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Review
. 2022 Sep 7;9(9):CD001704.
doi: 10.1002/14651858.CD001704.pub5.

Interventions for improving mobility after hip fracture surgery in adults

Affiliations
Review

Interventions for improving mobility after hip fracture surgery in adults

Nicola J Fairhall et al. Cochrane Database Syst Rev. .

Abstract

Background: Improving mobility outcomes after hip fracture is key to recovery. Possible strategies include gait training, exercise and muscle stimulation. This is an update of a Cochrane Review last published in 2011.

Objectives: To evaluate the effects (benefits and harms) of interventions aimed at improving mobility and physical functioning after hip fracture surgery in adults.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, trial registers and reference lists, to March 2021.

Selection criteria: All randomised or quasi-randomised trials assessing mobility strategies after hip fracture surgery. Eligible strategies aimed to improve mobility and included care programmes, exercise (gait, balance and functional training, resistance/strength training, endurance, flexibility, three-dimensional (3D) exercise and general physical activity) or muscle stimulation. Intervention was compared with usual care (in-hospital) or with usual care, no intervention, sham exercise or social visit (post-hospital).

Data collection and analysis: Members of the review author team independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We used the assessment time point closest to four months for in-hospital studies, and the time point closest to the end of the intervention for post-hospital studies. Critical outcomes were mobility, walking speed, functioning, health-related quality of life, mortality, adverse effects and return to living at pre-fracture residence.

Main results: We included 40 randomised controlled trials (RCTs) with 4059 participants from 17 countries. On average, participants were 80 years old and 80% were women. The median number of study participants was 81 and all trials had unclear or high risk of bias for one or more domains. Most trials excluded people with cognitive impairment (70%), immobility and/or medical conditions affecting mobility (72%). In-hospital setting, mobility strategy versus control Eighteen trials (1433 participants) compared mobility strategies with control (usual care) in hospitals. Overall, such strategies may lead to a moderate, clinically-meaningful increase in mobility (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.10 to 0.96; 7 studies, 507 participants; low-certainty evidence) and a small, clinically meaningful improvement in walking speed (CI crosses zero so does not rule out a lack of effect (SMD 0.16, 95% CI -0.05 to 0.37; 6 studies, 360 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to short-term (risk ratio (RR) 1.06, 95% CI 0.48 to 2.30; 6 studies, 489 participants; low-certainty evidence) or long-term mortality (RR 1.22, 95% CI 0.48 to 3.12; 2 studies, 133 participants; low-certainty evidence), adverse events measured by hospital re-admission (RR 0.70, 95% CI 0.44 to 1.11; 4 studies, 322 participants; low-certainty evidence), or return to pre-fracture residence (RR 1.07, 95% CI 0.73 to 1.56; 2 studies, 240 participants; low-certainty evidence). We are uncertain whether mobility strategies improve functioning or health-related quality of life as the certainty of evidence was very low. Gait, balance and functional training probably causes a moderate improvement in mobility (SMD 0.57, 95% CI 0.07 to 1.06; 6 studies, 463 participants; moderate-certainty evidence). There was little or no difference in effects on mobility for resistance training. No studies of other types of exercise or electrical stimulation reported mobility outcomes. Post-hospital setting, mobility strategy versus control Twenty-two trials (2626 participants) compared mobility strategies with control (usual care, no intervention, sham exercise or social visit) in the post-hospital setting. Mobility strategies lead to a small, clinically meaningful increase in mobility (SMD 0.32, 95% CI 0.11 to 0.54; 7 studies, 761 participants; high-certainty evidence) and a small, clinically meaningful improvement in walking speed compared to control (SMD 0.16, 95% CI 0.04 to 0.29; 14 studies, 1067 participants; high-certainty evidence). Mobility strategies lead to a small, non-clinically meaningful increase in functioning (SMD 0.23, 95% CI 0.10 to 0.36; 9 studies, 936 participants; high-certainty evidence), and probably lead to a slight increase in quality of life that may not be clinically meaningful (SMD 0.14, 95% CI -0.00 to 0.29; 10 studies, 785 participants; moderate-certainty evidence). Mobility strategies probably make little or no difference to short-term mortality (RR 1.01, 95% CI 0.49 to 2.06; 8 studies, 737 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to long-term mortality (RR 0.73, 95% CI 0.39 to 1.37; 4 studies, 588 participants; low-certainty evidence) or adverse events measured by hospital re-admission (95% CI includes a large reduction and large increase, RR 0.86, 95% CI 0.52 to 1.42; 2 studies, 206 participants; low-certainty evidence). Training involving gait, balance and functional exercise leads to a small, clinically meaningful increase in mobility (SMD 0.20, 95% CI 0.05 to 0.36; 5 studies, 621 participants; high-certainty evidence), while training classified as being primarily resistance or strength exercise may lead to a clinically meaningful increase in mobility measured using distance walked in six minutes (mean difference (MD) 55.65, 95% CI 28.58 to 82.72; 3 studies, 198 participants; low-certainty evidence). Training involving multiple intervention components probably leads to a substantial, clinically meaningful increase in mobility (SMD 0.94, 95% CI 0.53 to 1.34; 2 studies, 104 participants; moderate-certainty evidence). We are uncertain of the effect of aerobic training on mobility (very low-certainty evidence). No studies of other types of exercise or electrical stimulation reported mobility outcomes.

Authors' conclusions: Interventions targeting improvement in mobility after hip fracture may cause clinically meaningful improvement in mobility and walking speed in hospital and post-hospital settings, compared with conventional care. Interventions that include training of gait, balance and functional tasks are particularly effective. There was little or no between-group difference in the number of adverse events reported. Future trials should include long-term follow-up and economic outcomes, determine the relative impact of different types of exercise and establish effectiveness in emerging economies.

Trial registration: ClinicalTrials.gov NCT00006194 NCT00224367 NCT00389844 NCT04025866 NCT02295527 NCT01129219 NCT01174589 NCT02305433 NCT02407444 NCT02815254 NCT02938923 NCT03030092 NCT04095338 NCT04108793 NCT04207788 NCT04228068.

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Conflict of interest statement

NF: none SD: none JM: none JD: none WK: none CS: as Catherine Sherrington is an active investigator in several randomised trials in this area, assessment of eligibility of these trials and quality assessment of the four included trials was done independently by two other review authors. Independent data extraction and entry into Review Manager software, presentation and interpretation of these trials were also performed.

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias domain for each included study Note: a 'Yes' (+) judgement means that review authors considered there was a low risk of bias associated with the item, whereas a 'No' (‐) means that there was a high risk of bias. Assessments that resulted in an 'Unclear' (?) verdict often reflected a lack of information upon which to judge the domain. However, lack of information on blinding for mobility outcomes was always taken to imply that there was no blinding and rated as a 'No'; similarly for unblinded staff/self‐reported outcomes (health‐related quality of life, pain, falls, patient‐reported questionnaires and satisfaction), lack of information on blinding of researchers was rated as 'No', data collated by blinded researchers was rated 'Unclear'. An empty square (no judgement) indicates the domain was not applicable to that study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
4
4
Funnel plot of comparison 4: post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes. Outcome 4.16: walking speed: combined data for all strategy types
5
5
Funnel plot of comparison 4: post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes. Outcome 4.31: health‐related quality of life (measured using HRQoL scales): combined data for all strategy types
6
6
Funnel plot of comparison 5: post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes. Outcome: 5.9 strength
1.1
1.1. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 1: Mobility (measured using mobility scales): combined data for all strategy types
1.2
1.2. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 2: Mobility (failure to regain pre‐facture mobility): combined data for all strategy types
1.3
1.3. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 3: Mobility (measured using self‐reported outcomes): combined data for all strategy types
1.4
1.4. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 4: Mobility (measured using mobility scales): gait, balance and function
1.5
1.5. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 5: Mobility (measured using mobility scales): resistance/strength training
1.6
1.6. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 6: Mobility (measured in seconds using TUG): resistance/strength training
1.7
1.7. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 7: Mobility (measured using mobility scales) reporting individual outcome measures
1.8
1.8. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 8: Walking speed (measured as metres/time): combined data for all strategy types
1.9
1.9. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 9: Walking speed (measured as metres/time): gait, balance and function
1.10
1.10. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 10: Walking speed (measured as metres/time): electrical stimulation
1.11
1.11. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 11: Functioning (measured using functioning scales): combined data for all strategy types
1.12
1.12. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 12: Functioning (measured using functioning scales): gait, balance and function
1.13
1.13. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 13: Functioning (measured using functioning scales): resistance/strength training
1.14
1.14. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 14: Functioning (measured using functioning scales): electrical stimulation
1.15
1.15. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 15: Health‐related quality of life (measured using HRQoL scales): gait, balance and function
1.16
1.16. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 16: Mortality, short term: combined data for all strategy types
1.17
1.17. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 17: Mortality, short term: gait, balance and function
1.18
1.18. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 18: Mortality, short term: resistance/strength training
1.19
1.19. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 19: Mortality, short term: electrical stimulation
1.20
1.20. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 20: Mortality, long term: combined data for all strategy types
1.21
1.21. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 21: Mortality, long term: gait, balance and function
1.22
1.22. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 22: Mortality, long term: resistance/strength training
1.23
1.23. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 23: Adverse events (measured using dichotomous outcomes): combined data for all strategy types
1.24
1.24. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 24: Adverse events (measured using rate of falls): all studies were gait, balance and function
1.25
1.25. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 25: Adverse events (measured using continuous measures of pain): combined data for all strategy types
1.26
1.26. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 26: Return to living at pre‐fracture residence: combined data for all strategy types
1.27
1.27. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 27: Return to living at pre‐fracture residence: additional study not included in main analysis
1.28
1.28. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 28: Return to living at pre‐fracture residence: gait, balance and function
1.29
1.29. Analysis
Comparison 1: In‐hospital rehabilitation: mobilisation strategy versus usual care, critical outcomes, Outcome 29: Return to living at pre‐fracture residence: resistance/strength training
2.1
2.1. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 1: Walking, use of walking aid/need for assistance
2.2
2.2. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 2: Balance (measured using functional reach test, cm)
2.3
2.3. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 3: Balance (measured using balance scale)
2.4
2.4. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 4: Balance (measured using ability to tandem stand)
2.5
2.5. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 5: Balance (measured using step test; number of steps)
2.6
2.6. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 6: Balance (measured using self‐reported outcomes)
2.7
2.7. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 7: Sit to stand (measured as number of stand ups/second)
2.8
2.8. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 8: Strength
2.9
2.9. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 9: Activities of daily living (measured using ADL scales)
2.10
2.10. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 10: Resource use (measured by length of hospital stay)
2.11
2.11. Analysis
Comparison 2: In‐hospital rehabilitation: mobilisation strategy versus usual care, other important outcomes, Outcome 11: Resource use (measured by use of community services)
3.1
3.1. Analysis
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 1: Weight‐bearing at 2 wks v weight‐bearing at 12 weeks (mortality)
3.2
3.2. Analysis
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 2: Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (mortality)
3.3
3.3. Analysis
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 3: Weight‐bearing at 2 wks v weight‐bearing at 12 weeks (adverse events)
3.4
3.4. Analysis
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 4: Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (return to living at home)
3.5
3.5. Analysis
Comparison 3: In‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 5: Early assisted ambulation (< 48 hrs) v delayed assisted ambulation (walking aid/assistance)
4.1
4.1. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 1: Mobility (measured using mobility scales): combined data for all strategy types
4.2
4.2. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 2: Mobility (measured using Timed Up and Go, seconds): combined data for all strategy types
4.3
4.3. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 3: Mobility (measured using 6‐Minute Walk Test, metres): combined data for all strategy types
4.4
4.4. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 4: Mobility (measured using mobility scales): gait, balance and function
4.5
4.5. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 5: Mobility (measured using Timed Up and Go, seconds): gait, balance and function
4.6
4.6. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 6: Mobility (measured using Timed Up and Go, seconds): resistance/strength training
4.7
4.7. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 7: Mobility (measured using 6‐Minute Walk Test, metres): resistance/strength training
4.8
4.8. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 8: Mobility (measured using 6‐Minute Walk Test, metres): endurance training
4.9
4.9. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 9: Mobility (measured using mobility scales): multiple component
4.10
4.10. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 10: Mobility (measured using 6‐Minute Walk Test, metres): multiple component
4.11
4.11. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 11: Mobility (measured using mobility scales): other type of exercise (non‐weight bearing exercise)
4.12
4.12. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 12: Mobility (measured using Timed Up and Go, seconds): other type of exercise OT +/‐ sensor)
4.13
4.13. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 13: Mobility (measured using mobility scales) reporting individual outcome measures
4.14
4.14. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 14: Mobility (measured using self‐report, continuous scales): combined data for all strategy types
4.15
4.15. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 15: Mobility (measured using self‐reported, dichotomous outcome): combined data for all strategy types
4.16
4.16. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 16: Walking speed: combined data for all strategy types
4.17
4.17. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 17: Walking speed: gait, balance and function
4.18
4.18. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 18: Walking speed: resistance/strength training
4.19
4.19. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 19: Walking speed: endurance
4.20
4.20. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 20: Walking speed: multiple component
4.21
4.21. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 21: Walking speed: other (post‐discharge physio telephone support and coaching)
4.22
4.22. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 22: Walking speed: other (non‐weight bearing)
4.23
4.23. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 23: Walking speed subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types
4.24
4.24. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 24: Walking speed: subgrouped by outpatient v secondary and social care setting
4.25
4.25. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 25: Walking speed subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategies
4.26
4.26. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 26: Functioning (measured using functioning scales): combined data for all strategy types
4.27
4.27. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 27: Functioning (measured using functioning scales): gait, balance and function
4.28
4.28. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 28: Functioning (measured using functioning scales): resistance/strength training
4.29
4.29. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 29: Functioning (measured using functioning scales): multiple components
4.30
4.30. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 30: Functioning (measured using functioning scales): other: OT +/‐ sensor
4.31
4.31. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 31: Health‐related quality of life (measured using HRQoL scales): combined data for all strategy types
4.32
4.32. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 32: Health‐related quality of life (measured using HRQoL scales): gait, balance and function
4.33
4.33. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 33: Health‐related quality of life (measured using HRQoL scales): resistance/strength training
4.34
4.34. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 34: Health‐related quality of life (measured using HRQoL scales): endurance
4.35
4.35. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 35: Health‐related quality of life (measured using HRQoL scales): multiple components
4.36
4.36. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 36: Health‐related quality of life subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types
4.37
4.37. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 37: Health‐related quality of life subgrouped by outpatient v secondary and social care setting
4.38
4.38. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 38: Health‐related quality of life subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategy
4.39
4.39. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 39: Mortality, short term: combined data for all strategy types
4.40
4.40. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 40: Mortality, short term: gait, balance and function
4.41
4.41. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 41: Mortality, short term: resistance/strength training
4.42
4.42. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 42: Mortality, short term: multiple components
4.43
4.43. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 43: Mortality, short term: other: non‐weight bearing
4.44
4.44. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 44: Mortality, long term: combined data for all strategy types
4.45
4.45. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 45: Mortality, long term: gait, balance and function
4.46
4.46. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 46: Mortality, long term: multiple components
4.47
4.47. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 47: Adverse events (measured using dichotomous outcomes): combined data for all strategy types
4.48
4.48. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 48: Adverse events (measured using re‐admission rate: combined for all strategy types
4.49
4.49. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 49: Adverse events (measured using rate of falls): combined for all strategy types
4.50
4.50. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 50: Adverse events (measured using rate of falls): gait, balance and function
4.51
4.51. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 51: Adverse events (measured using rate of falls): other (additional phone support and coaching)
4.52
4.52. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 52: Adverse events (measured as number of people who experienced 1 or more falls)
4.53
4.53. Analysis
Comparison 4: Post‐hospital rehabilitation: mobilisation strategy versus control, critical outcomes, Outcome 53: Adverse events (measured using continuous measure of pain)
5.1
5.1. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 1: Walking (measured as use of walking aid/need for assistance)
5.2
5.2. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 2: Walking (measured using self‐reported outcomes)
5.3
5.3. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 3: Balance (measured using functional reach test, cm)
5.4
5.4. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 4: Balance (measured using timed standing in various positions)
5.5
5.5. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 5: Balance (measured using balance scale)
5.6
5.6. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 6: Balance (measured using continuous self‐reported meaure)
5.7
5.7. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 7: Balance (measured using dichotomous self‐reported measure)
5.8
5.8. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 8: Sit to stand (measured as number of stand ups/second)
5.9
5.9. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 9: Strength
5.10
5.10. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 10: Strength subgrouped by studies with cognitive impairment included v studies with cognitive impairment not included, combined data for all strategy types
5.11
5.11. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 11: Strength subgrouped by stage of rehabilitation
5.12
5.12. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 12: Strength subgrouped by mean age ≤ 80 years v > 80 years, combined data for all strategies
5.13
5.13. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 13: Activities of daily living (measured using ADL scales)
5.14
5.14. Analysis
Comparison 5: Post‐hospital rehabilitation: mobilisation strategy versus control, other important outcomes, Outcome 14: Self‐reported measures of lower limb/hip function
6.1
6.1. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 1: Resistance/strength training v endurance training (mobility measured using 6‐Minute Walk Test
6.2
6.2. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 2: Resistance/strength training v endurance training (walking speed)
6.3
6.3. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 3: Resistance/strength training v endurance training (health‐related quality of life)
6.4
6.4. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 4: Resistance/strength training v endurance training (strength)
6.5
6.5. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 5: Gait, balance and function v other (muscle contraction in supine) (mobility measured using mobility scale)
6.6
6.6. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 6: Gait, balance and function v other (muscle contraction in supine) (walking speed)
6.7
6.7. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 7: Gait, balance and function v other (muscle contraction in supine) (mortality)
6.8
6.8. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 8: Gait, balance and function v other (muscle contraction in supine) (Adverse events: pain)
6.9
6.9. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 9: Gait, balance and function v other (muscle contraction in supine) (Adverse events: number of people who fell)
6.10
6.10. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 10: Gait, balance and function v other (muscle contraction in supine) (Balance, observed)
6.11
6.11. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 11: Gait, balance and function v other (muscle contraction in supine) (Balance, self‐reported)
6.12
6.12. Analysis
Comparison 6: Post‐hospital rehabilitation: comparing different intervention strategies, critical outcomes, Outcome 12: Gait, balance and function v other (muscle contraction in supine) (strength)

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References

References to studies included in this review

Baker 1991 {published data only}
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Lamb 2002 {published data only}
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Lauridsen 2002 {published data only}
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Magaziner 2019 {published data only}
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Mangione 2005 {published data only}
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Mangione 2010 {published data only}
    1. Mangione KK, Craik RL, Palombaro KM, Tomlinson SS, Hofmann MT. Home-based leg-strengthening exercise improves function 1 year after hip fracture: a randomized controlled study. Journal of the American Geriatrics Society 2010;58(10):1911-7. - PMC - PubMed
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Miller 2006 {published and unpublished data}
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    1. Crotty M. [personal communication]. 25 July 2003.
    1. Miller MD, Crotty M, Whitehead C, Bannerman E, Daniels LA. Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial. Clinical Rehabilitation 2006;20(4):311-23. - PubMed
Mitchell 2001 {published and unpublished data}
    1. Martin BJ. Randomised, controlled trial of additional quadriceps strength training in patients rehabilitating after a proximal femoral fracture. In: National Research Register, Issue 2, 2001. Oxford: Update Software.
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Monticone 2018 {published data only}
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Moseley 2009 {published and unpublished data}
    1. ACTRN12605000649617. Enhancing mobility after hip fracture. www.anzctr.org.au/ACTRN12605000649617.aspx (first received 09 September 2005).
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Oh 2020 {published data only}
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Ohoka 2015 {published and unpublished data}
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Oldmeadow 2006 {published data only}
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Orwig 2011 {published data only}
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Pol 2019 {published data only}
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Resnick 2007 {published and unpublished data}
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Salpakoski 2015 {published and unpublished data}
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Sherrington 1997 {published and unpublished data}
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Sherrington 2003 {published and unpublished data}
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    1. Sherrington C, Lord SR, Herbert RD. The effects of exercise on physical ability following fall-related hip fracture: two randomised controlled trials. In: Proceedings of the Australian Physiotherapy Association 7th International Physiotherapy Congress; 2002 May 25-28; Sydney, Australia. 2002.
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Sherrington 2004 {published and unpublished data}
    1. Sherrington C, Lord SR, Herbert RD. A randomised controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after hip fracture and completion of usual care [Abstract]. In: XVIth Conference of the International Society for Postural and Gait Research; 2003 March 23-27; Sydney, Australia. www.powmri.unsw.edu.au/ispg2003/ (accessed 24 July 03).
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Sherrington 2020 {published and unpublished data}
    1. Sherrington C, Fairhall N, Kirkham C, Clemson L, Tiedemann A, Vogler C, et al. Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb or pelvic fracture in older people: the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomized controlled trial. Journal of General Internal Medicine 2020;35:2907–16. - PMC - PubMed
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Stasi 2019 {published data only}
    1. Stasi S, Papathanasiou G, Chronopoulos E, Dontas IA, Baltopoulos IP, Papaioannou NA. The effect of intensive abductor strengthening on postoperative muscle efficiency and functional ability of hip-fractured patients: a randomized controlled trial. Indian Journal of Orthopaedics 2019;53(3):407–19. - PMC - PubMed
Suwanpasu 2014 {published data only}
    1. Suwanpasua S, Aungsurochb Y, Jitapanyab C. Post-surgical physical activity enhancing program for elderly patients after hip fracture: a randomized controlled trial. Asian Biomedicine 2014;8(4):525-32.
Sylliaas 2011 {published data only}
    1. Sylliaas H, Brovold T, Wyller TB, Bergland A. Progressive strength training in older patients after hip fracture: a randomised controlled trial. Age and Ageing 2011;40(2):221-7. - PubMed
Sylliaas 2012 {published data only}
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Taraldsen 2019 {published data only}
    1. Taraldsen K, Thingstad P, Dohl O, Follestad T, Helbostad JL, Lamb SE, et al. Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial. PLoS One 2019;14(11):e0224971. - PMC - PubMed
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Tsauo 2005 {published data only}
    1. Tsauo J-Y, Leu W-S, Chen Y-T, Yang R-S. Effects on function and quality of life of postoperative home-based physical therapy for patients with hip fracture. Archives of Physical Medicine and Rehabilitation 2005;86(10):1953-7. - PubMed
Van Ooijen 2016 {published data only}
    1. Van Ooijen MW, Roerdink M, Timmermans C, Trekop M, Arendse S, Nijenhuis E, et al. Feasibility of C-mill gait-adaptability training in older adults after fall-related hip fracture: user's perspective and training content. European Geriatric Medicine 2014;5:S169.
    1. Van Ooijen MW, Roerdink M, Trekop M, Janssen TW, Beek PJ. The efficacy of treadmill training with and without projected visual context for improving walking ability and reducing fall incidence and fear of falling in older adults with fall-related hip fracture: a randomized controlled trial. BMC Geriatrics 2016;16(1):215. - PMC - PubMed
    1. Van Ooijen MW, Roerdink M, Trekop M, Visschedijk J, Janssen TW, Beek PJ. Functional gait rehabilitation in elderly people following a fall-related hip fracture using a treadmill with visual context: design of a randomized controlled trial. BMC Geriatrics 2013;13:34. - PMC - PubMed
Williams 2016 {published data only}
    1. Williams NH, Roberts JL, Din NU, Totton N, Charles JM, Hawkes CA, et al. Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture. BMJ Open 2016;6:e012422. - PMC - PubMed
    1. Williams NH, Roberts JL, Ud Din N, Charles JM, Totton N, Williams M, et al. Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomized feasibility study: fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technology Assessment 2017;21(44):1-527. - PMC - PubMed

References to studies excluded from this review

Adunsky 2011 {published data only}
    1. Adunsky A, Chandler J, Heyden N, Lutkiewicz J, Scott BB, Berd Y, et al. MK-0677 (ibutamoren mesylate) for the treatment of patients recovering from hip fracture: a multicenter, randomized, placebo-controlled phase IIb study. Archives of Gerontology and Geriatrics 2011;53(2):183-9. - PubMed
Aftab 2020 {published data only}
    1. Aftab A, Awan WA, Habibullah S, Lim JY. Effects of fragility fracture integrated rehabilitation management on mobility, activity of daily living and cognitive functioning in elderly with hip fracture. Pakistan Journal of Medical Sciences 2020;36(5):965-70. [DOI: 10.12669/pjms.36.5.2412] - DOI - PMC - PubMed
Beckman 2021 {published data only}
    1. Beckmann M, Bruun-Olsen V, Pripp AH, Bergland A, Smith T, Heiberg KE. Effect of an additional health-professional-led exercise programme on clinical health outcomes after hip fracture. Physiotherapy Research International 2021;26(2):e1896. [DOI: 10.1002/pri.1896] - DOI - PubMed
Berggren 2019 {published data only}
    1. Berggren M, Karlsson Å, Lindelöf N, Englund U, Olofsson B, Nordström P, et al. Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial. Clinical Rehabilitation 2019;33(1):64-73. - PMC - PubMed
Corna 2021 {unpublished data only}
    1. Corna S, Arcolin I, Giardini M, Bellotti L, Godi M. Addition of aerobic training to conventional rehabilitation after hip fracture: a randomized, controlled, pilot feasibility study [with consumer summary]. Clinical Rehabilitation 2021;35(4):568-77. - PubMed
    1. NCT04025866. The addition of aerobic training to conventional rehabilitation after proximal femur fracture: a randomized controlled trial. clinicaltrials.gov/ct2/show/NCT04025866 (first received 19 July 2019).
Dallimore 2015 {published data only}
    1. Dallimore KM. Personal communication. Email to: S Dyer 19 May 2017.
    1. Dallimore RK, Asinas-Tan M, Chan D, Hussain S, Willett C, Zainuldin R. A randomised double-blinded clinical study on the efficacy of multimedia presentation using an iPad for patient education of postoperative hip surgery patients in a public hospital in Singapore. Annals of the Academy of Medicine Singapore: Singapore Health and Biomedical Congress (SHBC); 2015 October 2-3 2015;44(10):S58. - PMC - PubMed
Invernizzi 2019 {published data only}
    1. Invernizzi M, Sire A, D'Andrea F, Carrera D, Reno F, Migliaccio S, et al. Effects of essential amino acid supplementation and rehabilitation on functioning in hip fracture patients: a pilot randomized controlled trial. Aging Clinical and Experimental Research 2019;31(10):1517-24. - PubMed
Kalron 2018 {published data only}
    1. Kalron A, Tawil H, Peleg-Shani S, Vatine JJ. Effect of telerehabilitation on mobility in people after hip surgery: a pilot feasibility study. International Journal of Rehabilitation Research 2018;41(3):244-50. - PubMed
Karlsson 2016 {published data only}
    1. Karlsson Å, Berggren M, Gustafson Y, Olofsson B, Lindelöf N, Stenvall M. Effects of geriatric interdisciplinary home rehabilitation on walking ability and length of hospital stay after hip fracture: a randomized controlled trial. Journal of the American Medical Directors Association 2016;17(5):464 e9-e15. - PubMed
    1. Karlsson A, Lindelof N, Olofsson B, Berggren M, Gustafson Y, Nordstrom P, et al. Effects of geriatric interdisciplinary home rehabilitation on independence in activities of daily living in older people with hip fracture: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2020;101:571-8. - PubMed
Kim 2020 {published data only}
    1. Kim P, Lee H, Choi W, Jung S. Effect of 4 weeks of anti-gravity treadmill training on isokinetic muscle strength and muscle activity in adults patients with a femoral fracture: a randomized controlled trial. International Journal of Environmental Research and Public Health 2020;17(22):1-9. - PMC - PubMed
Lahtinen 2017 {published data only}
    1. Lahtinen A, Leppilahti J, Vähänikkilä H, Harmainen S, Koistinen P, Rissanen P, et al. Costs after hip fracture in independently living patients: a randomised comparison of three rehabilitation modalities. Clinical Rehabilitation 2017;31(5):672-85. - PubMed
Laiz 2017 {published data only}
    1. Laiz A, Malouf J, Marin A, Longobardi V, Caso J, Farrerons J, et al. Impact of 3-monthly vitamin D supplementation plus exercise on survival after surgery for osteoporotic hip fracture in adult patients over 50 years: a pragmatic randomized, partially blinded, controlled trial. Journal of Nutrition, Health & Aging 2017;21(4):413-20. - PubMed
Lehrl 2012 {published data only}
    1. Lehrl S, Gusinde J, Schulz-Drost S, Rein A, Schlechtweg PM, Jacob H, et al. Advancement of physical process by mental activation: a prospective controlled study. Journal of Rehabilitation Research and Development 2012;49(8):1221-8. - PubMed
Pfeiffer 2020 {published data only}
    1. Pfeiffer K, Kampe K, Klenk J, Rapp K, Kohler M, Albrecht D, et al. Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age and Ageing 2020;49(5):771–8. - PubMed
Scheffers‐Barnhoorn 2019 {published data only}
    1. Scheffers-Barnhoorn MN, Van Eijk M, Van Haastregt JC, Schols JM, Van Balen R, Van Geloven N, et al. Effects of the FIT-HIP intervention for fear of falling after hip fracture: a cluster-randomized controlled trial in geriatric rehabilitation. Journal of the American Medical Directors Association 2019;20(7):857-65. - PubMed
Taraldsen 2015 {published data only}
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Wang 2020 {published data only}
    1. Wang K, Fan J, Li X, Yang S, Ren D, He C. Long-term intensive family rehabilitation training for postoperative functional recovery in elderly hip fracture patients. Chinese Journal of Tissue Engineering Research 2020;24(14):2158-63.
Wu 2010 {published data only}
    1. Wu XB, Zhang Q, Song LX, Zhang YZ. Effect of early rehabilitation on the hip joint function in patients with comminuted posterior wall fractures of the acetabulum after internal fixation. Journal of Clinical Rehabilitative Tissue Engineering Research 2010;14(4):732-5.

References to studies awaiting assessment

Che 2020 {unpublished data only}
    1. Che X, Zhang X, Li H, Xu P, Zhao D. Therapeutic effect of early rehabilitation training on the recovery of limb function in elderly patients with femoral neck fracture [Abstract]. Basic and Clinical Pharmacology and Toxicology 2020;127 (Suppl 3):300.
Wu XY 2019 {published data only}
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References to ongoing studies

ACTRN12617001345370 {unpublished data only}
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ACTRN12618000903280 {unpublished data only}
    1. ACTRN12618000903280. The feasibility of prescribing a walking program to improve physical functioning of people living in the community after hip fracture [The feasibility of prescribing a walking program to improve physical functioning of people living in the community after hip fracture: a phase II randomised controlled trial]. anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000903280 (first received 25 May 2018).
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ISRCTN32476360 {unpublished data only}32476360
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jRCTs052190018 {unpublished data only}
    1. jRCTs052190018. A pilot study of training using the Balance Exercise Assist Robot for the patients after the proximal femoral fractures surgery at the convalescent rehabilitation ward. rctportal.niph.go.jp/en/detail?trial_id=jRCTs052190018 (first received, unknown. date registered 17 May 2019).
jRCTs052190022 {unpublished data only}
    1. jRCTs052190022. A preliminary study of training using the Balance Exercise Assist Robot for the patients after the proximal femoral fractures surgery at the community-based integrated care ward. rctportal.niph.go.jp/en/detail?trial_id=jRCTs052190022 (first received, unknown. date registered 27 May 2019.
KCT0004122 {unpublished data only}
    1. KCT0004122. A randomized feasibility study of inpatient rehabilitation using advanced techniques in older people with fragility hip fracture. cris.nih.go.kr/cris/search/detailSearch.do?seq=14311&search_page=L&searc... (first received: unknown; approved 17 June 2019).
Lima 2016 {unpublished data only}
    1. Lima CA, Sherrington C, Guaraldo A, Moraes SA, Varanda RD, Melo J, et al. Effectiveness of a physical exercise intervention program in improving functional mobility in older adults after hip fracture in later stage rehabilitation: protocol of a randomized clinical trial (REATIVE Study). BMC Geriatrics 2016;16(1):198. - PMC - PubMed
NCT01129219 {unpublished data only}
    1. NCT01129219. Observation and progressive strength training after hip fracture. clinicaltrials.gov/ct2/show/NCT01129219 (first received 24 May 2010).
NCT01174589 {unpublished data only}
    1. NCT01174589. Training of patients with hip fracture. clinicaltrials.gov/show/NCT01174589 (first received 3 August 2010).
NCT02305433 {unpublished data only}
    1. NCT02305433. Effects of long-term intensive home-based physiotherapy on older people with an operated hip fracture or frailty (RCT) (HIPFRA) [Effects of long-term intensive home-based physiotherapy on older people with an operated hip fracture or frailty (RCT)]. clinicaltrials.gov/ct2/show/NCT02305433 (first received 2 December 2014).
NCT02407444 {unpublished data only}
    1. NCT02407444. Treatment efficacy of leg cycling as part of physiotherapy treatment in elderly patients with hip fracture [A comparison of two physiotherapy treatment protocols, with and without cycling training, in elderly patients with hip fractures at their subacute stage following surgery]. clinicaltrials.gov/ct2/show/NCT02407444 (first received 3 April 2015).
NCT02815254 {unpublished data only}
    1. ANCT02815254. The effect of exercise in elderly hip fracture patients: a clinical randomised trial. clinicaltrials.gov/ct2/show/NCT02815254 (first received 28 June 2016).
NCT02938923 {unpublished data only}
    1. NCT02938923. Starting a testosterone and exercise program after hip injury (STEP-HI) [Combining testosterone therapy and exercise to improve function post hip fracture]. clinicaltrials.gov/ct2/show/NCT02938923 (first received 19 October 2016).
NCT03030092 {unpublished data only}
    1. NCT03030092. Maximal strength training following hip fracture surgery: impact on muscle mass, balance, walking efficiency and bone density. clinicaltrials.gov/ct2/show/NCT03030092 (first received 24 January 2017).
NCT04095338 {unpublished data only}
    1. NCT04095338. Assistive robotic in the elderly: innovative models in the rehabilitation of the elderly with hip fractures through technological innovation. clinicaltrials.gov/ct2/show/NCT04095338 (first received 19 September 2019).
NCT04108793 {unpublished data only}
    1. NCT04108793. Effectiveness of home-based rehabilitation program in minimizing disability and secondary falls after a hip fracture: a randomized controlled trial. clinicaltrials.gov/ct2/show/NCT04108793 (first received 30 September 2019).
NCT04207788 {unpublished data only}
    1. NCT04207788. HIP fracture rehabilitation programme (HIP-REP) [HIp fracture rehabilitation programme for elderly with hip fracture]. clinicaltrials.gov/ct2/show/NCT04207788 (first received 23 December 2019).
NCT04228068 {unpublished data only}
    1. NCT04228068. The stronger at home study [A home-based rehabilitation program for patients with hip fracture: a pilot randomized trial]. clinicaltrials.gov/ct2/show/NCT04228068 (first received 14 January 2020).
NTR6794 {unpublished data only}
    1. NTR6794. Rehabilitation after hip fractures in elderly [COMplex Fracture Orthopedic Rehabilitation (COMFORT) - Real-time visual biofeedback on weight bearing versus standard training methods in the treatment of proximal femur fractures in elderly: a randomized controlled trial]. www.trialregister.nl/trial/6609 (date first received: unclear; date registered 20 October 2017).
UMIN000036379 {unpublished data only}
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References to other published versions of this review

Handoll 2003
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Associated data