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The Impact of Cognitive Impairment on Rehabilitation Outcomes in Elderly Patients Admitted with a Femoral Neck Fracture: A Systematic Review

Objective: To evaluate the evidence of rehabilitation outcomes after the surgical repair of a hip fracture in older people with cognitive impairment. Design: Systematic review. Methods: Searches were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials Register), ProQuest Dissertations, and Theses Database and bibliographies of extracted publications in the English language between 1990 and June 2007. Search terms included: dementia/Alzheimer disease/cognitive impairment, hip fracture, rehabilitation, outcome assessment/treatment outcome. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale, of the extracted articles. Only studies evaluating rehabilitation outcomes with data analysis specific for cognitive status were evaluated. Sackett's levels of evidence were used to summarize the main findings. Findings: Eleven studies met the inclusion criteria. Methodological quality of the studies ranged from fair to poor. The generalizability of study findings was limited by multiple rehabilitation settings in the acute and subacute phase postsurgery, multiple methods with varying thresholds for determining cognitive impairment and multiple functional outcome scales. Conclusion: There is some evidence that older adults with cognitive impairment who receive intensive inpatient rehabilitation after surgical repair of a hip fracture may be able to gain comparable benefit in physical function as cognitively intact patients. There is not enough information to guide recommendations of specific physical therapy interventions to optimize outcomes in this patient population. Further work is needed.