Table 1.
GRADE evaluation of interventions for hip fracture
| Important outcomes | Mortality, function, and mobility (includes proportion of people returning to previous residential status; mobility status; measures of mobility and competence in activities of daily living), pain, quality of life, orthopaedic complications (see Outcomes section for outcomes included), medical complications (see Outcomes section for outcomes included), length of stay in hospital, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of surgical interventions in people with hip fracture? | |||||||||
| 2 (129) | Orthopaedic complications | Conservative treatment v surgical treatment | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| At least 16 (at least 2618) | Mortality | Internal fixation v arthroplasty (intracapsular hip fracture) | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological issues of RCTs included in meta-analysis (concealing treatment allocation and no ITT analysis). Directness point deducted for wide range of implants assessed |
| At least 8 (at least 1113) | Function and mobility | Internal fixation v arthroplasty (intracapsular hip fracture) | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological issues of RCTs included in meta-analysis (concealing treatment allocation and no ITT analysis). Directness point deducted for wide range of implants assessed |
| 5 (at least 750) | Pain | Internal fixation v arthroplasty (intracapsular hip fracture) | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological issues of RCTs included in meta-analysis (concealing treatment allocation and no ITT analysis). Directness point deducted for wide range of implants assessed |
| 2 (520) | Quality of life | Internal fixation v arthroplasty (intracapsular hip fracture) | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for double analysis of some people included in the RCT |
| At least 19 (at least 3217) | Orthopaedic complications | Internal fixation v arthroplasty (intracapsular hip fracture) | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological issues of RCTs included in meta-analysis (concealing treatment allocation and no ITT analysis). Directness point deducted for wide range of implants assessed |
| At least 8 (at least 1339) | Medical complications | Internal fixation v arthroplasty (intracapsular hip fracture) | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological issues of RCTs included in meta-analysis (concealing treatment allocation and no ITT analysis). Directness point deducted for wide range of implants assessed |
| 1 (198) | Mortality | Different types of internal fixation implants v each other (intracapsular hip fracture) | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (118) | Function and mobility | Different types of internal fixation implants v each other (intracapsular hip fracture) | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 2 (317) | Orthopaedic complications | Different types of internal fixation implants v each other (intracapsular hip fracture) | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for incomplete reporting of results. Directness point deducted for narrow range of techniques assessed |
| At least 4 (at least 393) | Mortality | Cemented v uncemented prostheses | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| At least 3 (at least 147) | Function and mobility | Cemented v uncemented prostheses | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, methodological flaws in RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up) and statistical heterogeneity among RCTs included in meta-analysis. Directness point deducted for wide range of prostheses and surgical techniques used |
| 2 (97) | Pain | Cemented v uncemented prostheses | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| At least 4 (at least 411) | Orthopaedic complications | Cemented v uncemented prostheses | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 2 (159) | Medical complications | Cemented v uncemented prostheses | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, and for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 3 (433) | Mortality | Unipolar v bipolar hemiarthroplasty | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 1 (60) | Function and mobility | Unipolar v bipolar hemiarthroplasty | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, and for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| At least 5 (at least 668) | Orthopaedic complications | Unipolar v bipolar hemiarthroplasty | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 1 (48) | Medical complications | Unipolar v bipolar hemiarthroplasty | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, and for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 1 (180) | Mortality | Uncemented arthroplasty v total hip replacement | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, and for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 2 (187) | Function and mobility | Uncemented arthroplasty v total hip replacement | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, and for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 2 (232) | Orthopaedic complications | Uncemented arthroplasty v total hip replacement | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 2 (258) | Mortality | Cemented hemiarthroplasty v total hip replacement | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 2 (194) | Function and mobility | Cemented hemiarthroplasty v total hip replacement | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, and for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 1 (121) | Pain | Cemented hemiarthroplasty v total hip replacement | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, and for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 1 (131) | Quality of life | Cemented hemiarthroplasty v total hip replacement | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, and for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 4 (415) | Orthopaedic complications | Cemented hemiarthroplasty v total hip replacement | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| At least 3 (at least 339) | Medical complications | Cemented hemiarthroplasty v total hip replacement | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for methodological flaws of RCTs included in meta-analysis (failure to conceal treatment allocation, no ITT analysis, incomplete reporting, and short follow-up). Directness point deducted for wide range of prostheses and surgical techniques used |
| 3 (304) | Mortality | Arthroplasty v internal fixation (extracapsular hip fracture) | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for inadequate methodologies and for no long-term results. Directness point deducted for disparity in comparators assessed |
| 3 (at least 116) | Function and mobility | Arthroplasty v internal fixation (extracapsular hip fracture) | 4 | −2 | −1 | −1 | 0 | Very low | Quality points deducted for inadequate methodologies and for no long-term results. Consistency point deducted for conflicting results. Directness point deducted for disparity in comparators assessed |
| 3 (298) | Orthopaedic complications | Arthroplasty v internal fixation (extracapsular hip fracture) | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for inadequate methodologies and for no long-term results. Directness point deducted for disparity in comparators assessed |
| 1 (58) | Medical complications | Arthroplasty v internal fixation (extracapsular hip fracture) | 4 | −3 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, inadequate methodologies, and no long-term results. Directness point deducted for disparity in comparators assessed |
| 1 (98) | Mortality | Older nail plates v sliding hip screws | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for poor quality of RCT |
| 1 (78) | Function and mobility | Older nail plates v sliding hip screws | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for poor quality of RCT |
| 1 (78) | Pain | Older nail plates v sliding hip screws | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for poor-quality studies |
| 2 (145) | Orthopaedic complications | Older nail plates v sliding hip screws | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for poor quality of RCTs in analysis |
| 6 (873) | Mortality | Extramedullary fixation implants (other than older fixed nail plates) v sliding hip screws | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for methodological flaws in RCTs included in meta-analysis (no ITT analysis in one RCT, and lack of long-term functional data) |
| 2 (147) | Function and mobility | Extramedullary fixation implants (other than older fixed nail plates) v sliding hip screws | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for methodological flaws in RCTs included in meta-analysis (no ITT analysis in one RCT, and lack of long-term functional data) |
| 1 (84) | Pain | Extramedullary fixation implants (other than older fixed nail plates) v sliding hip screws | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 6 (936) | Orthopaedic complications | Extramedullary fixation implants (other than older fixed nail plates) v sliding hip screws | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for methodologically flawed studies and statistical heterogeneity among RCTs in meta-analysis of some outcomes (no ITT analysis in one RCT, and lack of long-term functional data) |
| 2 (266) | Medical complications | Extramedullary fixation implants (other than older fixed nail plates) v sliding hip screws | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for methodologically flawed studies (lack of long-term functional data) |
| 1 (100) | Mortality | External fixation v extramedullary fixation | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for lack of long-term follow-up |
| 3 (at least 85) | Function and mobility | External fixation v extramedullary fixation | 4 | −2 | 0 | −2 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results (no statistical assessment in some outcomes). Directness points deducted for population differences (differences in age of population and aetiology of fractures) and for no long-term results |
| 2 (140) | Medical complications | External fixation v extramedullary fixation | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for no long-term results |
| 24 (3313) | Mortality | Intramedullary fixation with a short cephalocondylic nail v extramedullary fixation with a sliding hip screw | 4 | 0 | 0 | 0 | 0 | High | |
| At least 10 (at least 1260) | Function and mobility | Intramedullary fixation with a short cephalocondylic nail v extramedullary fixation with a sliding hip screw | 4 | 0 | 0 | 0 | 0 | High | |
| 8 (897) | Pain | Intramedullary fixation with a short cephalocondylic nail v extramedullary fixation with a sliding hip screw | 4 | 0 | 0 | 0 | 0 | High | |
| At least 28 (at least 3993) | Orthopaedic complications | Intramedullary fixation with a short cephalocondylic nail v extramedullary fixation with a sliding hip screw | 4 | 0 | 0 | 0 | 0 | High | |
| 7 (1090) | Mortality | Intramedullary fixation with condylocephalic nails v extramedullary fixation | 4 | 0 | 0 | 0 | 0 | High | |
| 8 (1130) | Orthopaedic complications | Intramedullary fixation with condylocephalic nails v extramedullary fixation | 4 | 0 | 0 | 0 | 0 | High | |
| 8 (1209) | Mortality | Different types of intramedullary fixation v each other | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for narrow range of comparators (most comparisons compare one intramedullary fixation device versus Gamma nail) |
| 1 (137) | Function and mobility | Different types of intramedullary fixation v each other | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for narrow range of comparators (most comparisons compare one intramedullary fixation device versus Gamma nail) |
| 1 (156) | Pain | Different types of intramedullary fixation v each other | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for narrow range of comparators (most comparisons compare one intramedullary fixation device versus Gamma nail) |
| 6 (1024) | Orthopaedic complications | Different types of intramedullary fixation v each other | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for narrow range of comparators (most comparisons compare one intramedullary fixation device versus Gamma nail) |
| At least 4 (at least 591) | Medical complications | Different types of intramedullary fixation v each other | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for narrow range of comparators (most comparisons compare one intramedullary fixation device versus Gamma nail) |
| What are the effects of perisurgical medical interventions on surgical outcomes and prevention of complications in people with hip fracture? | |||||||||
| 3 (435) | Pain | Traction v no traction | 4 | 0 | 0 | 0 | 0 | High | |
| 2 (229) | Orthopaedic complications | Traction v no traction | 4 | 0 | 0 | 0 | 0 | High | |
| 1 (120) | Medical complications | Traction v no traction | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 2 (number not reported) | Pain | Skeletal traction v skin traction | 4 | −1 | −1 | 0 | 0 | Low | Quality point deducted for incomplete reporting. Consistency point deducted for conflicting results |
| 1 (number not reported) | Pain | Skin traction v pillow nursing | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting |
| 8 (1668) | Mortality | Regional v general anaesthesia | 4 | −1 | −1 | 0 | 0 | Low | Quality point deducted for selection bias. Consistency point deducted for conflicting results with different methods of statistical analysis |
| 4 (259) | Medical complications | Regional v general anaesthesia | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for selection bias |
| 9 (408) | Pain | Nerve block v no nerve block | 4 | 0 | 0 | −2 | 0 | Low | Directness points deducted for uncertainty about clinical benefit and for comparing different types of nerve blocks that were inserted at different times |
| At least 11 (at least 2500) | Orthopaedic complications | Prophylaxis with antibiotics v placebo/no prophylaxis | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| At least 7 (at least 2500) | Medical complications | Prophylaxis with antibiotics v placebo/no prophylaxis | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| At least 3 (at least 224) | Orthopaedic complications | Operative-day (less than 24 hours) antibiotics v longer-duration antibiotics | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| At least 3 (at least 121) | Medical complications | Operative-day (less than 24 hours) antibiotics v longer-duration antibiotics | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| At least 4 (at least 1747) | Orthopaedic complications | Single-dose regimens v multiple-dose regimens | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for methodological flaws of RCTs included in meta-analysis (impaired concealment of allocation and no assessor blinding) and incomplete reporting of results |
| At least 2 (numbers not reported) | Medical complications | Single-dose regimens v multiple-dose regimens | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for methodological flaws of RCTs included in meta-analysis (impaired concealment of allocation and no assessor blinding) and incomplete reporting of results |
| 8 (730) | Mortality | Heparin v placebo/no treatment | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for poor follow-up and inadequate diagnosis of DVT/PE |
| At least 13 (at least 993) | Medical complications | Heparin v placebo/no treatment | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for poor follow-up and inadequate diagnosis of DVT/PE |
| 3 (242) | Mortality | LMWH v unfractionated heparin | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for poor follow-up and inadequate diagnosis of PE/DVT |
| 5 (479) | Medical complications | LMWH v unfractionated heparin | 4 | −2 | −1 | 0 | 0 | Very low | Quality points deducted for poor follow-up and inadequate diagnosis of PE/DVT. Consistency point deducted for conflicting results on re-analysis |
| 1 (200) | Medical complications | LMWH v LMWH plus pulsatile foot pumps | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for poor follow-up and inadequate diagnosis of DVT. Directness point deducted for inclusion of people under 65 years of age |
| 1 (13356) | Mortality | Antiplatelets v placebo or no treatment | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for non-controlled use of other thromboprophylaxis |
| 11 (14254) | Medical complications | Antiplatelet agents v placebo or no treatment | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for non-controlled use of other thromboprophylaxis |
| 16 (2191) | Medical complications | Graduated elastic compression with or without antithrombotics v no prophylaxis | 4 | 0 | 0 | −1 | +1 | High | Directness point deducted for inclusion of people with different underlying conditions. Effect-size point added for OR less than 0.5 |
| 4 (256) | Mortality | Cyclical compression of foot or calf v no compression | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for poor allocation concealment and no ITT analysis. Directness point deducted for uncertain benefit on clinical outcomes |
| 5 (487) | Medical complications | Cyclical compression of foot or calf v no compression | 4 | −2 | 0 | −1 | +1 | Low | Quality points deducted for poor allocation concealment and no ITT analysis. Directness point deducted for uncertain benefit on clinical outcomes. Effect-size point added for RR less than 0.5 |
| 7 (337) | Mortality | Oral multinutrient feeds v no dietary supplement | 4 | −3 | 0 | 0 | 0 | Very low | Quality points deducted for poor allocation concealment, no assessor blinding, and no ITT analysis |
| 3 (139) | Medical complications | Oral multinutrient feeds v no dietary supplement | 4 | −3 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data, poor allocation concealment, no assessor blinding, and no ITT analysis. Directness point deducted for composite outcome in one study |
| 3 RCTs (at least 314) | Mortality | Protein supplementation v no protein | 4 | −3 | 0 | −1 | 0 | Very low | Quality points deducted for poor allocation concealment, no assessor blinding, and no ITT analysis. Directness point deducted for composite outcome in 1 study |
| 2 (223) | Medical complications | Protein supplementation v no protein supplementation | 4 | −3 | 0 | −1 | 0 | Very low | Quality points deducted for poor allocation concealment, no assessor blinding, and no ITT analysis. Directness point deducted for composite outcome |
| 1 (80) | Mortality | Additional nutritional supplementation v normal food and beverage | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and methodological limitations |
| 1 (80) | Medical complications | Additional nutritional supplementation v normal food and beverage | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data and methodological limitations. Directness point deducted for uncertainty about type of complication |
| 3 (280) | Mortality | Nasogastric multinutrient feeds v control | 4 | −1 | 0 | −2 | 0 | Very low | Quality point deducted for methodological weaknesses in RCTs included in meta-analysis (inadequate allocation concealment, assessor blinding, and no ITT analysis). Directness points deducted for uncertainty about benefit and for inclusion of people with different nutritional status |
| 1 (57) | Mortality | Nasogastric multinutrient feeds plus oral multinutrient feeds v control | 4 | −2 | 0 | −2 | 0 | Very low | Quality points deducted for sparse data and for methodological weaknesses of RCT (inadequate allocation concealment, assessor blinding, and no ITT analysis). Directness points deducted for uncertainty about benefit and for inclusion of people with different nutritional status |
| 1 (57) | Medical complications | Nasogastric multinutrient feeds plus oral multinutrient feeds v control | 4 | −2 | 0 | −2 | 0 | Very low | Quality points deducted for sparse data and for methodological weaknesses (inadequate allocation concealment, assessor blinding, and no ITT analysis). Directness points deducted for uncertainty about benefit and for inclusion of people with different nutritional status |
| What are the effects of rehabilitation interventions and programmes after hip fracture? | |||||||||
| 2 (353) | Mortality | Different mobilisation strategies v each other | 4 | −1 | 0 | −2 | 0 | Very low | Quality point deducted for poor follow-up. Directness points deducted for wide range of interventions and comparisons |
| 8 (808) | Function and mobility | Different mobilisation strategies v each other | 4 | −2 | 0 | −2 | 0 | Very low | Quality points deducted for poor follow-up and flaws in analysis. Directness points deducted for wide range of interventions and comparisons |
| 2 (300) | Orthopaedic complications | Different mobilisation strategies v each other | 4 | −2 | 0 | −2 | 0 | Very low | Quality points deducted for poor follow-up and flaws in analysis. Directness points deducted for wide range of interventions and comparisons, and for use of composite outcome in one RCT |
| 5 (388) | Length of hospital stay | Different mobilisation strategies v each other | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for poor follow-up and flaws in analysis. Directness point deducted for wide range of interventions and comparisons |
| 12 (at least 199) | Mortality | Co-ordinated multidisciplinary rehabilitation v usual care | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for wide range of interventions and comparisons |
| 12 (at least 2228) | Function and mobility | Co-ordinated multidisciplinary rehabilitation v usual care | 4 | 0 | 0 | −2 | 0 | Low | Directness points deducted for wide range of interventions and comparisons and for use of a composite outcome |
| 1 (199) | Orthopaedic complications | Co-ordinated multidisciplinary rehabilitation v usual care | 4 | −2 | 0 | −1 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 3 (520) | Medical complications | Co-ordinated multidisciplinary rehabilitation v usual care | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for wide range of interventions and comparisons |
| 2 (147) | Function and mobility | Early discharge to "hospital at home" v usual hospital care | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 2 (147) | Length of hospital stay | Early discharge to "hospital at home" v usual hospital care | 4 | −2 | −1 | 0 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for conflicting results |
| 2 (362) | Function and mobility | Systematic multi-component home-based rehabilitation v usual care | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for incomplete reporting of results. Directness point deducted for uncertainty about benefit |
Type of evidence: 4 = RCT; 2 = Observational consistency: similarity of results across studies Directness: generalisability of population or outcomes Effect size: based on relative risk (RR) or odds ratio (OR). PE, pulmonary embolism.