Lundstrom 2007.

Study characteristics
Methods	Design: RCT of multi‐component delirium prevention intervention for older hip fracture patients Date of study: May 2000 to December 2002 Power calculation: yes Inclusion criteria: patients aged 70 years and older consecutively admitted to the orthopaedic department in Umea hospital, Sweden. Exclusion criteria: age under 70, severe rheumatoid arthritis, severe hip osteoarthritis, severe renal failure, pathological fracture and patients who were bedridden before the fracture
Participants	Sample size: 199 Country: Sweden Setting: orthopaedic hip fracture patients Age: Mean age 82 years Sex: 74% female Co‐morbidity: no baseline between group differences in cardiovascular disease, respiratory disease, hypertension or diabetes. More patients in control group with depression (46% versus 32%, P = 0.03) Dementia: 27.5 % in intervention group, 37.1% in control group Frailty: not reported
Interventions	Intervention: multi‐disciplinary team providing comprehensive geriatric assessment, management and rehabilitation on a geriatric ward. Intervention comprising: staff education; teamwork; individual care planning; delirium prevention detection and treatment; prevention and treatment of complications; bowel/bladder function; sleep; decubitus ulcer prevention/treatment; pain management; oxygenation; body temperature measurement; nutrition; rehabilitation; secondary prevention of falls/fractures and osteoporosis prophylaxis Control: usual care on orthopaedic ward.
Outcomes	Outcomes reported: ‐ Incident delirium, diagnosed retrospectively using DSM‐IV based on nursing notes (for the duration of the inpatient stay) and organic brain scale (measured once between the 3rd and 5th postoperative day) ‐ Duration of delirium, diagnosed retrospectively using DSM‐IV based on nursing notes and OBS ‐ Length of admission ‐ Cognitive status, measured using MMSE ‐ Falls ‐ New pressure ulcers ‐ Psychological morbidity (Depression) ‐ Mortality ‐ inpatient and at 12 months Outcomes not reported: None Frequency of outcomes assessment: all patients tested once between day 3 and day 5 postoperatively using organic brain scale, MMSE and geriatric depression scale. Delirium diagnosed retrospectively after the study had finished by specialist in geriatric medicine blind to allocation group on the basis of the nursing assessments by applying the DSM IV criteria
Notes	Funding source: Swedish Research Council & Vardal Foundation Declarations of interest: not reported Prevalent delirium not excluded at enrolment (21.8% intervention group, 30.9% control group) but, patients with prevalent delirium appear to have been included in outcome data
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No information given on how randomisation sequence generated
Allocation concealment (selection bias)	Low risk	Sealed‐opaque envelopes to conceal allocation
Blinding of participants and personnel (performance bias) All outcomes	High risk	All staff aware of allocation group, patients potentially aware due to nature of intervention
Blinding of outcome assessment (detection bias) All outcomes	High risk	Staff recording outcome measurements not blind to study arm. Blinded specialist made diagnosis of delirium retrospectively based on staff measurements and medical/ nursing records
Incomplete outcome data (attrition bias) All outcomes	Low risk	All randomised patients included in the analysis
Selective reporting (reporting bias)	Unclear risk	Insufficient information to assess
Other bias	Low risk	No evidence of other bias