REHABILITATION AFTER PELVIC FRAGILITY FRACTURE IN OLDER ADULTS: A SCOPING REVIEW

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C Carter1, S Guerra 2, L Clothier 1, S Barlow 3, R Axenciuc 1, R Milton-Cole 2, X L Griffin 2, K Jane Sheehan 2
1 Barts Health NHS Trust, London, UK , 2 Bone and Joint Health, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary, University of London, London UK 3 Royal National Orthopaedic Hospital NHS Trust, London, UK
Scientific Research
SP - Falls
Rehabilitation

Abstract

Introduction: To synthesise the evidence available on components of reported rehabilitation interventions following pelvic fragility fracture in older adults and describe outcomes measured.

Methods: A scoping review reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. A systematic search of Cochrane CENTRAL, Embase, MEDLINE and PEDro for studies of rehabilitation among patients 60 years and older with non-pathological pelvic fragility fracture, published up to May 2024. Single case studies were excluded. Screening and study selection were completed in duplicate by four independent reviewers. One reviewer completed extraction with accuracy checked by a second reviewer. A narrative synthesis approach was employed with text and tables.

Results: 17 studies reporting on rehabilitation after pelvic fragility fracture were identified. For 13 studies, descriptors were limited to mobilisation strategies with 9 citing unrestricted mobilisation as the first prescription. Three studies reporting multicomponent, multidisciplinary (physiotherapy-led), rehabilitation interventions across inpatient and community settings, incorporating exercise, psychological components, and education/advice were identified. 31 outcome domains were identified with key domains including pain, mobility, activities of daily living, quality of life, and mortality. There was an absence of consensus on which patient reported outcome instruments to use to measure relevant domains.

Conclusions: There is overall limited evidence to guide rehabilitation for older adults following fragility fracture of the pelvis. A standardised approach to rehabilitation should be designed which improves outcomes which matter most to those people affected.

Comments

Interesting poster, speaking as someone with now more than a decade of looking after pelvic fracture patients in a community rehab hospital, I would say there is no "one-size fits all" approach to rehabbing this patient group. What I've learnt to be the most important, is the feedback from your MDT colleagues, especially Physio, as to realistic goal setting and likely speed of progression of regaining mobility. I agree it would be useful to have a consensus model that dictated the average expectations, but so few of my patients are average!

Submitted by martyn.patel12 on

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Thank you for your comment; absolutely agree: no one size fits all. As an Occupational Therapist who works with this population group, holistic intervention is so important. I would like to see model that no only focus on performance (mobility) but also participation, engagement and identity which leans more to the quality of life of the individual which also in turn will hopefully have a positive impact on their mental health.