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    Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis

    Access Status
    Fulltext not available
    Authors
    Talevski, J.
    Sanders, K.M.
    Duque, G.
    Connaughton, C.
    Beauchamp, A.
    Green, D.
    Millar, Lynne
    Brennan-Olsen, S.L.
    Date
    2019
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Talevski, J. and Sanders, K.M. and Duque, G. and Connaughton, C. and Beauchamp, A. and Green, D. and Millar, L. et al. 2019. Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis. Journal of the American Medical Directors Association. 20 (7): pp. 926.e1-926.e11.
    Source Title
    Journal of the American Medical Directors Association
    DOI
    10.1016/j.jamda.2019.02.022
    ISSN
    1525-8610
    Faculty
    Faculty of Health Sciences
    School
    School of Public Health
    Funding and Sponsorship
    http://purl.org/au-research/grants/nhmrc/1151089
    http://purl.org/au-research/grants/nhmrc/1150745
    http://purl.org/au-research/grants/nhmrc/1107510
    URI
    http://hdl.handle.net/20.500.11937/81106
    Collection
    • Curtin Research Publications
    Abstract

    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.

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