A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes
Aims: Performance indicators are increasingly used to evaluate the quality of healthcare provided to patients following a hip fracture. In this systematic review, we investigated the association between ‘early mobilization’ after surgery and patient outcomes. Methods: Evidence was searched through 1...
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The British Editorial Society of Bone & Joint Surgery
2025-07-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.67.BJO-2024-0243.R1 |
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| author | Veena Mazarello Paes Andrew Ting James Masters Mahalia V. I. Paes Simon Mathew Graham Matthew L. Costa On behalf of the HIPCARE investigators* |
| author_facet | Veena Mazarello Paes Andrew Ting James Masters Mahalia V. I. Paes Simon Mathew Graham Matthew L. Costa On behalf of the HIPCARE investigators* |
| author_sort | Veena Mazarello Paes |
| collection | DOAJ |
| description | Aims: Performance indicators are increasingly used to evaluate the quality of healthcare provided to patients following a hip fracture. In this systematic review, we investigated the association between ‘early mobilization’ after surgery and patient outcomes. Methods: Evidence was searched through 12 electronic databases and other sources. The methodological quality of studies meeting the inclusion criteria was assessed. The protocol for this suite of related systematic reviews was registered at PROSPERO: ID = CRD42023417515. Results: A total of 24,507 articles were reviewed, and 20 studies met the inclusion criteria for the review, involving a total of 317,173 patients aged over 60 years with a hip fracture. There were two randomized clinical trials, five prospective studies, and 13 retrospective cohort studies, conducted between January 1981 and June 2022. All but two studies came from high-income healthcare systems. The definition of early mobilization varied across studies and health systems; and weightbearing status was often not reported or ambiguously defined, making formal meta-analysis of the data impossible. Early mobilization (within 48 hours of surgery) was associated with improved outcomes in 29 of the 33 patient-reported outcomes, including improved mobility scores and improved assessments of daily activities of living. A total of 45 out of 51 clinical outcomes derived from hospital records showed a positive association with early mobilization, including reduced rates of postoperative complications, reduced length of acute hospital stay, and lower mortality. Conclusion: Early mobilization after surgery for hip fracture in older people is associated with improved patient-reported outcomes and reduced length of hospital stay. Standardization of the definition of early mobilization and consistent reporting of weightbearing status would improve future evidence synthesis. Cite this article: Bone Jt Open 2025;6(7):741–747. |
| format | Article |
| id | doaj-art-c4888621e0ef4ff6a5fe31ff86ac9b30 |
| institution | DOAJ |
| issn | 2633-1462 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj-art-c4888621e0ef4ff6a5fe31ff86ac9b302025-08-20T02:46:24ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622025-07-016774174710.1302/2633-1462.67.BJO-2024-0243.R1A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomesVeena Mazarello Paes0Andrew Ting1James Masters2Mahalia V. I. Paes3Simon Mathew Graham4Matthew L. Costa5On behalf of the HIPCARE investigators*Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKOxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKOxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKQueen Mary University of London, London, UKOxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKOxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKAims: Performance indicators are increasingly used to evaluate the quality of healthcare provided to patients following a hip fracture. In this systematic review, we investigated the association between ‘early mobilization’ after surgery and patient outcomes. Methods: Evidence was searched through 12 electronic databases and other sources. The methodological quality of studies meeting the inclusion criteria was assessed. The protocol for this suite of related systematic reviews was registered at PROSPERO: ID = CRD42023417515. Results: A total of 24,507 articles were reviewed, and 20 studies met the inclusion criteria for the review, involving a total of 317,173 patients aged over 60 years with a hip fracture. There were two randomized clinical trials, five prospective studies, and 13 retrospective cohort studies, conducted between January 1981 and June 2022. All but two studies came from high-income healthcare systems. The definition of early mobilization varied across studies and health systems; and weightbearing status was often not reported or ambiguously defined, making formal meta-analysis of the data impossible. Early mobilization (within 48 hours of surgery) was associated with improved outcomes in 29 of the 33 patient-reported outcomes, including improved mobility scores and improved assessments of daily activities of living. A total of 45 out of 51 clinical outcomes derived from hospital records showed a positive association with early mobilization, including reduced rates of postoperative complications, reduced length of acute hospital stay, and lower mortality. Conclusion: Early mobilization after surgery for hip fracture in older people is associated with improved patient-reported outcomes and reduced length of hospital stay. Standardization of the definition of early mobilization and consistent reporting of weightbearing status would improve future evidence synthesis. Cite this article: Bone Jt Open 2025;6(7):741–747.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.67.BJO-2024-0243.R1performance indicatorsquality standardship fracturefragility fractureearly mobilizationweightbearing statussystematic reviewtraumahip fracture surgeryhip fracturepatient-reported outcomesrandomized clinical trialsclinical outcomesretrospective cohort studiespostoperative complicationsprospective studiesdeep vein thrombosis12-item short form survey (sf-12) |
| spellingShingle | Veena Mazarello Paes Andrew Ting James Masters Mahalia V. I. Paes Simon Mathew Graham Matthew L. Costa On behalf of the HIPCARE investigators* A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes Bone & Joint Open performance indicators quality standards hip fracture fragility fracture early mobilization weightbearing status systematic review trauma hip fracture surgery hip fracture patient-reported outcomes randomized clinical trials clinical outcomes retrospective cohort studies postoperative complications prospective studies deep vein thrombosis 12-item short form survey (sf-12) |
| title | A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes |
| title_full | A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes |
| title_fullStr | A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes |
| title_full_unstemmed | A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes |
| title_short | A systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes |
| title_sort | systematic review of evidence regarding the association between time to mobilization following hip fracture surgery and patient outcomes |
| topic | performance indicators quality standards hip fracture fragility fracture early mobilization weightbearing status systematic review trauma hip fracture surgery hip fracture patient-reported outcomes randomized clinical trials clinical outcomes retrospective cohort studies postoperative complications prospective studies deep vein thrombosis 12-item short form survey (sf-12) |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.67.BJO-2024-0243.R1 |
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