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Systematic review of home physiotherapy after hip fracture surgery
Saurabh P Mehta1, Jean-Sébastien Roy
1School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. mehtas8@mcmaster.ca
Objective:
To compare the benefits of home physiotherapy, institution-based physiotherapy and no physiotherapy following hip fracture surgery.
Design:
Systematic review and meta-analysis of randomized controlled trials.
Methods:
Two reviewers independently extracted data from 5 included studies. Standardized mean differences were pooled for health-related quality of life and performance-based outcomes. Review Manager Version 5 was used for data analysis.
Results:
Analysis of the 5 included studies indicated that home physiotherapy was better than no physiotherapy and similar to outpatient physiotherapy in improving patient-reported health-related quality of life. Performance-based outcomes were marginally better following outpatient physiotherapy compared with home physiotherapy 3 and 6 months after surgery. The risk of bias was high for most outcomes due to methodological issues in the included studies.
Discussion:
There was a trend of better results with increasing intensity of physiotherapy intervention, but this did not convert into significant effect sizes. The results of this review do not build a strong consensus for recommending one mode of physiotherapy over the others. The quality of evidence was low mainly due to the high risk of bias in the included studies.
Conclusion:
In light of no strong consensus, physiotherapists should continue to follow their current workplace practice policies for determining suitable discharge settings.
