Objectives Orthopaedic surgery is primarily aimed at improving function and pain reduction. Additional integrated care may enhance patient’s participation in sports and work, possibly improving performance of physical activities and quality of life (QoL). We aimed to assess the effectiveness of integrated care among orthopaedic surgery patients.
Design Systematic review with meta-analysis.
Data source Medline, EMBASE and CINAHL (until 17 June 2019).
Eligibility for selecting studies We searched for controlled studies on integrated care interventions consisting of active referral to case managers, rehabilitation with participation-based goals and/or e/mHealth, with outcomes of sports and work participation, performance of physical activities and/or QoL. Outcomes were normalised to 0–100 scales and statistically pooled.
Results Seventeen articles (n=2494) of moderate quality were included reporting on patients receiving back, upper limb, knee or hip surgery. Only one study reported on return to sports and found no significant benefit. For return to work, one study did (90% vs 82%) and one did not (relative risk=1.18 (0.80 to 1.70)) observe significant benefits. Integrated care showed small effects for improving performance of physical activities (2.69 (–0.20 to 5.58); eight studies, n=1267) and QoL (2.62 (1.16 to 5.05); nine studies, n=1158) compared with usual care.
Summary/Conclusion We found insufficient and inconsistent evidence for the effectiveness of integrated care for orthopaedic surgery patients regarding sport and work participation. Small effects were found for performance of physical activities and QoL. High quality research on integrated care focusing on sports and work participation is needed before integrated care can be implemented for orthopaedic surgery patients.
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Contributors JD designed the electronic database search. PC, PK and GH conducted literature screening and data extraction of all included papers. PC analysed the data. All authors (PC, GH, JD, RvG, GK, MvT, JH, JA and PK) analysed the data and reviewed the manuscript for important intellectual content. PK is the study guarantor.
Funding The study has partly been funded by the Amsterdam Public Health Research Institute as well as by The Netherlands Organisation for Health Research and Development, ZonMW (grant number 852001929).
Competing interests JA intends to set up a spin-off company concerning the implementation of a mobile application concerning the IkHerstel intervention in the Netherlands, holds a chair in Insurance Medicine paid by the Dutch Social Security Agency Is stockholder of Evalua Received grants from ZonMw/NWO, Instituut Gak, UWV, SZW, VWS, Pfizer, Achmea, CVZ/Zorg Instituut outside the submitted work. All other authors declare no conflicts of interests, financial of other.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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