Article

Although the principal goal of hip fracture management is a return to
the pre-event functional level, most survivors fail to regain their former levels
of autonomy. One of the most effective strategies to mitigate the fracture's
consequences is therapeutic exercise. The purpose of this study was to
review and quantify the reported effects of an extended exercise rehabilitation
program offered beyond the regular rehabilitation period on improving physical
functioning for patients with hip fractures. SOURCES: The Cochrane libraries,
PubMed, CINAHL, PEDro, and EMBASE were searched to April 2012. STUDY SELECTION:
All randomized controlled trials comparing extended exercise programs with usual
care for community-dwelling people after hip fracture were included in the
review. DATA EXTRACTION AND SYNTHESIS: Two reviewers conducted each step
independently. The data from the included studies were summarized, and pooled
estimates were calculated for 11 functional outcomes. RESULTS: Thirteen trials
were included in the review and 11 in the meta-analysis. The extended exercise
program showed modest effect sizes (ESs), which reached significance, under
random theory, for knee extension strength for the affected and nonaffected sides
(ES=0.47, 95% confidence interval [CI]=0.27-0.66, and ES=0.45, 95% CI=0.16-0.74,
respectively), balance (ES=0.32, 95% CI=0.15-0.49), physical performance-based
tests (ES=0.53, 95% CI=0.27-0.78), Timed "Up & Go" Test (ES=0.83, 95%
CI=0.28-1.4), and fast gait speed (ES=0.42, 95% CI=0.11-0.73). Effects on normal
gait speed, Six-Minute Walk Test, activities of daily living and instrumental
activities of daily living, and physical function subscale of the 36-Item
Short-Form Health Survey (SF-36-PF) did not reach significance. Community-based
programs had larger ESs compared with home-based programs. CONCLUSIONS: To the
authors' knowledge, this is the first meta-analysis to provide evidence that an
extended exercise rehabilitation program for patients with hip fractures has a
significant impact on various functional abilities. The focus of future research
should go beyond just effectiveness and study the cost-effectiveness of extended
programs.

Langue : ANGLAIS