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The effect of care pathways for hip fractures: a systematic overview of secondary studies

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Abstract

The aim of this paper was to perform a systematic overview of secondary literature studies on care pathways (CPs) for hip fracture (HF). The online databases MEDLINE–PubMed, Ovid–EMBASE, CINAHL–EBSCO–host, and The Cochrane Library were searched. A total of six papers, corresponding to six secondary studies, were included but only four secondary studies were HF-specific and thus assessed. Secondary studies were evaluated for patients’ clinical outcomes. There were wide differences among the studies that assessed the effects of CPs on HF patients, with some contrasting clinical outcomes reported. Secondary studies that were non-specific for CPs and included other multidisciplinary care approaches as well showed, in some cases, a shorter hospital length of stay (LOS) compared to usual care; studies that focused on promoting early mobilization showed better outcomes of mortality, morbidity, function, or service utilization; CPs mainly based on intensive occupational therapy and/or physical therapy exercises improved functional recovery and reduced LOS, with patients also discharged to a more favorable discharge destination; CPs principally focused on early mobilization improved functional recovery. A secondary study specifically designed for CPs showed lower odds of experiencing common complications of hospitalization after HF. In conclusion, although our overview suggests that CPs can reduce significantly LOS and can have a positive impact on different outcomes, data are insufficient for formal recommendations. To properly understand the effects of CPs for HF, a systematic review is needed of primary studies that specifically examined CPs for HF.

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Acknowledgments

This study was supported by the European Pathway Association (www.E-P-A.org) through an unrestricted educational grant from PFIZER. We hereby acknowledge PFIZER BELGIUM, PFIZER ITALY, PFIZER IRELAND, AND PFIZER PORTUGAL for providing the unrestricted educational grant. The funding sources played no role in the design, execution, and evaluation of the present study. Fabrizio Leigheb got from European Pathway Association an unrestricted educational grant of about € 16,000 granted for 3 consecutive years of PhD course (2009–2011) at the Department of Clinical and Experimental Medicine (from year 2012 established and renamed as the Department of Translational Medicine) of the University of Eastern Piedmont “Amedeo Avogadro,” Novara, Italy.

Conflict of interest

The authors of the present manuscript, Fabrizio Leigheb, Kris Vanhaecht, Walter Sermeus, Cathy Lodewijckx, Svin Deneckere, Steven Boonen, Paulo A Boto, Rita Veloso Mendes, and Massimiliano Panella, declare that they have not proprietary interest or conflict of interest.

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Correspondence to Fabrizio Leigheb.

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Leigheb, F., Vanhaecht, K., Sermeus, W. et al. The effect of care pathways for hip fractures: a systematic overview of secondary studies. Eur J Orthop Surg Traumatol 23, 737–745 (2013). https://doi.org/10.1007/s00590-012-1085-x

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