15.13Review protocol – Multidisciplinary rehabilitation

ComponentDescription
Review questionIn patients with hip fracture what is the clinical and cost effectiveness of ‘orthogeriatrician’ involvement in the whole pathway of assessment, peri-operative care and rehabilitation on functional status, length of stay in secondary care, mortality, place of residence/discharge, hospital readmission and quality of life?
ObjectivesTo identify the benefit of an orthogeriatrician involved early in the care pathway to patient outcomes.
PopulationPatients >18 years old with a hip fracture undergoing different types of surgery for hip fracture repair

People with fractures caused by specific pathologies other than osteoporosis or osteopaenia, and patients under 18 years old are excluded from the scope.
InterventionInvolvement of an orthogeriatrician/physician throughout patient care, starting from admission
ComparisonNo involvement of an orthogeriatrician/physician throughout the care pathway (e.g. only present in rehabilitation).
Outcomes

Mortality (30 days, 3 months, 1 year)

Length of stay in secondary care

Length of time before community resettlement/discharge.

Place of residence (compared with baseline) 12 months after fracture.

Functional status (30 days, 3 months, 1 year)

Hospital readmission

Quality of life (30 days, 3 months, 1 year)

Search strategyThe databases to be searched are Medline, Embase, The Cochrane Library, CINAHL and AMED.

Randomised controlled trials (RCTs) will be considered. If no RCTs are found for certain outcomes such as adverse events, well conducted cohort studies and observational studies may also be considered.

Studies will be restricted to English language only

No date restriction will be applied. Databases will be searched from their date of origin
The review strategyMeta-analyses will be conducted where possible.

If there is heterogeneity the following subgroups will be analysed separately:

Comorbidities strongly predictive of outcome (as mentioned in the scope but will need the GDG to list them)

Concurrent medication

Age

Gender

Cognitive impairment

Palliative care patients

Patients from nursing homes

ComponentDescription
Review questionIn patients with hip fracture what is the clinical and cost effectiveness of hospital-based multidisciplinary rehabilitation on functional status, length of stay in secondary care, mortality, place of residence/discharge, hospital readmission and quality of life?
ObjectivesTo identify the effectiveness of hospital-based multidisciplinary rehabilitation compared to usual care.
PopulationPatients >18 years old with a hip fracture undergoing different types of surgery for hip fracture repair

People with fractures caused by specific pathologies other than osteoporosis or osteopaenia, and patients under 18 years old are excluded from the scope.
InterventionMultidisciplinary hospital-based rehabilitation. Multidisciplinary rehabilitation after hip fracture will be assumed if the following core components are present: medicine; nursing; physiotherapy; occupational therapy; social care. Additional components may include: nutrition, pharmacy, clinical psychology. Additional criteria include formal arrangements for co-ordination/teamwork and regular on-going multidisciplinary assessment.

Types of multidisciplinary hospital-based rehabilitation include Geriatric orthopaedic rehabilitation unit (GORU); mixed assessment and rehabilitation unit (MARU); geriatric hip fracture programme (GHFP).
ComparisonUsual hospital-based care (not multidisciplinary)
Outcomes

Mortality (30 days, 3 months, 1 year)

Length of stay in secondary care

Length of time before community resettlement/discharge.

Place of residence (compared with baseline) 12 months after fracture.

Functional status (30 days, 3 months, 1 year)

Hospital readmission

Quality of life (30 days, 3 months, 1 year)

Search strategyThe databases to be searched are Medline, Embase, The Cochrane Library, CINAHL and AMED.

Randomised controlled trials (RCTs) will be considered. If no RCTs are found for certain outcomes such as adverse events, well conducted cohort studies and observational studies may also be considered.

Studies will be restricted to English language only

No date restriction will be applied. Databases will be searched from their date of origin
The review strategyMeta-analyses will be conducted where possible.

If there is heterogeneity the following subgroups will be analysed separately:

Type of hospital-based MDR

Comorbidities strongly predictive of outcome (as mentioned in the scope but will need the GDG to list them)

Concurrent medication

Age

Gender

Cognitive impairment

Palliative care patients

Patients from nursing homes

ComponentDescription
Review questionIn patients with hip fracture what is the clinical and cost effectiveness of community-based multidisciplinary rehabilitation on functional status, length of stay in secondary care, mortality, place of residence/discharge, hospital readmission and quality of life?
ObjectivesTo compare community-based programmes with each other and usual care.
PopulationPatients >18 years old with a hip fracture undergoing different types of surgery for hip fracture repair

People with fractures caused by specific pathologies other than osteoporosis or osteopaenia, and patients under 18 years old are excluded from the scope.
InterventionCommunity-based multidisciplinary rehabilitation, including intermediate care unit-based, home-based (early supported discharge) and social care unit-based. Any programme starting more than 1 week postoperatively will be excluded.
ComparisonUsual hospital-based care (not multidisciplinary)
Outcomes

Mortality (30 days, 3 months, 1 year)

Length of stay in secondary care

Length of time before community resettlement/discharge.

Place of residence (compared with baseline) 12 months after fracture.

Functional status (30 days, 3 months, 1 year)

Hospital readmission

Quality of life (30 days, 3 months, 1 year)

Search strategyThe databases to be searched are Medline, Embase, The Cochrane Library, CINAHL and AMED.

Randomised controlled trials (RCTs) will be considered. If no RCTs are found for certain outcomes such as adverse events, well conducted cohort studies and observational studies may also be considered.

Studies will be restricted to English language only

No date restriction will be applied. Databases will be searched from their date of origin
The review strategyMeta-analyses will be conducted where possible.

If there is heterogeneity the following subgroups will be analysed separately:

Type of community rehabilitation programme

Comorbidities strongly predictive of outcome (as mentioned in the scope but will need the GDG to list them)

Concurrent medication

Age

Gender

Cognitive impairment

Palliative care patients

Patients from nursing homes

From: Appendix C, Review protocols

Cover of The Management of Hip Fracture in Adults
The Management of Hip Fracture in Adults [Internet].
NICE Clinical Guidelines, No. 124.
National Clinical Guideline Centre (UK).
Copyright © 2011, National Clinical Guideline Centre.

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