Estratégias de Mobilidade Após Fratura
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Estratégias de Mobilidade Após Fratura

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Cochrane Database of Systematic Reviews
Interventions for improvingmobility after hip fracture
surgery in adults (Review)
Handoll HHG, Sherrington C, Mak JCS
Handoll HHG, Sherrington C, Mak JCS.
Interventions for improving mobility after hip fracture surgery in adults.
Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD001704.
DOI: 10.1002/14651858.CD001704.pub4.
www.cochranelibrary.com
Interventions for improvingmobility after hip fracture surgery in adults (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
http://www.cochranelibrary.com
T A B L E O F C O N T E N T S
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
20DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23AUTHORS\u2019 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
76DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 1.2. Comparison 1 Early (< 48 hours) versus delayed (> 48 hours) assisted ambulation after surgery, Outcome 2
Poor functional mobility at 7 days. . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Analysis 1.4. Comparison 1 Early (< 48 hours) versus delayed (> 48 hours) assisted ambulation after surgery, Outcome 4
Mortality and cardiovascular challenged participants. . . . . . . . . . . . . . . . . . . . . 98
Analysis 1.5. Comparison 1 Early (< 48 hours) versus delayed (> 48 hours) assisted ambulation after surgery, Outcome 5
Discharge location. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Analysis 2.1. Comparison 2 Early (2 weeks) versus delayed (12 weeks) weight bearing, Outcome 1 Mortality. . . . 99
Analysis 2.2. Comparison 2 Early (2 weeks) versus delayed (12 weeks) weight bearing, Outcome 2 Non-union (fixation
failure). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Analysis 2.3. Comparison 2 Early (2 weeks) versus delayed (12 weeks) weight bearing, Outcome 3 Avascular necrosis. 100
Analysis 2.4. Comparison 2 Early (2 weeks) versus delayed (12 weeks) weight bearing, Outcome 4 Unfavourable outcome
(death, failure or infection). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Analysis 3.1. Comparison 3 Intensive versus usual physiotherapy, Outcome 1 Orthopaedic complication (as reason for
withdrawal from trial). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Analysis 3.2. Comparison 3 Intensive versus usual physiotherapy, Outcome 2 Adductor muscle strength (kp) at 9 weeks. 102
Analysis 3.3. Comparison 3 Intensive versus usual physiotherapy, Outcome 3 Non-completion of training programme. 102
Analysis 3.4. Comparison 3 Intensive versus usual physiotherapy, Outcome 4 Withdrawal from trial by patient. . . 103
Analysis 3.6. Comparison 3 Intensive versus usual physiotherapy, Outcome 6 Length of hospital stay (days). . . . 104
Analysis 4.1. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 1 Unable to walk at all
or without two sticks or a frame. . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Analysis 4.2. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 2 Unable to do a lateral
step-up unsupported or with one hand alone. . . . . . . . . . . . . . . . . . . . . . . . 105
Analysis 4.3. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 3 Physical Performance
and Mobility Examination score (0: failure to 12: top score). . . . . . . . . . . . . . . . . . . 106
Analysis 4.4. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 4 Gait parameters. 106
Analysis 4.5. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 5 Balance. . . 107
Analysis 4.6. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 6 Subjective rating of
pain, fall risk, balance, sleep quality and general health. . . . . . . . . . . . . . . . . . . . 108
Analysis 4.7. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 7 Fracture fixation
problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Analysis 4.8. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 8 Strength measures
(newtons). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Analysis 4.9. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 9 Participant\u2019s
perception of exercise programmes. . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Analysis 4.10. Comparison 4 Weight-bearing exercises versus non-weight-bearing exercises, Outcome 10 Total length of
stay in hospital (days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
iInterventions for improving mobility after hip fracture surgery in adults (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 5.4. Comparison 5 Quadriceps training programme versus conventional physiotherapy alone, Outcome 4
Functional reach (inches). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Analysis 5.5. Comparison 5 Quadriceps training programme versus conventional physiotherapy alone, Outcome 5
Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Analysis 5.6. Comparison 5 Quadriceps training programme versus conventional physiotherapy alone, Outcome 6 New
comorbidity at follow-up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Analysis 5.9. Comparison 5 Quadriceps training programme versus conventional physiotherapy alone, Outcome 9 Leg
extensor power (watts). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Analysis 6.1. Comparison 6 Treadmill gait training versus conventional gait training, Outcome 1 Failure to regain pre-
fracture mobility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Analysis 6.2. Comparison 6 Treadmill gait training versus conventional gait training, Outcome 2 Gait velocity
(metres/minute). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Analysis 7.2. Comparison 7 Electrical stimulation of quadriceps versus no or placebo stimulation, Outcome 2 Failure to
regain pre-fracture mobility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Analysis 7.3. Comparison 7 Electrical stimulation of quadriceps versus no or placebo stimulation, Outcome 3 Gait velocity
(walking speed over 15.25 metres) (metres/second). . . . . . . . . . . . . . . . . . . . . . 117
Analysis 7.4. Comparison 7 Electrical stimulation of quadriceps versus no or placebo stimulation, Outcome 4 Unable to
\u2019tandem stand\u2019 (postural instability). . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Analysis 7.5. Comparison 7 Electrical stimulation of quadriceps versus no or placebo stimulation, Outcome 5 Pain (6 point
scale: 6 = constant severe pain). .