Summary of findings 4. Summary of findings: different types of intervention on mobility outcome, post‐hospital.
| Different types of mobility strategies compared with control after hip fracture surgery, on mobility, in the post‐hospital setting | |||||||
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Patient or population: adults following hip fracture surgery Settings: post‐hospital Comparison: non‐provision controla Outcome: mobilityb | |||||||
| Intervention type (according to ProFaNE)c | Mobility outcome | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | ||||||
| Control | Intervention | ||||||
| Gait, balance and functional training Follow‐up: range 2 months to 12 months |
Mobility scales, using different scales: SPPB (range 0 to 12), PPME (range 0 to 12). A higher score indicates better mobility. | In the control group, the mean scores for the outcomes were: SPPB (range 6 to 7.72), PPME (10.1). | SMD 0.20 higher (0.05 higher to 0.36 higher) | SMD 0.20 (95% CI 0.05 to 0.36) |
621 (5) | ⊕⊕⊕⊕ Highd | Interventions classified as gait, balance and functional training cause a smalle increase in mobility compared with control. Re‐expressing the results using the 12‐point SPPB, the intervention group scored 0.55 points higher (95% CI 0.14 to 1.0). Small meaningful change for SPPB: 0.27 to 0.55 points; substantial meaningful change: 0.99 to 1.34 points (Perera 2006). |
| TUG (lower score = faster) | The mean TUG time in the control group was 30.22 seconds. |
MD 7.57 seconds faster (19.25 seconds faster to 4.11 seconds slower) | MD ‐7.57 (‐19.25 to 4.11) |
128 (1) | ⊕⊝⊝⊝ Very lowf | Gait, balance and functional training may increase TUG speed by 7.57 seconds; however, the 95% confidence interval includes both a reduction and increase in TUG. | |
| 6 Minute Walk Test | 0 | ||||||
| Resistance/strength training Follow‐up: range 10 weeks to 3 months |
Mobility scales | 0 | |||||
| TUG | The mean TUG time in the control group was 20 seconds. | MD 6 seconds faster (12.95 seconds faster to 0.95 seconds slower) | MD ‐6.00 (‐12.95, 0.95) | 96 (1) | ⊕⊕⊝⊝ Lowg | Resistance/strength training may increase TUG speed by 6 seconds; however, the 95% confidence interval includes both a reduction and increase in TUG. | |
| 6MWT | The mean 6MWT distance in the control group was 243 m. | MD 56 metres further (29 metres further to 83 metres further) | MD 55.65 (28.58 to 82.72) | 198 (3) | ⊕⊕⊝⊝ Lowh | Resistance/strength training may increase 6MWT by 53 metres. MID for the 6MWT (adults with pathology) is typically 14.0 to 30.5m (Bohannon 2017). |
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| Flexibility | All | 0 | 0 studies contained a mobility strategy categorised as primarily being flexibility. | ||||
| 3D (Tai Chi, dance) | All | 0 | 0 studies contained a mobility strategy categorised as primarily being 3D. | ||||
| General physical activity | All | 0 | 0 studies contained a mobility strategy categorised as primarily being general physical activity. | ||||
| Endurance Follow‐up: 3 months |
Mobility scales | 0 | |||||
| TUG | 0 | ||||||
| 6MWT | The mean 6MWT distance in the control group was 266 m. | MD 12.7 metres further (72 metres less to 97 metres further). | MD 12.70 (‐72.12, 97.52) | 21 (1) | ⊕⊝⊝⊝ Very lowi | We are uncertain whether endurance training improves mobility as the certainty of the evidence is very low. | |
| Multiple primary types of exercise Follow‐up: range 2 months to 6 months |
Mobility scales, using different mobility scales: mPPT (range 0 to 36), POMA (range 0 to 30). | In the control group, the mean scores for the outcomes were: mPPT (23.3), POMA (range 20.7). | SMD 0.94 higher (0.53 higher to 1.34 higher) | SMD 0.94 (0.53 to 1.34) | 104 (2) | ⊕⊕⊕⊝ Moderatej | Interventions that contain multiple types of exercise probably leads to a moderate increase in mobility. Re‐expressing the results using the 12‐point SPPB, the intervention group scored 2.6 points higher (95% CI 1.47 to 3.71). Substantial meaningful change for SPPB: 0.99 to 1.34 points (Perera 2006). |
| TUG | 0 | ||||||
| 6MWT | The mean 6MWT distance in the control group was 233.1 m. | MD 9 metres further (15 metres less to 33 metres further) | 9.30 (‐14.62 to 33.22) | 187 (1) | ⊕⊕⊝⊝ Lowk | Interventions containing strength training and endurance training may increase 6MWT by 9 metres. MID for the 6MWT (adults with pathology) is typically 14.0 to 30.5m (Bohannon 2017). |
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| Electrical stimulation | 0 | 0 studies contained a mobility strategy categorised as primarily being electrical stimulation | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). 6MWT: 6‐Minute Walk Test; CI: confidence interval; MID: minimal important difference; mPPT: modified Physical Performance Test; POMA: Performance Oriented Mobility Assessment; PPME: Physical Performance and Mobility Examination; SMD: standardised mean difference; SPPB: Short Physical Performance Battery; TUG: Timed Up and Go test. | |||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | |||||||
aA non‐provision control is defined as no intervention, usual care, sham exercise (the exercise was intended to be a control, or appeared to be of insufficient intensity and progression to have beneficial effects on mobility) or a social visit. bMobility, measuring the ability of a person to move. Scales may measure a number of aspects of mobility (e.g. sit to stand, walking, turning, stairs). A higher score indicates better mobility. cMobility strategies involve postoperative care programmes such as immediate or delayed weight bearing after surgery, and any other mobilisation strategies, such as exercises, physical training and muscle stimulation, used at various stages in rehabilitation, which aim to improve walking and minimise functional impairments. We categorised the exercise and physical training strategies using the Prevention of Falls Network Europe (ProFaNE) guidelines, see Appendix 1. These categories are gait, balance and functional training; strength/resistance training; flexibility; 3D (Tai Chi, dance); general physical activity; endurance; multiple types of exercise; other. Electrical stimulation is an additional intervention type. dNot downgraded for risk of bias (removing studies with high risk of bias in one or more domains had no important impact on results). eCohen's effect size 0.2 is described as small, 0.5 as medium/moderate effect, 0.8 as large effect (Sawilowsky 2009). fDowngraded one level for risk of bias and two levels for imprecision. gDowngraded two levels for imprecision. hDowngraded one level for risk of bias (all studies had high risk of bias for at least one item) and one level for imprecision. iDowngraded one level for risk of bias (removing studies with high risk of bias in one or more domains had an important impact on results) and two levels for imprecision). jDowngraded for imprecision. kDowngraded one level for risk of bias and one level for imprecision.