Effectiveness of Supervised Home-Based Exercise Therapy Compared to a Control Intervention on Functions, Activities, and Participation in Older Patients After Hip Fracture: A Systematic Review and Meta-analysis

Abstract

Objective: The aim of this review was to investigate whether supervised home-based exercise therapy after hospitalization is more effective on improving functions, activities, and participation in older patients after hip fracture than a control intervention (including usual care). Furthermore, we aimed to account the body of evidence for therapeutic validity.

Data sources: Systematic searches of Medline, Embase, and CINAHL databases up to June 30, 2016.

Study selection: Randomized controlled trials studying supervised home-based exercise therapy after hospitalization in older patients (≥65y) after hip fracture.

Data extraction: Two reviewers assessed methodological quality (Physiotherapy Evidence Database) and therapeutic validity (Consensus on Therapeutic Exercise Training). Data were primary analyzed using a best evidence synthesis on methodological quality and meta-analyses.

Data synthesis: A total of 9 articles were included (6 trials; 602 patients). Methodological quality was high in 4 of 6 studies. One study had high therapeutic validity. We found limited evidence in favor of home-based exercise therapy for short- (≤4mo) and long-term (>4mo) performance-based activities of daily living (ADL) and effects at long-term for gait (fast) and endurance. Evidence of no effectiveness was found for short- and long-term effects on gait and self-reported (instrumental) ADL and short-term effects on balance, endurance, and mobility. Conflicting evidence was found for strength, long-term balance, short-term gait (comfortable), long-term self-reported ADL, and long-term mobility.

Conclusions: Research findings show no evidence in favor of home-based exercise therapy after hip fracture for most outcomes of functions, activities, and participation. However, trials in this field have low therapeutic validity (absence of rationale for content and intensity and reporting of adherence), which results in interventions that do not fit patients' limitations and goals.

Keywords: Community health services; Elderly; Exercise; Hip fractures; Rehabilitation.