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Effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults post hip fracture: a systematic review and meta-analysis

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Abstract

This study determines the effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults after hip fracture. Ovid MEDLINE, Embase, Global Health, APAPsych, CENTRAL, CIHAHL, PEDro and Open Grey were searched from database inception to June 10, 2022 for definitive, pilot or feasibility randomised controlled trials of rehabilitation interventions (versus any comparator) which reported depressive symptoms among older adults post hip fracture. Nonrandomised trials and those not published in English were excluded. Selection, quality appraisal (Cochrane Risk of Bias 2) and extraction in duplicate. Results were synthesised narratively and with meta-analysis (Hedge’s g for intervention effect, I2 for heterogeneity). Eight trials (1146 participants) were included. Interventions were predominantly face-to-face exercise rehabilitation (range three to 56 sessions) at home versus usual care. Three trials were assigned overall low risk of bias, three some concerns and two high risk. The pooled effect of rehabilitation on depressive symptoms at intervention end favoured the intervention group (Hedges’s g −0.43; 95% CI: −0.87, 0.01; four trials). Three trials demonstrated no between group difference following adjustment for baseline depressive symptoms. One trial found lower odds of depression when the intervention additionally included falls prevention, nutrition consultation and depression management. There is a potential benefit of exercise rehabilitation interventions on depressive symptoms after hip fracture. A mechanism for benefit may relate to baseline symptom severity, exercise frequency, frequency of health professional contacts, addition of a psychological component or of the quality of the underlying trials. To appropriately inform clinical guidelines, further appropriately powered trials with follow-up are warranted.

Trial registration

ClinicalTrials.gov Identifier: CRD42022342099

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Data availability

All data reported by the systematic review is from published primary evidence sources.

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Author information

Authors and Affiliations

  1. Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK

    Rhian Milton-Cole, Kareema Kazeem, Alexander Gibson, Stefanny Guerra & Katie Jane Sheehan

Authors
  1. Rhian Milton-Cole
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  2. Kareema Kazeem
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  3. Alexander Gibson
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  4. Stefanny Guerra
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  5. Katie Jane Sheehan
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Contributions

RMC, KS contributed to the conception and design of the study. AG, KK, SG, RMC contributed to the acquisition and the analysis of data. All authors contributed to the interpretation of the analysis. All authors contributed to drafting and critically revising the manuscript for important intellectual content. All authors approved the final version for submission and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Katie Jane Sheehan.

Ethics declarations

Conflict of interest

RMC, SG, AG, KK have no conflicts of interest to declare. KS received funding from UK Research & Innovation Future Leaders Fellowship, the National Institutes of Health Research (NIHR) and Chartered Society of Physiotherapy Charitable Trust for hip fracture health services research. KS is the Chair of the Scientific and Publications Committee of the Falls and Fragility Fracture Audit Programme at the Royal College of Physicians.

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Appendices

Appendix 1

Search Strategy -Ovid Medline

  1. 1

    exp Hip Fracture/

  2. 2

    ((hip* or ((femur* or femoral*) adj3 (neck or proximal))) adj4 fracture*).tw.

  3. 3

    ((trochant* or pertrochant* or intertrochant* or subtrochant* or intracapsular* or extracapsular*) adj3 fracture*) or /1−2

  4. 4

    exp Rehabilitation/

  5. 5

    Daily Life Activity/

  6. 6

    Mobilization/

  7. 7

    Occupational Therapy/ or exp Physiotherapy/

  8. 8

    Clinical Pathway/

  9. 9

    Hospitalization/

  10. 10

    Patient care/ or Rehabilitation Care/ or exp Elderly Care/

  11. 11

    exp Health Care Delivery/

  12. 12

    Geriatric Assessment/

  13. 13

    rh.fs.

  14. 14

    rehab*.tw.

  15. 15

    (early adj1 (mobil* or discharg*or ambulat*)).tw.

  16. 16

    (occupational therap* or physiotherap* or physical therap*).tw.

  17. 17

    (multidisciplin* or interdisciplinar* or multidisciplinar* or multiprofessional* or multimodal* or integrated).tw.

  18. 18

    (geriatr* or geriatr*orthop* or ortho*-geriatr* or orthogeriatr* or GORU).tw.

  19. 19

    hospital at home.tw.

  20. 20

    or/4−19

  21. 21

    3 and 20

  22. 22

    Randomized controlled trial/

  23. 23

    Clinical trial/

  24. 24

    Controlled clinical trial/

  25. 25

    Randomization/

  26. 26

    Single blind procedure/

  27. 27

    Double blind procedure/

  28. 28

    Crossover procedure/

  29. 29

    Placebo/

  30. 30

    Prospective study/

  31. 31

    ((clinical or controlled or comparative or placebo or prospective* or randomi#ed) adj3 (trial or study)).tw.

  32. 32

    (random* adj7 (allocat* or allot* or assign* or basis* or divid* or order*)).tw.

  33. 33

    ((singl* or doubl* or trebl* or tripl*) adj7 (blind* or mask*)).tw.

  34. 34

    (cross?over* or (cross adj1 over*)).tw.

  35. 35

    ((allocat* or allot* or assign* or divid*) adj3 (condition* or experiment* or intervention* or treatment* or therap* or control* or group*)).tw.

  36. 36

    RCT.tw.

  37. 37

    or/22−36

  38. 38

    3 and 20 and 37

English language only

Humans only

Supplementary

Appendix 2: Studies excluded at full text and reason for exclusion.

Excluded due to study design

  1. 1.

    Intensive home-based rehabilitation following hip fracture is no more effective than usual home-based rehabilitation. Sherrington C. Australian Journal of Physiotherapy / 2000;46(1):61

  2. 2.

    Effectiveness of the Geriatric Activation Program Pellenberg (GAPP) on the Geriatric Rehabilitation Ward. NCT03109483.

  3. 3.

    Tele-rehabilitation Intervention for People Post Hip Fracture - Randomized Controlled Trial (RCT) NCT03376750.

  4. 4.

    A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial Scheffers-Barnhoorn M.N.; van Haastregt J.C.; Schols J.M.; Kempen G.I.; van Balen R.; Visschedijk J.H.; van den Hout W.B.; Dumas E.M.; Achterberg W.P.; van Eijk M. BMC geriatrics / 2017;17(1):71

  5. 5.

    Electrical stimulation of quadriceps during rehabilitation following proximal femoral fracture. Barber M.; Braid V.; Mitchell S.L.; Martin B.J.; Grant S.J.; Granat M.; Stott D.J. International Journal of Rehabilitation Research / 2002;25(1):61−63

  6. 6.

    Effectiveness of task specific gait and balance exercise 4 months after hip fracture: protocol of a randomized controlled trial--the Eva-hip study. Thingstad P.; Taraldsen K.; Hagen G.; Sand S.; Saltvedt I.; Sletvold O.; Helbostad J.L. Physiotherapy research international : the journal for researchers and clinicians in physical therapy / 2015;20(2):87−99

  7. 7.

    Functional recovery of older hip-fracture patients after interdisciplinary intervention follows three distinct trajectories. Tseng M.Y.; Shyu Y.I.; Liang J. The Gerontologist / 2012;52(6):833−842

  8. 8.

    Intensive physical training in geriatric patients after severe falls and hip surgery. Hauer K.; Specht N.; Schuler M.; Bartsch P.; Oster P. Age and Ageing /2002;31 (1):49−57

Excluded due to population

  1. 1.

    Geriatric rehabilitative care after fractures of the proximal femur: One year follow up of a randomised clinical trial. Reid J.; Kennie D.C. British Medical Journal / 1989;298(6690):25−26

  2. 2.

    Should we provide outreach rehabilitation to very old people living in nursing care facilities after a hip fracture? A randomised controlled trial [with consumer summary] Crotty M; Killington M; Liu E; Cameron ID; Kurrle S; Kaambwa B; Davies O; Miller M; Chehade M; Ratcliffe J. Age and Ageing 2019 May;48(3):373−380 2019;():

Excluded due to intervention

  1. 1.

    O'Halloran, P.D., et al., Motivational interviewing increases physical activity and self-efficacy in people living in the community after hip fracture: a randomized controlled trial. Clin Rehabil, 2016. 30(11): p. 1108−119.

Excluded due to outcome

  1. 1.

    The stronger at home study: A feasibility randomized controlled trial of homebased physiotherapy program for patients after hip fractures Auais M.; Miller J.; Varette K.; Zaman M.S.Osteoporosis International / 2020;31(SUPPL 1):S571

  2. 2.

    Interdisciplinary inpatient care for elderly people with hip fracture: A randomized controlled trial. Naglie G.; Tansey C.; Kirkland J.L.; Ogilvie-Harris D.J.; Detsky A.S.; Etchells E.; Tomlinson G.; O'Rourke K.; Goldlist B. CMAJ / 2002;167(1):25−32

  3. 3.

    Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation after Hip Fracture in Older Adults: The CAP Randomized Clinical Trial. Magaziner J.; Mangione K.K.; Orwig D.; Baumgarten M.; Magder L.; Terrin M.; Fortinsky R.H.; Gruber-Baldini A.L.; Beamer B.A.; Tosteson A.N.A.; Kenny A.M.; Shardell M.; Binder E.F.; Koval K.; Resnick B.; Miller R.; Forman S.; McBride R.; Craik R.L. JAMA - Journal of the American Medical Association / 2019;322(10):946−956.

  4. 4.

    Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status Liu H.-Y.; Tseng M.-Y.; Li H.-J.; Wu C.-C.; Cheng H.-S.; Yang C.-T.; Chou S.-W.; Chen C.-Y.; Shyu Y.I.L. Journal of the American Medical Directors Association / 2014;15(6):416−422

  5. 5.

    Treatment of fear of falling in geriatric rehabilitation after hip fracture: Effects of a cluster randomized controlled trial (FIT-HIP). Scheffers-Barnhoorn; Van Eijk M.; Van Haastregt J.C.M.; Schols J.M.G.A.; Van Balen R.; Van Geloven N.; Kempen G.I.J.M.; Achterberg W.P. European Geriatric Medicine / 2019;10(Supplement 1):S102−S103

  6. 6.

    Progressive strength training in older patients after hip fracture: a randomised controlled trial [with consumer summary]. Sylliaas H; Brovold T; Wyller TB; Bergland A. Age and Ageing 2011 Mar;40(2):221−227 2011;():

  7. 7.

    Comprehensive and subacute care interventions improve health-related quality of life for older patients after surgery for hip fracture: A randomised controlled trial. Shyu Y.I.L.; Liang J.; Tseng M.-Y.; Li H.-J.; Wu C.-C.; Cheng H.-S.; Chou S.-W.; Chen C.-Y.; Yang C.-T. International Journal of Nursing Studies / 2013;50(8):1013−1024

  8. 8.

    Effect of occupational therapy on functional and emotional outcomes after hip fracture treatment: a randomized controlled trial [with consumer summary]. Martin-Martin LM; Valenza-Demet G; Jimenez-Moleon JJ; Cabrera-Martos I; Revelles-Moyano FJ; Valenza MC. Clinical Rehabilitation 2013 Nov 22;28(6):541−551 2013;():

  9. 9.

    Effectiveness of sensor monitoring in a rehabilitation programme for older patients after hip fracture: A three-arm stepped wedge randomised trial. Pol M.C.; Ter Riet G.; Van Hartingsveldt M.; Krose B.; Buurman B.M. Age and Ageing / 2019;48(5):648−655

  10. 10.

    Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial. Berggren M.; Karlsson A.; Lindelof N.; Englund U.; Olofsson B.; Nordstrom P.; Gustafson Y.; Stenvall M. Clinical rehabilitation / 2019;33(1):64−73

  11. 11.

    Rehabilitation intensification after hip fracture: a randomized, controlled trial of exercise training. Binder EF; Sinacore DR; Steger-May K; Schechtman KB; Brown M. Journal of Geriatric Physical Therapy 11// 2003;26(3):39−39.

  12. 12.

    Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: A randomized clinical trial. Latham N.K.; Harris B.A.; Bean J.F.; Heeren T.; Goodyear C.; Zawacki S.; Heislein D.M.; Mustafa J.; Pardasaney P.; Giorgetti M.; Holt N.; Goehring L.; Jette A.M. JAMA - Journal of the American Medical Association / 2014;311(7):700−708

  13. 13.

    Mobility training after hip fracture: a randomised controlled trial [with consumer summary] Moseley AM; Sherrington C; Lord SR; Barraclough E; St George RJ; Cameron ID. Age and Ageing 2009 Jan;38(1):74−80 2009;():

  14. 14.

    Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home? Mangione K.K.; Craik R.L.; Tomlinson S.S.; Palombaro K.M. Physical Therapy / 2005;85(8):727−739

  15. 15.

    Home-based multicomponent rehabilitation program for older persons after hip fracture: A randomized trial. Tinetti M.E.; Baker D.I.; Gottschalk M.; Williams C.S.; Pollack D.; Garrett P.; Gill T.M.; Marottoli R.A.; Acampora D. Archives of Physical Medicine and Rehabilitation / 1999;80(8):916−922

  16. 16.

    Home rehabilitation after hip fracture a randomized controlled study on balance confidence, physical function and everyday activities [with consumer summary] Ziden L; Frandin K; Kreuter M. Clinical Rehabilitation 2008 Dec;22(12):1019−1033 2008;():

  17. 17.

    Neuromuscular stimulation of the quadriceps muscle after hip fracture: A randomized controlled trial. Lamb S.E.; Oldham J.A.; Morse R.E.; Evans J.G. Archives of Physical Medicine and Rehabilitation / 2002;83(8):1087−1092

  18. 18.

    Back to the future - Feasibility of recruitment and retention to patient education and telephone follow-up after hip fracture: A pilot randomized controlled trial. Langford D.P.; Fleig L.; Brown K.C.; Cho N.J.; Frost M.; Ledoyen M.; Lehn J.; Panagiotopoulos K.; Sharpe N.; Ashe M.C.

  19. 19.

    Home exercise to improve strength and walking velocity after hip fracture: A randomized controlled trial. Sherrington C.; Lord S.R. Archives of Physical Medicine and Rehabilitation / 1997;78(2):208−212

  20. 20.

    Effect of a multicomponent home-based physical therapy intervention on ambulation after hip fracture in older adults: the CAP randomized clinical trial [with consumer summary] Magaziner J; Mangione KK; Orwig D; Baumgarten M; Magder L; Terrin M; Fortinsky RH; Gruber-Baldini AL; Beamer BA; Tosteson ANA; Kenny AM; Shardell M; Binder EF; Koval K; Resnick B; Miller R; Forman S; McBride R; Craik RL. JAMA 2019 Sep 10;322(10):946−956

  21. 21.

    Randomized controlled trial of quadriceps training after proximal femoral fracture [with consumer summary]. Mitchell SL; Stott DJ; Martin BJ; Grant SJ. Clinical Rehabilitation 2001 Jun;15(3):282−290

  22. 22.

    Mobility training after hip fracture: A randomised controlled trial. Moseley A.M.; Sherrington C.; Lord S.R.; Barraclough E.; St George R.J.; Cameron I.D. Age and Ageing 2009; 38(1): 74−80.

  23. 23.

    Six Versus 12 Weeks of Outpatient Physical Therapy Including Progressive Resistance Training in Cognitively Intact Older Adults After Hip Fracture: A Multicenter Randomized Controlled Trial. Overgaard J.A.; Kallemose T.; Mangione K.K.; Kristensen M.T. The journals of gerontology. Series A, Biological sciences and medical sciences. 2021 https://doi.org/10.1093/gerona/glab256

  24. 24.

    Post-surgical physical activity enhancing program for elderly patients after hip fracture: A randomized controlled trial. Suwanpasu S.; Aungsuroch Y.; Jitapanya C. Asian Biomedicine 2014/8(4) 525−532.

  25. 25.

    Effect of occupational therapy on functional and emotional outcomes after hip fracture treatment: a randomized controlled trial. Martin-Martin L.M.; Valenza-Demet G.; Jimenez-Moleon J.J.; Cabrera-Martos I.; Revelles-Moyano F.J.; Valenza M.C. Clinical rehabilitation 2014/28(6): 541−551

  26. 26.

    Efficacy of Combined Antigravity Treadmill and Conventional Rehabilitation After Hip Fracture in Patients With Sarcopenia. Oh M.-K.; Yoo J.-I.; Byun H.; Chun S.-W.; Lim S.-K.; Jang Y.J.; Lee C.H. The journals of gerontology. Series A, Biological sciences and medical sciences 2020/75(10)e173−e181

  27. 27.

    Health-related quality of life and self-reported ability concerning ADL and IADL after hip fracture: A randomized trial. Hagsten B.; Svensson O.; Gardulf A. Acta Orthopaedica 2006/ 77(1):114−119

  28. 28.

    High-intensity exercise training following hip fracture. Peterson M.G.E.; Ganz S.B.; Allegrante J.P.; Cornell C.N. Topics in Geriatric Rehabilitation 2004/20(4):273−284.

  29. 29.

    How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial [with consumer summary]. Monticone M; Ambrosini E; Brunati R; Capone A; Pagliari G; Secci C; Zatti G; Ferrante S. Clinical Rehabilitation 2018 Mar;32(3):340−351

  30. 30.

    Randomised controlled trial of electrical stimulation of the quadriceps after proximal femoral fracture. Braid V.; Barber M.; Mitchell S.L.; Martin B.J.; Granat M.; Stott D.J. Aging Clinical and Experimental Research 2008/20(1):62−66.

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Milton-Cole, R., Kazeem, K., Gibson, A. et al. Effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults post hip fracture: a systematic review and meta-analysis. Osteoporos Int 35, 227–242 (2024). https://doi.org/10.1007/s00198-023-06923-3

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