检索。
搜索确定了 1844 篇潜在相关文章。20 项随机对照试验评估了物理再训练、认知再训练和护理模式干预对 3075 名髋部骨折后身体、社会和心理方面的社区再融入的影响。
使用参与者特征、干预类型和设置以及与社区再融入相关的结果的预定模板提取数据。使用物理治疗证据数据库量表评估方法学质量，并应用推荐评估、制定和评估方法对每个荟萃分析进行分级。
使用逆方差方法和随机效应模型汇总干预后数据，以计算风险比（RR）、均值差、标准化均数差和 95%置信区间（CI）。与常规护理或无康复相比，有中等质量的证据表明物理再训练干预改善了户外活动能力（RR，1.45；95%CI，1.09-1.91；I=0%），并且有中等质量的证据表明物理再训练改善了诺丁汉扩展日常生活活动量表评分（身体和社会融入），平均提高 3.5 个单位（95%CI，0.99-6.01；I=0%）。荟萃分析表明，认知再训练和护理模式干预对社区再融入的任何维度均无显著影响。
初步证据表明，髋部骨折后的物理康复可改善社区再融入的身体和社会方面。心理和家庭干预对社区再融入的影响目前尚不清楚。需要进一步研究，使用包含社区再融入所有维度的干预措施和措施来确定康复对社区再融入的影响。
