Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Hip fracture is an increasingly important health problem and many people experience lasting impacts on their mobility and physical function after breaking their hip. An updated Cochrane review of interventions for improving mobility after hip fractures was published in September 2022 by researchers in Australia. In this podcast, Venisa Wing Kwok speaks with one of the authors, Nicola Fairhall both from the Institute for Musculoskeletal Health in the University of Sydney about the findings.

Venisa: Hello Nikki, thanks for talking to us about the review. Perhaps you could begin with a few words about hip fracture and the importance of this review?

Nicola: Thanks Venisa. Hip fractures are a major problem in people of older age and the numbers are increasing as the population is ageing around the world. Although surgical treatment is generally successful, many people do not recover fully. For instance, they may not walk as well as before the fracture or they may become more dependent on others. And, some who are not able to look after themselves, may need to be admitted to a nursing home.
Our updated review examines the effect of interventions that target mobility, that is, interventions intended to help people be safe on their feet, and able to stand and walk again. Most of the strategies that were implemented during a hospital stay or after discharge focus on exercise.
In regard to its important, the current updated review presents evidence from randomised trials of interventions that aim to improve mobility at various stages after hip fracture. By bringing this evidence together, we hope to help healthcare professionals select the most appropriate interventions for people who have had a hip fracture.

Venisa: So, what and how much did you find for this updated review?

Nicola: We now include 40 clinical trials conducted in 17 countries, involving nearly 4100 people with hip fracture, with an average age of 80. Of the 40 trials, 18 evaluated mobility strategies that started in hospital within a week of the hip fracture surgery and 22 evaluated longer-duration mobility strategies that started after discharge from hospital and were undertaken in people's homes, outpatient clinics and retirement villages.

Venisa: Looking at this evidence, what stood out in this update?

Nicola: Firstly, whether done in hospital or following discharge, interventions that are intended to improve mobility do indeed lead to meaningful improvements. Exercises that target balance, walking and functional tasks in additional to standard physiotherapy are particularly helpful in improving mobility and walking speed both in the hospital and after discharge from hospital. We found that extra strength or fitness training may also improve mobility after discharge from hospital.
However, we are unsure whether mobility strategies delivered in the hospital improved health-related quality of life, functioning or mortality over the longer term, although there was an increase in health-related quality of life with interventions given after discharge from hospital.
Lastly, the data from the three studies that assessed electrical stimulation delivered in hospital provided too little data to clearly indicate the effectiveness of this approach.

Venisa: It is encouraging for healthcare professionals that there are some evidence-based interventions that they can deliver for people following hip fracture, but do you want to say anything more about the quality of the included trials or research gaps?

Nicola: Thanks. Although we are confident in the results of the studies conducted after discharge from hospital, our confidence in the results of the studies done in hospital is lower because some of them did not report all their results or they used different ways of delivering the treatments and many of the studies were small. We think that more research in the form of larger, preferably multicentre, high-quality randomised trials is still required to inform practice.

Venisa: Thanks again for speaking with me today, Nikki. If people would like to read the review, how can they get hold of it?

Nicola: Thanks Venisa. The review's available online. If people go to Cochrane Library dot com and type 'mobility and hip fracture' in the search box, they'll get a link to it.