Abstract
Objective
Older people with hip fractures are often undernourished, which adversely affects
their functional prognosis. A previous review reported that oral multinutritional
supplements may prevent complications after hip fracture surgery. However, it is unclear
whether interventions that combine rehabilitation and nutritional therapy have prognostic
benefits. The objective of this study was to determine whether nutritional therapy
is effective for patients with hip fractures undergoing rehabilitation.
Design
Systematic literature review and meta-analysis.
Setting and Participants
Randomized controlled trials involving patients at least 65 years of age with hip
fracture undergoing rehabilitation with or without nutritional therapy. Older patients
with hip fractures undergoing rehabilitation were included.
Methods
A systematic literature search using 5 databases (PubMed, Cochrane Central Register
of Controlled Trials, EMBASE, WHO ICTRP, and Ichu-shi Web) was conducted in December
2018 and identified all randomized controlled trials. Outcome variables include mortality,
complications, activities of daily living, quality of life, and muscle strength.
Results
Of the 1431 studies found, 10 met the inclusion criteria, involving a total of 1119
patients. Four studies reported mortality, 5 studies reported complications, and 4
studies reported grip strength. Nutritional therapy showed a significant reduction
in mortality [relative risk (RR) 0.61, 95% confidence interval (CI) 0.39, 0.93; I2 = 0%] and complications (RR 0.67, 95% CI 0.44, 1.03; I2 = 79%), and improved grip strength (mean difference = 2.01, 95% CI 0.81, 3.22; I2 = 0%). The effects of nutritional therapy on activities of daily living, quality
of life, and knee extension strength are unknown. The majority of studies were assessed
as low quality.
Conclusions and Implications
Our study showed that the combination of rehabilitation and nutritional therapy for
older patients with hip fractures reduced mortality and postoperative complications
and enhanced grip strength, although the quality of the evidence was low. A well-designed
controlled study is needed for further investigation.
Keywords
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Article info
Footnotes
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
The authors have no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
