Poster Presentation 29th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2019

Effect of Clinical Care Pathways on Health-Related Quality of Life and Physical Function Following Fragility Fracture: A Meta-Analysis (#125)

Jason Talevski 1 , Kerrie Sanders 1 , Catherine Connaughton 2 , Gustavo Duque 1 , Alison Beauchamp 1 , Darci Green 1 , Lynne Millar 1 , Sharon Brennan-Olsen 1
  1. Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, St Albans, VIC, Australia
  2. Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia

Objectives: This meta-analysis aimed to evaluate the effect of clinical care pathways (CCPs) on health-related quality of life (HRQoL) and physical function following fragility fracture of the most common sites –hip, wrist, vertebrae and humerus.

Methods: We searched 4 online databases for all published studies that involved participants aged >50 years who sustained a fragility fracture; evaluated the effects of a CCP compared to usual post-fracture care; and reported outcomes of HRQoL or physical function.

Results: 22 studies (17 randomized controlled trials, 5 non-randomized studies) were included comprising 5,842 participants. 21 studies included hip fracture patients, and one included wrist fracture patients. 82% of studies were assessed as high quality. Meta-analyses showed moderate improvements in the CCP group for HRQoL [standardized mean difference (SMD)=0.24; 95% CI, 0.12-0.35; n=10 studies] and physical function (SMD=0.21; 95% CI, 0.10-0.33; n=15 studies) compared with usual care. Sensitivity analyses by study design showed no difference in effects. 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. CCPs with >5 components showed greater improvements in HRQoL (SMD=0.32; 95% CI, 0.22-0.43; n=5 studies) and physical function (SMD=0.21; 95% CI, 0.06-0.36; n=10 studies) compared to CCPs with <5 components.

Conclusions: Meta-analysis by fracture type was not possible due to lack of non-hip fracture studies. Following fragility fracture, CCPs 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, and to evaluate the effects of CCPs in patients with non-hip fractures.