Effect of home-based rehabilitation for hip fracture: A meta-analysis of randomized controlled trials

Abstract

Background: Home-based rehabilitation following hip fracture may be beneficial; however, the evidence is controversial. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of home-based rehabilitation in patients with hip fracture. Methods: PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were searched systematically. Randomized controlled trials (RCTs) assessing the effect of home-based rehabilitation for patients with hip fracture were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. Primary outcomes were mobility and daily activity. Meta-analysis was performed using the random- effect model. Results: Nine RCTs involving 887 patients were included in the meta-analysis. Overall, compared with control intervention for hip fracture, home-based rehabilitation was found to significantly improve mobility (standard mean difference (SMD) 0.56; 95% confidence interval (95% CI) 0.24-0.87; p = 0.006), daily activity (SMD 0.72; 95% CI 0.12-1.33; p = 0.02), instrumental activity (SMD 0.85; 95% CI 0.06-1.64; p = 0.03) and balance (SMD 0.89; 95% CI 0.06-1.73; p = 0.04), but resulted in no significant influence on walking outdoors (risk ratio (RR) 1.36; 95% CI 0.74-2.49; p = 0.32), usual gait speed (SMD 0.28; 95% CI -0.33 to 0.90; p = 0.37), fast gait speed (SMD 0.34; 95% CI -0.54 to 1.22; p = 0.45), and emergency department visit (RR 0.69; 95% CI 0.11-4.32; p = 0.69). Conclusion: The results of the meta-analysis showed that home-based rehabilitation has considerable positive effects on physical functioning after hip fracture. Home-based rehabilitation is therefore recommended for hip fracture.