Background
Methods
Eligibility
Types of studies
Types of participants
Types of interventions
Types of outcomes
Search strategy for identification of studies
Selection of studies
Data extraction
Assessment of risk of bias in included studies
Intervention reporting
Quality assessment criteria | |
---|---|
Clear | Necessary details reported |
Unclear | Some detail reported but did not satisfy the criteria fully |
Not reported | No reference to the reporting domain in study report(s) |
Not applicable | Reporting domain not applicable to the exercise intervention described |
Domain of intervention reporting | |
When after injury | Intended or actual timing for the start of the intervention after fracture or surgery explicitly stated. |
Where done | Location/s of where the intervention took place. Reporting home, hospital, rehabilitation centre was sufficient. |
Who delivered | Who administered the intervention (where applicable). Which recognised health professionals (e.g. physiotherapist/ physical therapist, occupational therapist) or for non-health professionals (e.g. administrative staff, trainer) additional information about training or expertise required. |
Group/individual | Intervention conducted in a group, individually, or both. |
Duration of intervention | Session duration (e.g. minutes) for supervised sessions and period of time over which intervention took place (e.g. weeks). Session duration of home programmes, and supervised sessions where only one exercise was performed and the specifics of the exercise are outlined, did not need to be reported. |
Frequency of intervention | How often the intervention was to be completed over a specific period of time i.e. the intended schedule. |
Specifics of exercise prescription so would be reproducible | The exercises, sets and repetitions for resistance exercises, duration for aerobic exercises, and exercise loading or intensity needed to be described in sufficient detail, or a reference provided that describes these in sufficient detail, that would allow the intervention to be reproduced. |
Tailoring/modifications | Any component of the intervention was explicitly stated to be adapted to the individual and how this was achieved was explained. |
Adherence | Completed intervention sessions expressed relative to the prescribed number of sessions for either the supervised or home component of the intervention where applicable e.g. 70% or 20/30, except pragmatic studies where the number of sessions was not prescribed but the number of sessions received by participants was reported. |
Data synthesis
Changes to protocol
Results
Study selection and characteristics
Characteristics of included studies
Characteristic | |
---|---|
Year published (N = 37) | |
1997–2001 | 3 |
2002–2006 | 12 |
2007–2011 | 9 |
2012–2016 | 11 |
2017–2019 | 2 |
Country (N = 37) | |
Australia | 10 |
USA | 8 |
Sweden, UK | 3 |
Norway | 2 |
Canada, Egypt, Finland, Germany, Italy, Japan, Netherlands, Spain, Switzerland, Taiwan, Thailand | 1 |
RCT design (N = 37) | |
Parallel | 35 |
Factorial | 2 |
Cluster | 0 |
Other | 0 |
Number of intervention groups (N = 37) | |
2 | 31 |
3 | 3 |
4 | 3 |
Participants | |
Total all studies (median; IQR) (N = 36) | 3565 (80.5; 47.5 to 123.5) |
Age median (IQR) (N = 32) | 80.75 (79.29 to 82.24) |
Gender (male: female) (N = 32) | 820: 2536 |
Fracture types (N = 37) | |
Pelvic | 0 |
Hipa | 36 |
Tibia (diaphysis/metaphyseal) | 0 |
Femur (diaphysis/distal metaphyseal) | 0 |
Knee | 0 |
Ankle | 1 |
Foot | 0 |
Mixture of lower limb fractures | 0 |
Orthopaedic management (N = 37) | |
Surgical | 30 |
Conservative | 0 |
Both | 2 |
Unclear | 5 |
Exercise intervention typeb(N = 37) | |
Resistance exercise | 14 |
Dose of sessions with health professional | 13 |
Weight bearing exercise | 5 |
Treadmill training, timing of weight bearing, aerobic exercise | 2 |
Setting of intervention (N = 36) | |
Inpatient | 11 |
Outpatient | 6 |
Community | 13 |
Combination | 6 |
Subjective mobility outcomes (N = 22) | |
Hip fracture studies (N = 21): | |
Harris Hip Scorec, Physical Performance and Mobility Examination, participant self-reported/rated mobility (not a mobility outcome questionnaire/scale) | 3 |
Performance Oriented Mobility Assessment, Yale Physical Activity Scale, Clinician assessment of gait, Functional Ambulatory Categories | 2 |
Functional Status Questionnaire, Hip Rating Questionnaire, Nursing Home Life-Space Diameter, Disability Rating Index, Activity Measure for Post-Acute Care, WOMAC, Assistance required for bed transfers, Modified Functional Status Index, Modified Grimby Scale, Harvard Alumni Physical Activity Index, Physical Activity Scale for the Elderly, Part C of the National Health and Nutrition Examination Survey, International Physical Activity Questionnaire long-from, Assessment of gait using 5 items from the gait component of the Performance Oriented Mobility Assessment | 1 |
Ankle fracture studies (N = 1): | |
Lower Extremity Functional scale, International Physical Activity Questionnaire short-form | 1 |
Objective mobility outcomes (N = 29) | |
Hip fracture studies (N = 28): | |
Timed Up and Go Test | 11 |
Gait speed | 10 |
6 min walk test | 7 |
Timed 6 m walk test | 3 |
Modified Physical Performance Test, Short Physical Performance Battery, 10 m walk test, cadence during timed 6 m walk test, number of steps during timed 6 m walk test, step length during timed 6 m walk test, timed stair climbing | 2 |
2 min walk test, 10 min walk test, 10 min walk test with obstacles, 10 min walk test with cognitive task, daily walking distance, distance walked during treatment, Lower Extremity Gain Scale, 48 h step count, timed transfer lying to sitting, 50 ft walk test, time to walk 10 ft and turn back | 1 |
Ankle Fracture studies (N = 1): | |
Gait speed | 1 |
Mixed subjective and objective mobility outcomes (N = 4) | |
Hip fracture studies (N = 4): | |
Modified Iowa Level of Assistance Scale, Elderly Mobility Scale | 2 |
Ankle Fracture studies (N = 0) | |
Duration of follow-up (longest time frame in each study) (N = 34) | |
0–6 weeks | 7 |
> 6–16 weeks | 9 |
> 16 weeks | 18 |
Total median (IQR) (N = 33) | 6 (2.5 to 12) months |
Interventions
Intervention | Control | Study | |||
---|---|---|---|---|---|
Resistance exercise | Resistance exercise only | ||||
Resistance exercise | Aerobic exercise | Inactive control | Mangione et al. 2005 [13] a | ||
Resistance exercise | TENS | Mangione et al. 2010 [14] | |||
Resistance exercise | Resistance exercise and supplementary nutrition | Supplementary nutrition | Advice | Miller et al. 2006 [15] | |
Resistance exercise | Inactive control | Sherrington et al. 1997 [16] | |||
Resistance and functional movement exercises | |||||
Resistance and functional movement exercises | Inactive control | Sylliaas et al. 2012 [17] | |||
Resistance and functional movement exercises | Inactive control | Sylliaas et al. 2011 [18] | |||
Resistance, balance, and flexibility exercise, and advice | |||||
Resistance, balance, and flexibility exercise, and advice | Non-weight bearing flexibility exercise and advice | Moseley et al. 2015 [12] | |||
Resistance, functional movement, and balance exercise | |||||
Resistance, functional movement, and balance exercise | Functional movement and balance exercise | Mitchell et al. 2001 [19] | |||
Resistance, functional movement, and balance exercise | Physical activity and cognitive task practice | Hauer 2002 [20] | |||
Resistance and aerobic exercise | |||||
Resistance and aerobic exercise | Resistance and aerobic exercise, \and behaviour change strategies | Behaviour change strategies | Inactive control | Resnick et al 2007 [21] | |
Resistance, flexibility, balance, and aerobic exercise | |||||
Resistance, flexibility, balance, and aerobic exercise | Flexibility exercise | Binder et al. 2004 [22] | |||
Resistance, aerobic, and balance exercise | |||||
Resistance, aerobic, and balance exercise | Inactive control | Peterson et al. 2004 [23] | |||
Resistance and functional movement exercise, and behaviour change strategies | |||||
Resistance and functional movement exercise, and behaviour change strategies | Dietary advice | Latham et al. 2016 [24] | |||
Resistance and balance exercise, and complex optional intervention components | |||||
Resistance and balance exercise, and complex optional intervention components | Usual care including physiotherapy | Singh et al. 2012 [25] | |||
Weight bearing exercise | Weight bearing resistance and functional movement exercise | ||||
Weight bearing resistance and functional movement exercise | Non-weight bearing flexibility and functional movement exercise | Sherrington et al. 2003 [26] | |||
Higher dose weight bearing resistance and functional movement exercise | Lower dose limited weight bearing resistance and functional movement exercise | Moseley et al. 2009 [27] | |||
Weight bearing resistance exercise only | |||||
Weight bearing resistance exercise | Non-weight bearing flexibility exercise | Inactive control | Sherrington et al. 2004 [28] | ||
Weight bearing resistance and balance exercise, and advice | |||||
Weight bearing resistance and balance exercise, and advice | Inactive control | Elinge et al. 2003 [29] | |||
Weight bearing balance and functional movement exercise | |||||
Weight bearing balance and functional movement exercise | Limited weight bearing resistance, flexibility, and functional movement exercise | Monticone et al. 2018 [30] | |||
Treadmill training | Body Weight-Supported Treadmill Training and usual physical therapy | Usual physical therapy | Ohoka et al. 2015 [31] | ||
Adaptability treadmill training and multimodal exerciseb | Conventional treadmill training and multimodal exercise | Multimodal exercise | van Ooijen et al. 2016 [32] | ||
Dose of sessions with health professional | Multi-disciplinary care: | ||||
Higher dose multi-disciplinary care | Lower dose multi-disciplinary care | Ryan et al. 2006 [33] | |||
Higher dose multi-disciplinary care | Lower dose multi-disciplinary care | Crotty et al. 2019 [34] | |||
Physiotherapy: | |||||
Higher dose physiotherapy | Lower dose physiotherapy | Kimmel et al. 2016 [35] | |||
Higher dose physiotherapy and high dose cholecalciferol | Higher dose physiotherapy and low dose cholecalciferol | Lower dose physiotherapy and high dose cholecalciferol | Lower dose physiotherapy and low dose cholecalciferol | Bischoff-Ferrari et al. 2010 [36] | |
Higher dose physiotherapy | Lower dose physiotherapy | Tsauo et al. 2005 [37] | |||
Occupational therapy/functional training | |||||
Occupational therapy/functional training and usual care including physiotherapy | Usual care including physiotherapy | Hagsten et al. 2004 [38] | |||
Occupational therapy/functional training and multimodal exercise | Multimodal exercise | Martín-Martín et al. 2014 [39] | |||
Occupational therapy/functional training and higher dose multimodal exercise | Lower dose multimodal exercise | Tinetti et al. 1999 [40] | |||
Behaviour change strategies and exercise: | |||||
Behaviour change strategies, unspecified exercise, and usual care | Usual care | Suwanpasu et al. 2014 [41] | |||
Behaviour change strategies, higher dose functional movement exercise, and functional training | Lower dose functional movement exercise and functional training | Zidén et al. 2008 [42] | |||
Behaviour change strategies, resistance, and aerobic exercise | Inactive control | Orwig et al. 2011 [43] | |||
Behaviour change strategies, multimodal exercise, and flexibility exercise | Flexibility exercise | Salpakoski et al. 2014 [44] | |||
Behaviour change strategies, functional movement exercise, and usual care | Usual care | Williams et al. 2017 [45] | |||
Timing of weight bearing | Early weight bearing and flexibility exercise | Delayed weight bearing and flexibility exercise | Ali 2010 [46] | ||
Early weight bearing and usual physiotherapy | Delayed weight bearing and usual physiotherapy | Oldmeadow et al. 2006 [47] | |||
Aerobic exercise | Aerobic exercise only | ||||
Aerobic exercise | Resistance exercise | Inactive control | |||
Aerobic and multimodal exercise | |||||
Aerobic and multimodal exercise | Multimodal exercise | Mendelsohn et al. 2008 [48] |