The effectiveness and cost-effectiveness of clinical fracture-risk assessment tools in reducing future osteoporotic fractures among older adults: a structured scoping review.

This scoping review described the use, effectiveness, and cost-effectiveness of clinical fracture-risk assessment tools to prevent future osteoporotic fractures among older adults. Results show that the screening was not superior in preventing all osteoporosis-related fractures to usual care. However, it positively influenced participants' perspectives on osteoporosis, may have reduced hip fractures, and seemed cost-effective. PURPOSE: We aim to provide a synopsis of the evidence about the use of clinical fracture-risk assessment tools to influence health outcomes, including reducing future osteoporotic fractures and their cost-effectiveness. METHODS: We followed the guidelines of Arksey and O'Malley and their modifications. A comprehensive search strategy was created to search CINAHL, Medline, and Embase databases until June 29, 2021, with no restrictions. We critically appraised the quality of all included studies. RESULTS: Fourteen studies were included in the review after screening 2484 titles and 68 full-text articles. Four randomized controlled trials investigated the effectiveness of clinical fracture-risk assessment tools in reducing all fractures among older women. Using those assessment tools did not show a statistically significant reduction in osteoporotic fracture risk compared to usual care; however, additional analyses of two of these trials showed a trend toward reducing hip fractures, and the results might be clinically significant. Four studies tested the impact of screening programs on other health outcomes, and participants reported positive results. Eight simulation studies estimated the cost-effectiveness of using these tools to screen for fractures, with the majority showing significant potential savings. CONCLUSION: According to the available evidence to date, using clinical fracture-risk assessment screening tools was not more effective than usual care in preventing all osteoporosis-related fractures. However, using those screening tools positively influenced women's perspectives on osteoporosis, may have reduced hip fracture risk, and could potentially be cost-effective. This is a relatively new research area where additional studies are needed.

Understanding the relationship between psychological factors and important health outcomes in older adults with hip fracture: A structured scoping review.

BACKGROUND: Recovery after hip fractures is often poor despite successful surgeries and rehabilitation programs, which suggests factors beyond the physical might be at play. The purpose of this study was to provide an overview of existing literature on the role of psychological factors in older adults' recovery after hip fracture. METHODS: A scoping review directed by the modified guidelines of Arksey and O'Malley was carried out to systematically search the peer-reviewed literature until Dec 2020. Included studies with original data examined the role of psychological factors in recovery after hip fracture. Recovery outcomes included any important health outcome and categorized into three supgroups (mortality, functional, and other outcomes). Studies comprising individuals not living in the community or <65 years of age were excluded. RESULTS: The initial search found 7883 articles. After duplicates were removed, 6798 were screened based on title and abstract, and the full text of 235 articles was assessed for eligibility. Fifty-five articles were eventually included. Overall, the influence of psychological factors on hip fracture recovery varies by the factors under study (e.g., depression, anxiety) and the outcome of interest (e.g., physical functioning, mortality). The main psychological factor studied was depression (examined in 49 articles). Depression seems to impede recovery after hip fracture, especially with moderate-to-severe symptoms or when co-occurring with other psychological or cognitive factors. CONCLUSION: Many psychological factors exist among older adults with hip fractures that play a role in recovery. Health systems may implement early screening to recognize and prevent psychological factors from contributing to sub-optimal recovery and mortality.

A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults.

OBJECTIVE: Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF. METHODS: Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis. RESULTS: Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). CONCLUSION: This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. IMPACT: These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.