Abstract
Objective To determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes.
Design Systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE, and ClinicalTrials.gov for randomized controlled trials of rehabilitation interventions after hip fracture published between 1st January 2008 and 30th May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool), and data extraction (Cochrane’s PROGRESS-Plus framework).
Results 23 published, 8 protocol, 4 registered ongoing randomized controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age, and/or nonsurgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions.
Conclusion The generalizability of trial results to the underlying population of frail older adults is limited. Yet this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated.
PROSPERO CRD42018085930
Design Systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE, and ClinicalTrials.gov for randomized controlled trials of rehabilitation interventions after hip fracture published between 1st January 2008 and 30th May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool), and data extraction (Cochrane’s PROGRESS-Plus framework).
Results 23 published, 8 protocol, 4 registered ongoing randomized controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age, and/or nonsurgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions.
Conclusion The generalizability of trial results to the underlying population of frail older adults is limited. Yet this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated.
PROSPERO CRD42018085930
| Original language | English |
|---|---|
| Article number | afz031 |
| Pages (from-to) | 489-497 |
| Number of pages | 9 |
| Journal | Age and Ageing |
| Volume | 48 |
| Issue number | 4 |
| Early online date | 9 Apr 2019 |
| DOIs | |
| Publication status | Published - Jul 2019 |
Keywords
- hip fracture
- equity
- rehabilitation
- cognitive impairment
- older people
- systematic review