Inequity in rehabilitation interventions after hip fracture: a systematic review

K J Sheehan, L Fitzgerald, S Hatherley, C Potter, S Ayis, F C Martin, C L Gregson, I D Cameron, L A Beaupre, D Wyatt, Rhian Milton-Cole, S DiGiorgio, C Sackley

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)
99 Downloads (Pure)

Abstract

Objective
to determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes.

Design
systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE and ClinicalTrials.gov for randomised controlled trials of rehabilitation interventions after hip fracture published between 1 January 2008 and 30 May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool) and data extraction (Cochrane’s PROGRESS-Plus framework).

Results
twenty-three published, eight protocol, four registered ongoing randomised controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age and/or non-surgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions.

Conclusion
the generalisability of trial results to the underlying population of frail older adults is limited. Yet, this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated.

PROSPERO
CRD42018085930.
Original languageEnglish
Article numberafz031
Pages (from-to)489-497
Number of pages9
JournalAge and Ageing
Volume48
Issue number4
DOIs
Publication statusPublished - 9 Apr 2019

Keywords

  • cognitive impairment
  • equity
  • hip fracture
  • older people
  • rehabilitation
  • systematic review

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