Introduction
Methods
Data sources and searches
Study selection
Data extraction and quality assessment
Study | Clearly stated aim | Inclusion of consecutive patients | Prospective collection of data | Endpoints appropriate to aim of study + ITT | Unbiased assessment of study endpoint(s) | Follow-up period appropriate to aim of study | Loss to follow-up <5% | Prospective calculation of study size | Adequate control group | Con-temporary groups | Baseline equivalence of groups | Adequate statistical analyses | Randomizationa
| Total score |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
[19] | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 0 | 22 |
[20] | 2 | 2 | 2 | 1 | 2 | 2 | 1 | 0 | 2 | 2 | 1 | 2 | 0 | 19 |
[21] | 2 | 2 | 2 | 1 | 1 | 2 | 0 | 1 | 2 | 2 | 2 | 2 | 2 | 21 |
[22] | 2 | 2 | 2 | 1 | 1 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 0 | 20 |
[23] | 2 | 2 | 2 | 2 | 1 | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 2 | 23 |
[25] | 2 | 1 | 2 | 1 | 2 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 2 | 22 |
[26] | 2 | 1 | 2 | 2 | 0 | 2 | 1 | 2 | 0 | 2 | 1 | 2 | 2 | 19 |
2 | 2 | 2 | 1 | 0 | 2 | 1 | 1 | 2 | 2 | 2 | 2 | 2 | 21 | |
2 | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 2 | 25 | |
[30] | 2 | 2 | 2 | 1 | 0 | 2 | 1 | 0 | 2 | 2 | 2 | 1 | 2 | 19 |
[31] | 2 | 2 | 2 | 1 | 2 | 2 | 0 | 2 | 2 | 2 | 2 | 2 | 2 | 23 |
[32] | 2 | 2 | 2 | 1 | 2 | 2 | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 24 |
Data synthesis and analysis
Study | Study period | Design | Setting | Population | IGCT members | Sample size | Mean age (SD) | ||
---|---|---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | ||||||
[19] | 2007 to 2008 | CD | Leuven, Belgium | ≥65 years with traumatic hip fracture surgery | Geriatrician, geriatric nurse, SW, OT, PT | 94 | 77 | 80.4 (7.0) | 81.1 (7.2) |
[20] | 1982 to 1984 | CD | Montreal, Canada | ≥70 years, admitted from ED to medical ward | Geriatrician, geriatric nurse consultant, SW, OT, PT | 222 | 182 | 78.7 (6.5) | 78.3 (6.7) |
[21] | 1984 | RCT | Halifax, Canada | ≥75 years, at least one of following criteria: confusion, impaired mobility, falls, urinary incontinence, polypharmacy, living in nursing home, admission within the past 3 months | Geriatrician, nurse, PT | 57 | 56 | 82.2 (6.2) | 83.3 (6.0) |
[22] | 1985 | CD | Halifax, Canada | ≥75 years, in category 3 to 5 of Geriatric Status Scale | Specialist in geriatric medicine, nurse coordinator, SW, OT, PT, dietician, pastoral care | 66 | 66 | 83.0 (5.8) | 83.5 (5.9) |
[23] | 1997 to 2000 | Multicenter RCT | Germany | ≥65 years with expected LOS of at least 8 days, functionally impaired | Physician, nurse, SW | 150 | 129 | 79.0 (6.9) | 78.4 (6.9) |
[25] | 1991 | RCT | Chicago, USA | ≥70 years, admitted from the ED to the medicine service | Geriatrician, SW, medical house staff | 51 | 60 | 80.1 (6.6) | 80.1 (6.7) |
[26] | 1991 to 1994 | RCT | Southern California, USA | ≥65 years, at least one of 13 screening criteria (stroke, immobility, impairment in ADL, malnutrition, incontinence, confusion or dementia, prolonged bed rest, falls, depression, social problems, unplanned admission within past 3 months, new fracture, ≥80 years) | Geriatrician, nurse practitioner, SW | 1337 | 1016 | 77.6 (-) | 76.7 (-) |
1983 to 1984 | RCT | North Carolina, USA | ≥75 years admitted to all in-patient units other than intensive care | Attending physician and fellow in geriatric medicine, geriatric CNS, SW | 93 | 92 | 80.9 (5.8) | 82.0 (5.8) | |
2001 to 2003 | RCT | Taiwan | ≥60 years with accidental single-side hip fracture | Geriatrician, geriatric nurse, PT, rehabilitation physician | 80 | 82 | 77.4 (8.2) | 78.9 (7.3) | |
[30] | ? | RCT | North Carolina, USA | ≥70 years | Physician, CNS, home health nurse, SW, PT, dietician, pharmacist | 62 | 58 | 77 (5.4) | 76 (5.4) |
[31] | 1997 | RCT | Madrid, Spain | ≥65 years with acute hip fracture | Geriatrician, SW, rehabilitation specialist | 155 | 164 | 81.1 (7.8) | 82.6 (7.4) |
[32] | 1985 to 1989 | RCT | California, USA | ≥65 years, male, functionally impaired and one of the following criteria: confusion, dependence in ADL, polypharmacy, chronic illness, stressed caregiver system | Attending faculty geriatrician, geriatric fellow, CNS, SW, internal medical house officer | 99 | 98 | 75.7 (9.0) | 76.6 (9.7) |
Study | Follow up | ||||||
---|---|---|---|---|---|---|---|
Functional status | |||||||
Instrument | Discharge | 1 month | 3 months | 6 months | 8 months | 12 months | |
[19] | Six-item Katz ADL Mean (SD) (range 6 to 18)a
| I: 11.2 (3.4) C: 11.9 (3.1) | I: 10.0 (3.8) C: 10.8 (3.9) | I: 9.8 (3.8) C: 10.0 (3.4) | |||
[20] | Barthel Index Mean (SD) (range 0 to 100)b
| I: 71.6 (32.6) C: 68.2 (35.8) | I: 80.2 (27.3) C: 75.0 (33.2) | I: 83.1 (26.0) C: 81.7 (28.5) | |||
[21] | Barthel Index Increaseb
| I: 85% C: 76% | |||||
[22] | Barthel Index Increase | I: 69% C: 52% | I: 77% C: 69% |
I: 75%
C: 44%
| |||
[23] | Barthel Index Median (IQR) (range 0 to 100)b
| I: 90 (35) C: 95 (35) | |||||
[26] | Basic ADL Mean (95% CI) (range 0 to 100)b
| I: 80.5 (78.9 to 82.1) C: 80.2 (78.4 to 82.0) | |||||
Seven-item ADL | Better I: 30/88 (34%) C: 23/90 (26%) Same I: 33/88 (38%) C: 35/90 (39%) Worse I: 25/88 (28%) C: 32/90 (36%) | ||||||
Chinese Barthel Index Mean (SD) (range 0 to 100)b
|
I: 81.2 (15.5)
C: 72.9 (19.8)
|
I: 88.8 (13.4)
C: 79.9 (20.0)
|
I: 91.8 (11.4)
C: 84.1 (18.7)
|
I: 90.5 (18.4)
C: 84.4 (24.0)
| |||
[30] | Functional Assessment Inventory Mean (SD) (range 6 to 30)a
| I: 14.0 (3.0) C: 14.3 (3.5) | |||||
[31] | Katz ADL recovery (= same or better) | I: 2% C: 0.7% | I: 66/125 (53%) C: 52/125 (43%) | ||||
[32] | Physical Self-Maintenance Score Mean (SD) (range 0 to 6)a
| I: 3.2 (1.9) C: 3.1 (2.2) | I: 3.4 (2.0) C: 3.6 (2.1) | I: 3.4 (2.0) C: 3.5 (2.2) | I: 3.6 (2.0) C: 4.0 (2.1) | ||
Length of stay
|
Mortality
| ||||||
1 month
|
3/4 months
|
6 months
|
8 months
|
12 months
| |||
[19] | I: mean 11.1 (SD 5.1) C: mean 12.4 (SD 8.5) | I: 4/94 (4.3%) C: 3/77 (3.9%) | I: 15/94 (16.0%) C: 9/77 (11.7%) | I: 20/94 (21.3%) C: 17/77 (22.1%) | |||
[20] | I: mean 20.6 (SD 23.4) C: mean 20.6 (SD 25.3) | I: 20/222 (9.0%) C: 27/182 (14.8%) | I: 45/222 (20.3%) C: 45/182 (24.7%) | I: 56/222 (25.2%) C: 62/182 (34.1%) | |||
[21] | I: mean 15.8 (SD 12.7) C: mean 14.2 (SD 13.3) |
I: 7/47 (14.9%)
C: 14/46 (30.4%)
| I: 9/47 (19.1%) C: 14/46 (30.4%) | I: 11/47 (23.4%) C: 18/46 (39.1%) | I: 19/47 (40.4%) C: 20/46 (43.5%) | ||
[22] |
I: 3/56 (5.4%)
C: 13/56 (23.2%)
|
I: 5/56 (8.9%)
C: 14/56 (25.0%)
| I: 6/56 (10.7%) C: 16/56 (28.6%) | I: 14/56 (25.0%) C: 20/56 (35.7%) | |||
[23] | I: median 24 (range 18 to 34) C1: median 22 (range 17 to 33) | I: 28/150 (18.7%) C1: 20/129 (15.5%) | |||||
[25] | I: mean 5.4 (SD 5.5) C: mean 7.0 (SD 7.0) | ||||||
[26] | I: 210/808 (26.0%) C: 155/619 (25.0%) | ||||||
I: mean 18.3 (SD 16.1) C: mean 16.6 (SD 14.9) | I: 17/86 (19.8%) C: 23/87 (26.4%) | ||||||
I: mean 10.1 (SD 3.7) C: mean 9.7 (SD 5.0) | I: 0/80 (0%) C: 0/82 (0%) | I: 3/80 (3.8%) C: 3/82 (3.7%) | I: 6/80 (7.5%) C: 8/82 (9.8%) | I: 13/80 (16.2%) C: 15/82 (18.3%) | |||
[30] | I: mean 9.0 (SD 7.5) C: mean 10.1 (SD 7.6) |
I: 3/62 (4.8%)
C: 12/58 (20.7%)
| I: 7/68 (10.3%) C: 13/64 (20.3%) | ||||
[31] | I: median 16 (IQR 6) C: median18 (IQR 11) | I: 29/154 (18.8%) C: 39/155 (25.2%) | |||||
[32] | I: mean 24.8 (SD 22) C: mean 26.7 (SD 33) | I: 41/99 (41.4%) C: 35/98 (35.7%) | |||||
Readmission
| |||||||
1 month
|
3 months
|
6 months
|
8 months
|
12 months
| |||
[19] | I: 3/94 (3.2%) C: 5/77 (6.5%) | I: 10/94 (10.6%) C: 11/77 (14.3%) | I: 25/94 (26.6%) C: 22/77 (28.6%) | ||||
[22] | I: 10/56 (17.9%) C: 15/56 (26.8%) | I: 23/56 (41.0%) C: 32/56 (56.1%) | |||||
[23] | I: 84/150 (56.0%) C: 65/129 (50.4%) | ||||||
[26] | I: 341/808 (42.2%) C: 278/619 (44.9%) | ||||||
I: 29/69 (42.0%) C: 19/64 (29.7%) | |||||||
I: 4/80 (5.0%) C: 5/82 (6.1%) | I: 8/80 (10.0%) C: 10/82 (12.2%) | I: 16/80 (20.0%) C: 14/82 (17.1%) | I: 29/80 (36.3%) C: 25/82 (30.5%) | ||||
[30] |
I: mean 0.3 (SD 0.6)
C: mean 0.6 (SD 1.0)
| ||||||
[32] | I: mean 1.0 (SD 1.3) C: mean1.2 (SD 1.7) |
Results
Selected studies and methodological quality
Characteristics of studies and patients
Effects on functional status
Outcome | Follow-up (months) | Treatment effect | Heterogeneity | Publication bias | Number of studies | ||||
---|---|---|---|---|---|---|---|---|---|
Effect measure | Pooled estimate (95% CI) |
Pvalue for treatment effect |
Pvalue for Cochran's Q test | I squared statistica
| Number of studies trimmedb
| Adjusted pooled estimatec
| |||
Functional status | 1 | Hedges' g | 0.11 (-0.22 to 0.45) | 0.50 | 0.009 | 79% | 0 | 0.11 (-0.22 to 0.45) | |
3 | 0.07 (-0.11 to 0.26) | 0.44 | 0.006 | 73% | 0 | 0.07 (-0.11 to 0.26) | |||
6 | 0.09 (-0.14 to 0.33) | 0.41 | 0.034 | 63% | 1 | 0.15 (-0.07 to 0.37) | |||
12 | 0.01 (-0.15 to 0.16) | 0.94 | 0.15 | 44% | 0 | 0.01 (-0.15 to 0.16) | |||
Length of stay | Weighted mean difference | -0.35 (-1.24 to 0.55) | 0.45 | 0.75 | 0% | 1 | -0.34 (-1.24 to 0.56) | ||
Mortality | 1 | Relative risk | 0.66 (0.40 to 1.09) | 0.10 | 0.46 | 0% | NA | NA | |
3/4 | 0.72 (0.44 to 1.17) | 0.19 | 0.12 | 47% | 0 | 0.72 (0.44 to 1.17) | |||
6 |
0.66 (0.52 to 0.85)
|
0.001
| 0.37 | 0% | 2 | 0.73 (0.52 to 1.02) | |||
8 |
0.51 (0.31 to 0.85)
|
0.009
| 0.39 | 0% | NA | NA | |||
12 | 0.98 (0.86 to 1.11) | 0.75 | 0.52 | 0% | 2 | 1.01 (0.87 to 1.16) | |||
Readmission | 1 | Relative risk | 0.65 (0.25 to 1.67) | 0.37 | 0.59 | 0% | NA | NA | |
3 | 0.93 (0.82 to 1.04) | 0.18 | 0.74 | 0% | 2 | 0.94 (0.84 to 1.05) | |||
6 | 0.88 (0.40 to 1.96) | 0.76 | 0.001 | 86% | 0 | 0.88 (0.40 to 1.96) | |||
12 | 0.99 (0.83 to 1.19) | 0.94 | 0.34 | 12% | 2 | 1.09 (0.87 to 1.36) |