Geriatric rehabilitation following fractures in older people: a systematic review

Cameron I, Crotty M, Currie C, Finnegan T, Gillespie L, Gillespie W, Handoll H, Kurrie S, Madhok R, Murray G, Quinn K, Torgerson D
Record ID 31999009021
Authors' objectives:

The objectives of this review were to identify, critically appraise and synthesise the published evidence for the effectiveness and cost-effectiveness of programmes of care following the acute management of fractures in older people. The principal focus is on rehabilitative care after proximal femoral fracture.

Authors' recommendations: Geriatric service interventions after hip fracture are complex: their form and outcomes are strongly influenced by local conditions. Comparative studies comparing different treatments and strategies are of poor to moderate quality, allowing only tentative conclusions. As an overall strategy for rehabilitation after hip and other lower limb fractures, geriatric orthopaedic rehabilitation units (GORUs) are unlikely to be cost-effective, but some frailer patients may benefit in respect of reduced readmission rates and need for nursing home placement. Geriatric hip fracture programmes (GHFPs) and early supported discharge (ESD) are probably cost-effective, since they appear to shorten the average length of hospital stay, and are associated with significantly increased rates of return to previous residential status. These programmes are not mutually exclusive; an optimal GHFP is likely to involve several elements. As ESD is suitable only for a subset of less disabled patients, an alternative programme for more disabled patients is needed; this is likely to require transfer following surgery, initially to an inpatient setting which might be provided in a GORU or a mixed assessment and rehabilitation unit (MARU). No direct comparison of GORUs and MARUs has been published. Both comparisons of packages of care (such as the GORU or MARU) and comparison of individual elements in these packages may require further research. The adoption of an agreed outcome data set for audit and research would be justified.
Authors' methods: Systematic review
Project Status: Completed
URL for project:
Year Published: 2000
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Aged
  • Fractures, Bone
  • Geriatrics
  • Rehabilitation
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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Copyright: 2000 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.