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Effectiveness of community-based rehabilitation interventions incorporating outdoor mobility on ambulatory ability and falls-related self-efficacy after hip fracture: a systematic review and meta-analysis

Research output: Contribution to journalReview articlepeer-review

Katie Sheehan, Laura Fitzgerald, Kate Lambe, Finbarr Martin, Sallie Lambe, Catherine Sackley

Original languageEnglish
Article number99
JournalArchives of osteoporosis
Issue number1
Accepted/In press24 May 2021
PublishedDec 2021

Bibliographical note

Funding Information: KS received funding from the NIHR Research for Patient Benefit, the Chartered Society of Physiotherapy Charitable Trust and UKRI Future Leaders Fellowship for hip fracture health services research. KS is the current Lead of the International Fragility Fracture Network’s Hip Fracture Recovery Research Special Interest Group. CS received funding from the National Institutes of Health Research and Dunhill Medical Trust for research not related to the current study. LF, FCM KL, and SL declare no competing interests. Publisher Copyright: © 2021, The Author(s).

King's Authors


Summary: There is limited evidence from 11 randomised controlled trials on the effect of rehabilitation interventions which incorporate outdoor mobility on ambulatory ability and/or self-efficacy after hip fracture. Outdoor mobility should be central (not peripheral) to future intervention studies targeting improvements in ambulatory ability. Purpose: Determine the extent to which outdoor mobility is incorporated into rehabilitation interventions after hip fracture. Synthesise the evidence for the effectiveness of these interventions on ambulatory ability and falls-related self-efficacy. Methods: Systematic search of MEDLINE, Embase, PsychInfo, CINAHL, PEDro and OpenGrey for published and unpublished randomised controlled trials (RCTs) of community-based rehabilitation interventions incorporating outdoor mobility after hip fracture from database inception to January 2021. Exclusion of protocols, pilot/feasibility studies, secondary analyses of RCTs, nonrandomised and non-English language studies. Duplicate screening for eligibility, risk of bias, and data extraction sample. Random effects meta-analysis. Statistical heterogeneity with inconsistency-value (I 2). Results: RCTs (n = 11) provided limited detail on target or achieved outdoor mobility intervention components. There was conflicting evidence from 2 RCTs for the effect on outdoor walking ability at 1–3 months (risk difference 0.19; 95% confidence intervals (CI): 0.21, 0.58; I 2 = 92%), no effect on walking endurance at intervention end (standardised mean difference 0.05; 95% CI: − 0.26, 0.35; I 2 = 36%); and suggestive (CI crosses null) of a small effect on self-efficacy at 1–3 months (standardised mean difference 0.25; 95% CI: − 0.29, 0.78; I 2 = 87%) compared with routine care/sham intervention. Conclusion: It was not possible to attribute any benefit observed to an outdoor mobility intervention component due to poor reporting of target or achieved outdoor mobility and/or quality of the underlying evidence. Given the low proportion of patients recovering outdoor mobility after hip fracture, future research on interventions with outdoor mobility as a central component is warranted. Trial registration: PROSPERO registration: CRD42021236541

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