Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis
Objectives: To evaluate the effect of clinical care pathways (CCPs) on health-related quality of life (HRQoL) and physical function following fragility fracture and identify the specific characteristics of CCPs that are associated with improved outcomes. Design Systematic review and meta-analys...
| Main Authors: | , , , , , , , |
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| Format: | Journal Article |
| Published: |
Elsevier
2019
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1151089 http://hdl.handle.net/20.500.11937/81106 |
| _version_ | 1848764315829534720 |
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| author | Talevski, J. Sanders, K.M. Duque, G. Connaughton, C. Beauchamp, A. Green, D. Millar, Lynne Brennan-Olsen, S.L. |
| author_facet | Talevski, J. Sanders, K.M. Duque, G. Connaughton, C. Beauchamp, A. Green, D. Millar, Lynne Brennan-Olsen, S.L. |
| author_sort | Talevski, J. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Objectives:
To evaluate the effect of clinical care pathways (CCPs) on health-related quality of life (HRQoL) and physical function following fragility fracture and identify the specific characteristics of CCPs that are associated with improved outcomes.
Design
Systematic review and meta-analysis.
Setting and participants:
Randomized controlled studies and nonrandomized studies that involved participants aged ≥50 years who sustained a fragility fracture, evaluated the effects of a CCP compared to usual care, and reported outcomes of HRQoL or physical function.
Methods:
We systematically searched Ovid Medline, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials from the earliest records to July 25, 2018. Two reviewers independently extracted study data and assessed methodologic quality.
Results:
Overall, 22 studies (17 randomized controlled trials, 5 nonrandomized studies) were included, comprising 5842 participants. Twenty-one studies included hip fracture patients, and 1 included wrist fracture patients. Majority of studies (82%) were assessed as high quality. Meta-analyses showed moderate improvements in the CCP group for HRQoL [standardized mean difference (SMD) = 0.24, 95% confidence interval (CI) 0.12, 0.35] and physical function (SMD 0.21, 95% CI 0.10, 0.33) compared with usual care post hip fracture. Inpatient CCPs that extended to the outpatient setting showed greater improvements in HRQoL and physical function compared to CCPs that were only inpatient or outpatient. CCPs that included a care coordinator, geriatric assessment, rehabilitation, prevention of inpatient complications, nutritional advice, or discharge planning also showed greater improvements in outcomes.
Conclusions and Implications
Treatment with CCPs following fragility fracture showed greater improvements in HRQoL and physical function compared with usual care. Further research is warranted to assess the combination of CCP components that provide the most beneficial results, evaluate the effect of CCPs in patients with nonhip fractures, and determine which patient groups are more likely to benefit from CCPs. |
| first_indexed | 2025-11-14T11:17:25Z |
| format | Journal Article |
| id | curtin-20.500.11937-81106 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T11:17:25Z |
| publishDate | 2019 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-811062021-01-15T06:58:29Z Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis Talevski, J. Sanders, K.M. Duque, G. Connaughton, C. Beauchamp, A. Green, D. Millar, Lynne Brennan-Olsen, S.L. Objectives: To evaluate the effect of clinical care pathways (CCPs) on health-related quality of life (HRQoL) and physical function following fragility fracture and identify the specific characteristics of CCPs that are associated with improved outcomes. Design Systematic review and meta-analysis. Setting and participants: Randomized controlled studies and nonrandomized studies that involved participants aged ≥50 years who sustained a fragility fracture, evaluated the effects of a CCP compared to usual care, and reported outcomes of HRQoL or physical function. Methods: We systematically searched Ovid Medline, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials from the earliest records to July 25, 2018. Two reviewers independently extracted study data and assessed methodologic quality. Results: Overall, 22 studies (17 randomized controlled trials, 5 nonrandomized studies) were included, comprising 5842 participants. Twenty-one studies included hip fracture patients, and 1 included wrist fracture patients. Majority of studies (82%) were assessed as high quality. Meta-analyses showed moderate improvements in the CCP group for HRQoL [standardized mean difference (SMD) = 0.24, 95% confidence interval (CI) 0.12, 0.35] and physical function (SMD 0.21, 95% CI 0.10, 0.33) compared with usual care post hip fracture. Inpatient CCPs that extended to the outpatient setting showed greater improvements in HRQoL and physical function compared to CCPs that were only inpatient or outpatient. CCPs that included a care coordinator, geriatric assessment, rehabilitation, prevention of inpatient complications, nutritional advice, or discharge planning also showed greater improvements in outcomes. Conclusions and Implications Treatment with CCPs following fragility fracture showed greater improvements in HRQoL and physical function compared with usual care. Further research is warranted to assess the combination of CCP components that provide the most beneficial results, evaluate the effect of CCPs in patients with nonhip fractures, and determine which patient groups are more likely to benefit from CCPs. 2019 Journal Article http://hdl.handle.net/20.500.11937/81106 10.1016/j.jamda.2019.02.022 http://purl.org/au-research/grants/nhmrc/1151089 http://purl.org/au-research/grants/nhmrc/1150745 http://purl.org/au-research/grants/nhmrc/1107510 Elsevier restricted |
| spellingShingle | Talevski, J. Sanders, K.M. Duque, G. Connaughton, C. Beauchamp, A. Green, D. Millar, Lynne Brennan-Olsen, S.L. Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis |
| title | Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis |
| title_full | Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis |
| title_fullStr | Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis |
| title_full_unstemmed | Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis |
| title_short | Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis |
| title_sort | effect of clinical care pathways on quality of life and physical function after fragility fracture: a meta-analysis |
| url | http://purl.org/au-research/grants/nhmrc/1151089 http://purl.org/au-research/grants/nhmrc/1151089 http://purl.org/au-research/grants/nhmrc/1151089 http://hdl.handle.net/20.500.11937/81106 |