Rehabilitation after pelvic fragility fracture in older adults: a scoping review

To synthesise the evidence available on components of reported rehabilitation interventions following pelvic fragility fracture in older adults and describe outcomes measured.

A scoping review reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. A systematic search of Cochrane CENTRAL, Embase, MEDLINE, and PEDro for studies of rehabilitation among patients 60 years and older with non-pathological pelvic fragility fractures, published up to May 2024. Single case studies were excluded. Screening and study selection were completed in duplicate by four independent reviewers. One reviewer completed extraction with accuracy checked by a second reviewer. A narrative synthesis approach was employed with text and tables.

A total of 17 studies reporting on rehabilitation after pelvic fragility fracture were identified. For 13 studies, descriptors were limited to mobilisation strategies, with 9 citing unrestricted mobilisation as the first prescription. Three studies reporting multicomponent, multidisciplinary (physiotherapy-led) rehabilitation interventions across inpatient and community settings, incorporating exercise, psychological components, and education/advice were identified. A total of 31 outcome domains were identified, with key domains including pain, mobility, activities of daily living, quality of life, and mortality. There was an absence of consensus on which patient reported outcome instruments to use to measure relevant domains.

There is overall limited evidence to guide rehabilitation for older adults following fragility fracture of the pelvis. A standardised approach to rehabilitation should be designed which improves outcomes which matter most to those people affected.