Zhao Lijun, Zhao Xiaona, Dong Bin, Li Xiaobin
Department of Orthopaedic Trauma, Yuncheng Central Hospital affiliated to Shanxi Medical University, Yuncheng, Shanxi Province, China.
PLoS One. 2024 Dec 19;19(12):e0315707. doi: 10.1371/journal.pone.0315707. eCollection 2024.
This systematic review and meta-analysis was performed to assess effectiveness of home-based exercise compared with control interventions for functional rehabilitation in elderly patients after hip fracture surgery. Comprehensive literature search was performed on PubMed, EMBASE, Web of Science, Cochrane library, and Clinicaltrails.gov to identify eligible randomized controlled trials (RCTs). Standard mean difference (SMD) and risk ratio (RR) with 95% confidence interval (CI) was calculated. The certainty of evidence of each outcome was assessed by using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 28 articles reporting 21 unique RCTs (n = 2470) were finally included. Compared with control interventions, home-based exercise significantly improved Berg balance scale (BBS, SMD = 0.28, 95%CI: 0.03 to 0.53, P = 0.030), timed-up-and-go test (TUG, SMD = -0.28, 95%CI: -0.50 to -0.07, P = 0.009), Short Fort-36 physical component score (SF-36 PCS, SMD = 0.49, 95%CI: 0.28 to 0.70, P<0.001), and knee extensor strength (SMD = 0.23, 95%CI: 0.09 to 0.37, P = 0.001). No significant improvement was observed in gait speed, 6-minute walking test, short physical performance battery performance (SPPB), activities of daily living (ADL), or fear of falling in the home exercise group. Risk of adverse events, including emergency department visits, hospital readmissions, and falls, did not differ between both groups. According to GRADE, the overall certainty of evidence was moderate for usual gait speed, SPPB, ADL, fear of falling, and SF-36 PCS, and was low or very low for the other outcomes. Our meta-analysis demonstrated home-based exercise had positive effect on physical function after hip fracture surgery. Home-based rehabilitation might be recommended for rehabilitation of fractured patients after hospital discharge.
本系统评价和荟萃分析旨在评估与对照干预措施相比，居家锻炼对髋部骨折手术后老年患者功能康复的有效性。通过在PubMed、EMBASE、Web of Science、Cochrane图书馆和Clinicaltrails.gov上进行全面的文献检索，以确定符合条件的随机对照试验（RCT）。计算了具有95%置信区间（CI）的标准平均差（SMD）和风险比（RR）。采用推荐分级评估、制定和评价（GRADE）方法评估每个结局的证据确定性。最终纳入了28篇报告21项独立RCT（n = 2470）的文章。与对照干预措施相比，居家锻炼显著改善了伯格平衡量表（BBS，SMD = 0.28，95%CI：0.03至0.53，P = 0.030）、计时起立行走测试（TUG，SMD = -0.28，95%CI：-0.50至-0.07，P = 0.009）、简明健康调查36项量表身体成分得分（SF-36 PCS，SMD = 0.49，95%CI：0.28至0.70，P<0.001）和膝关节伸肌力量（SMD = 0.23，95%CI：0.09至0.37，P = 0.001）。居家锻炼组在步速、6分钟步行试验、简短体能状况量表表现（SPPB）、日常生活活动能力（ADL）或跌倒恐惧方面未观察到显著改善。两组之间包括急诊就诊、再次入院和跌倒在内的不良事件风险没有差异。根据GRADE，对于通常步速、SPPB、ADL、跌倒恐惧和SF-36 PCS，证据的总体确定性为中等，而对于其他结局则为低或非常低。我们的荟萃分析表明，居家锻炼对髋部骨折手术后的身体功能有积极影响。出院后的骨折患者康复可能推荐采用居家康复。
