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: http://www.hta.ac.uk/1009

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

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

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

Copyright: 2000 Queen's Printer and Controller of HMSO