Counseling, quality of life, and acute postoperative pain in elderly patients with hip fracture Translating research into practice intervention improves management of acute pain in older hip fracture patients. Improving pain management after total joint replacement surgery. Orthopaedic management improves the rate of early osteoporosis treatment after hip fracture. A randomized clinical trial. Development and delivery of patient treatment in the Trondheim Hip Fracture Trial. A new geriatric in-hospital pathway for elderly patients with hip fracture A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. HipWatch: osteoporosis investigation and treatment after a hip fracture: a 6-month randomized controlled trial. Back to the future – feasibility of recruitment and retention to patient education and telephone follow-up after hip fracture: a pilot randomized controlled trial To evaluate the effectiveness of a discharge-planning programme for hip fracture patients. A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia--subgroup analyses of a randomized controlled trial. Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. Treatment and prevention of depression after surgery for hip fracture in older people: randomized, controlled trials. Effectiveness of a multidisciplinary team approach to hip fracture management. Randomized trial to improve fracture prevention in nursing home residents. Nursing care and management of the elderly hip fractured patient. Comprehensive and subacute care interventions improve health-related quality of life for older patients after surgery for hip fracture: a randomised controlled trial. Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture.
Introduction Hip fractures represent one of the most important causes of morbidity and mortality in elderly people . Anxiety and depression affect their quality of life and increase pain severity , and have adverse effects on functional recovery . Recent World Health Organization guidelines emphasize that therapeutic regimes need to be individualized and combined with psychological support . This study was launched with the primary endpoint of assessing if and to what extent client-centered therapy affects the perception of pain , reduces anxiety and depression , and increases the quality of life of elderly patients with hip fracture . Material s and methods Forty patients were admitted to the Orthopedic and Trauma Surgery ward for hip fracture . Patients were r and omly divided into two subgroups : ( 1 ) case ( group C ) , had to receive patient-centered counseling throughout the hospitalization ; and ( 2 ) control ( group NC ) , receiving the analgesic treatment without receiving counseling .  Short Form-36-item Health Survey Question naire , State – Trait Anxiety Inventory , and Hamilton Rating Scale for Depression scores were recorded before any treatment , at discharge , and after 30 days . Pain levels were evaluated by means of Visual Analog Scale every 12 hours during the hospitalization from the day of surgery until day 5 . Results The hierarchical clustering analysis identified before any treatment were two clusters based on different physical functioning perceptions and role limitations , which were due to physical and emotional problems . Counseling did have a positive impact on quality of life on all patients , but in a more relevant way if patients were low functioning upon admittance to the ward . Anxiety and depression decreased in patients undergoing counseling , and their pain levels were lower than among patients not receiving it . Conclusion This study reveals that hip fracture patients can be clustered on the basis of Short Form-36 baseline scores . Counseling affects the evolution of mental and physical status in these patients , and the major benefit is reported in patients whose quality of life perception is worse after the trauma . Decreasing anxiety and depression levels , as well as more satisfying pain management , assessed by means of specific tests , confirm the effectiveness of counseling in elderly patients with hip fracture OBJECTIVE To test an interdisciplinary , multifaceted , translating research into practice ( TRIP ) intervention to ( a ) promote adoption , by physicians and nurses , of evidence -based ( EB ) acute pain management practice s in hospitalized older adults , ( b ) decrease barriers to use of EB acute pain management practice s , and ( c ) decrease pain  intensity of older hospitalized adults . STUDY DESIGN Experimental design with the hospital as the unit of r and omization . STUDY SETTING Twelve acute care hospitals in the Midwest . DATA SOURCES ( a ) Medical records ( MRs ) of patients > or = 65 years or older with a hip fracture admitted before and following implementation of the TRIP intervention and ( b ) physicians and nurses who care for those patients . DATA COLLECTION Data were abstract ed from MRs and questions distributed to nurses and physicians . PRINCIPAL FINDINGS The Summative Index for Quality of Acute Pain Care ( 0 - 18 scale ) was significantly higher for the experimental ( 10.1 ) than comparison group ( 8.4 ) at the end of the TRIP implementation phase . At the end of the TRIP implementation phase , patients in the experimental group had a lower mean pain intensity rating than those in the comparison group ( p<.0001 ) . CONCLUSION The TRIP intervention improved quality of acute pain management of older adults hospitalized with a hip fracture PURPOSE To test the effects of implementing evidence -based postoperative pain management content and strategies on patient , provider ( nurse and physician ) , and fiscal outcomes . SAMPLE 118 patients , 57 before and 61 after implementation , having total knee replacement ( TKR ) ( 54 % ) and total hip replacement ( THR ) ( 45 % ) , and 28 orthopaedic nurses . METHODS A research utilization approach with a pretest/posttest design was used . Independent variables ( interventions ) included evidence -based pain management content , education of care providers and patients , and system changes at the point of care . Dependent variables ( outcomes ) were patient perception of the postoperative pain experience , provider practice patterns , and length of stay ( LOS ) . FINDINGS The hypotheses of decreased provider use of meperidine and increased use of hydromorphone , i.v . route , pain plans of care , and nurse knowledge were supported . LOS was significantly reduced . The patient hypotheses decreased pain intensity and side effects and increased satisfaction and function were not supported . CONCLUSION Method ical implementation of evidence -based pain management information changed practice and fiscal outcomes . Improvement in the patient perception of pain management was more difficult to achieve BACKGROUND Although osteoporosis is strongly associated with hip fractures , the initiation of osteoporosis treatment following hip fractures occurs at surprisingly low rates of between 5 % and 30 % . Currently , most patients receiving treatment have been referred back to their primary care physician for osteoporosis management . The purpose of this study was to compare the effect of osteoporosis management initiated by the orthopaedic team and osteoporosis management initiated by the primary care physician on the rates of treatment at six months . METHODS A prospect i ve r and omized trial was conducted to assess the difference in the rate of osteoporosis treatment  when an in-house assessment of osteoporosis was initiated by the orthopaedic surgeon and follow-up was conducted in a specialized orthopaedic osteoporosis clinic compared with osteoporosis education and " usual " care . RESULTS Sixty-two patients were enrolled in the study . Thirty-one patients each were in the control and intervention groups . The percentage of patients who were on pharmacologic treatment for osteoporosis  at six months after the fracture was significantly greater when the evaluation was initiated by the orthopaedic surgeon and was managed in a specialized orthopaedic osteoporosis clinic ( 58 % ) than when treatment was managed by a primary care physician ( 29 % ) ( p = 0.04 ) . CONCLUSIONS An active role by orthopaedic surgeons in the management of osteoporosis improves the rate of treatment at six months following a hip fracture Background Hip fractures are common among frail elderly persons and often have serious consequences on function , mobility and mortality . Traditional treatment of these patients is performed in orthopedic departments without additional geriatric assessment . However , studies have shown that interdisciplinary geriatric treatment may be beneficial compared to traditional treatment . The aim of the present study is to investigate whether treatment of these patients in a Department of Geriatrics ( DG ) during the entire hospital stay gives additional benefits as compared to conventional treatment in a Department of Orthopaedic Surgery ( DOS ) . Findings A new clinical pathway for in-hospital treatment of hip fracture patients was developed . In this pathway patients were treated pre- and postoperatively in DG .  Comprehensive geriatric assessment  was performed as an interdisciplinary , multidimensional , systematic assessment of all patients focusing on each patient ’s capabilities and limitations as recommended in guidelines and systematic review s. Identification and treatment of co-morbidities , pain relief , hydration , oxygenation , nutrition , elimination , prevention and management of delirium , assessment of falls and osteoporosis were emphasized .  Discharge planning  started as early as possible . Initiation of rehabilitation with focus on early mobilisation and development of individual plans was initiated in hospital and continued after discharge from hospital . Fracture specific treatment was based upon st and ard treatment for the hospital , expert opinions and a review of the literature . Conclusion A new treatment program for old hip fracture patients was developed , introduced and run in the DG , the potential benefits of which being compared with traditional care of hip fracture patients in the DOS in a r and omised clinical trial OBJECTIVES To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan . DESIGN R and omized experimental design . SETTING A 3,800-bed medical center in northern Taiwan . PARTICIPANTS Elderly patients with hip fracture ( N=137 ) were r and omly assigned to an experimental ( n=68 ) or control ( n=69 ) group . INTERVENTION An interdisciplinary program of geriatric consultation , continuous rehabilitation , and discharge planning . MEASUREMENTS Demographic and outcome variables were measured . Outcome variables included service utilization , clinical outcomes , self-care abilities , health-related quality -of-life ( HRQOL ) outcomes , and depressive symptoms . RESULTS Subjects in the experimental group improved significantly more than those in the control group in the following outcomes : ratio of hip flexion 1 month after discharge ( P=.02 ) , recovery of previous walking ability at 1 month ( P=.04 ) and 3 months ( P=.001 ) after discharge , and activities of daily living at 1 month ( P=.01 ) and 2 months ( P=.001 ) after discharge . Three months after discharge , the experimental group showed significant improvement in peak force of the fractured limb 's quadriceps ( P=.04 ) and the following health outcomes : bodily pain ( P=.03 ) , vitality ( P<.001 ) , mental health ( P=.02 ) , physical function ( P<.001 ) , and role physical ( P=.006 ) . They also had fewer depressive symptoms ( P=.008 ) 3 months after discharge . CONCLUSION This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes , self-care abilities , and HRQOL and by decreasing depressive symptoms within 3 months after discharge OBJECTIVE We aim ed to determine whether a novel Patient Empowerment and Physician Alerting ( PEPA ) intervention would improve the proportion of seniors who were investigated and treated for osteoporosis after hip fracture . METHODS We undertook a 6-month r and omized controlled trial ( RCT ) in 48 women and men > /= 60 years old who had suffered a hip fracture and were admitted to a tertiary-care university hospital . The primary outcome measure was the proportion of participants offered one or more osteoporosis-specific ' best practice s ' measured using the Diagnosis and Management Question naire ( DMQ ) . Participant responses were vali date d in part by physician report . RESULTS In the PEPA intervention group , 19 ( 68 % ) were offered one or more components of best practice care  compared with 7 ( 35 % ) in the ' usual care ' group ( p < .05 ) . In the PEPA group , 15 ( 54 % ) ( p < .01 ) were prescribed  bisphosphonate therapy  , 8 ( 29 % ) ( p < .01 ) had a bone mineral density scan , 11 ( 39 % ) were prescribed calcium and vitamin D ( p = .32 ) , and 9 ( 32 % ) ( p < .01 ) were prescribed exercise .  In the usual care group , 0 ( 0 % ) were prescribed  bisphosphonate therapy , a  bone mineral density assessment , or exercise  and 6 ( 30 % ) were prescribed calcium and vitamin D. CONCLUSIONS This simple , inexpensive PEPA intervention result ed in far superior clinical management than did usual care in a population at high risk of future hip fracture Objectives Our primary aim of this pilot study was to test feasibility of the planned design , the interventions ( education plus telephone coaching ) , and the outcome measures , and to facilitate a power calculation for a future r and omized controlled trial to improve adherence to recovery goals following hip fracture . Design This is a parallel 1:1 r and omized controlled feasibility study . Setting The study was conducted in a teaching hospital in Vancouver , BC , Canada . Participants Participants were community-dwelling adults over 60 years of age with a recent hip fracture . They were recruited and assessed in hospital , and then r and omized after hospital discharge to the intervention or control group by a web-based r and omization service . Treatment allocation was concealed to the investigators , measurement team , and data entry assistants and analysts . Participants and the research physiotherapist were aware of treatment allocation . Intervention Intervention included usual care for hip fracture plus a 1-hour in-hospital educational session using a patient-centered educational manual and four videos , and up to five postdischarge telephone calls from a physiotherapist to provide recovery coaching . The control group received usual care plus a 1-hour in-hospital educational session using the educational manual and videos . Measurement Our primary outcome was feasibility , specifically recruitment and retention of participants . We also collected selected health outcomes , including health-related quality of life ( EQ5D-5L ) , gait speed , and psychosocial factors ( ICEpop CAPability measure for Older people and the Hospital Anxiety and Depression Scale ) . Results Our pilot study results indicate that it is feasible to recruit , retain , and provide follow-up telephone coaching to older adults after hip fracture . We enrolled 30 older adults ( mean age 81.5 years ; range 61–97 years ) , representing a 42 % recruitment rate . Participants excluded were those who were not community dwelling on admission , were discharged to a residential care facility , had physician-diagnosed dementia , and /or had medical contraindications to participation . There were 27 participants who completed the study : eleven in the intervention group , 15 in the control group , and one participant completed a qualitative interview only . There were no differences between groups for health measures . Conclusion We highlight the feasibility of telephone coaching for older adults after hip fracture to improve adherence to mobility recovery goals AIMS AND OBJECTIVES This study aim ed to evaluate the effectiveness of a comprehensive discharge-planning service for hip fracture patients , including length of stay , functional status , self-care knowledge and quality of life ( QOL ) . BACKGROUND Hip fractures are the most devastating result of osteoporosis . Care of these patients from the moment they enter the hospital until discharge and postdischarge is a challenging task , requiring a coordinated approach by an interdisciplinary team . DESIGN An experimental design was used . Methods . Fifty hip fracture patients were recruited from a medical centre in Taipei , Taiwan and r and omly divided into two groups . The control group received routine discharge nursing care and the experimental group received comprehensive discharge planning . After patient admission , research ers assessed discharge-planning needs , provided discharge nursing instruction , coordinated services and determined discharge placement based on assessment results . RESULTS ( i ) Mean age of 50 hip fracture patients was 78.75 ( SD 6.99 ) years .  Mean length of stay was 6.04 ( SD 2.41 ) days for the experimental group and 6.29 ( SD 2.17 ) for the control group . Difference between groups was not significant ( t = -0.394 , p = 0.696 ) . ( ii ) The self-care knowledge of the experimental group was higher than that of the control group ( F = 11.569 , p = 0.001 ) . ( iii ) Significant improvements were observed in functional status of both groups at three months postdischarge , with no significant differences observed between groups . However , the functional status of experimental group patients showed a slightly better trend than that of the control group . ( iv ) At three months postdischarge , QOL of experimental group patients was better than control group patients . CONCLUSIONS A comprehensive discharge-planning service can improve hip fracture patients '  self-care knowledge and QOL . RELEVANCE TO CLINICAL PRACTICE Results of this study can be used clinical ly as a basis for practical implementation of discharge-planning services in fracture patients BACKGROUND People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery , about 30 - 50 % of all those who sustain a hip fracture have dementia . Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia . METHODS A r and omized controlled trial with subgroup analyses among patients with dementia . Sixty-four patients with femoral neck fracture , aged ≥70 years at Umeå University Hospital , Sweden . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications , especially delirium . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation , including a follow-up at 4 months postoperatively . The control group followed conventional postoperative routines . RESULTS There were fewer postoperative complications in the intervention group such as urinary tract infections , p=0.001 ; nutritional problems , p=0.025 ; postoperative delirium , p=0.002 ; falls , p=0.006 . At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance , p=0.005 . At 12 months a larger proportion in the intervention group had regained the activities of daily living ( ADL ) performance level they had before the fracture , p=0.027 . CONCLUSION This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs BACKGROUND Treatment of osteoporosis following a hip fracture has been notoriously poor . Many efforts have been made to improve treatment rates . The purpose of this study was to determine whether a perioperative inpatient intervention program , involving patient education and providing a list of questions for the primary care physician , increased the percentage of patients in whom osteoporosis was addressed following a hip fracture . METHODS A prospect i ve , r and omized trial involving eighty patients who had been admitted to an academic medical center with a low-energy hip fracture was conducted . During their hospitalization , the study group patients were engaged in a fifteen-minute discussion regarding the association between osteoporosis and hip fractures , the efficacy of dual-energy x-ray absorptiometry scans in the diagnosis of osteoporosis and of bisphosphonates in its treatment , and the importance of medical follow-up for osteoporosis management . These patients were also provided with five questions regarding osteoporosis treatment to be given to their primary medical physician , and they were reminded about the questions during a follow-up telephone call six weeks later . The patients in the control group received a brochure describing methods for preventing falls . Both groups were contacted by telephone at six months after discharge to determine whether osteoporosis had been addressed . Positive indicators of intervention included assessment of bone mineral density with dual-energy x-ray absorptiometry and initiation of antiresorptive therapy .  RESULTS The average age in each group was eighty-two years , and 78 % of the patients were female . Four patients in each group did not survive through the six-month follow-up period and were excluded from the trial . Fifteen ( 42 % ) of the thirty-six patients who had been r and omized to the study group , compared with only seven ( 19 % ) of the thirty-six patients in the control group , had their osteoporosis addressed by their primary physician . This difference between the groups was significant ( p = 0.036 ) . CONCLUSIONS Patients who were provided with information and questions for their primary care physician about osteoporosis were more likely to receive appropriate therapeutic intervention than were patients who had not received the information and questions . Orthopaedic surgeons have a unique opportunity to improve the rate of osteoporosis treatment in the perioperative period following a hip fracture by educating patients and directing them toward channels for long-term osteoporosis management OBJECTIVES To evaluate the effect of a psychiatric intervention in treating depression ( treatment study ) and the effect of a psychological treatment in preventing depression ( prevention study ) after hip fracture in older people . DESIGN Two linked r and omized , controlled trials . SETTING Orthopedic units in Manchester , Engl and . PARTICIPANTS Two hundred ninety-three older people who had undergone surgery for a fractured hip : 121 in the treatment study and 172 in the prevention study . MEASUREMENTS The Geriatric Depression Scale and Hospital Anxiety and Depression Scale for mood , functional tests for mobility and pain measures . RESULTS There was a slight reduction in depressive symptoms in the active arm of the treatment study . In the prevention study , there was no significant difference in incident depression between the psychological intervention and treatment as usual . There were no differences in the functional and pain outcomes . CONCLUSION The results from these two r and omized , controlled trials show that , after hip fracture surgery , no statistically significant benefits can be achieved from a psychiatric intervention in people who are depressed or a psychological intervention to prevent the onset of depression The purpose of the current study was to evaluate the effectiveness of a multidisciplinary Hip Fracture Service in the treatment of hip fractures in elderly patients . Baseline information and hospital outcomes were compared for 510 patients over the age of 65 with hip fracture treated before and after the institution of the Hip Fracture Service .  Data included basic demographic data , admission laboratory results , surgical information , number of comorbidities , mortality , medical complications , discharge information , time to surgery , and length of stay in hospital . The demographics of the two groups of patients were similar . Patients treated as part of the Hip Fracture Service had fewer medical complications ( 36 % vs. 51 % ) , more often had surgery within 24 hours ( 63 % vs. 35 % ) , and had shorter hospital stays ( mean , 5.7 days vs. 8.1 days ) than patients treated before the Hip Fracture Service . These findings provide the rationale for a prospect i ve , r and omized trial of the service BACKGROUND Interventions to improve the fracture prevention in nursing homes are needed . METHODS Cluster-r and omized , single-blind , controlled trial of a multi-modal quality improvement intervention .  Nursing homes ( n=67 ) with > or = 10 residents with a diagnosis of osteoporosis or recent hip fracture ( n=606 ) were r and omized to receive an early or delayed intervention consisting of audit and feedback , educational modules , teleconferences , and academic detailing . Medical record abstract ion and the Minimum Data Set were used to measure the prescription of osteoporosis therapies before and after the intervention period . Analysis was at the facility-level and Generalized Estimating Equation modeling was used to account for clustering . RESULTS No significant improvements were observed in any of the quality indicators . The use of osteoporosis pharmacotherapy or hip protectors improved by 8.0 % in the intervention group and 0.6 % in the control group , but the difference was not statistically significant ( P=.72 ) . Participation in the intervention activities was low , but completion of the educational module ( odds ratio [ OR ] 4.8 , 95 % confidence interval [ CI ] , 1.9 - 12.0 ) and direct physician contact by an academic detailer ( OR 4.5 , 95 % CI , 1.1 - 18.2 ) were significantly associated with prescription of osteoporosis pharmacotherapy or hip protectors in multivariable models . CONCLUSIONS Audit-feedback and education interventions were ineffective in improving fracture prevention in the nursing home setting , although results may have been tempered by low participation in the intervention activities 1 . This study examined the effects of a geriatric orthopaedic nursing education program of care for the elderly hip fractured patient on select patient outcomes using a post-test nonequivalent control group design . 2 . Nursing staff of a 26-bed orthopaedic unit attended a day long education workshop focusing on common clinical problems the elderly patient experiences in the acute care setting . 3 . This program provided nursing staff with sound knowledge for the provision of effective care to the acutely ill elderly patient , which result ed in improved patient outcomes and use of health care re sources BACKGROUND Elderly patients with hip fracture have been found to benefit from subacute care interventions that usually comprise usual care with added geriatric intervention , early rehabilitation , and supported discharge . However , no studies were found on the effects of combining subacute care and health-maintenance interventions on health outcomes for elders with hip fracture . OBJECTIVES To compare the effects of an interdisciplinary comprehensive care programme with those of subacute care and usual care programmes on health-related quality of life ( HRQoL ) for elderly patients with hip fracture . DESIGN R and omised controlled trial . SETTING S A 3000-bed medical centre in northern Taiwan . PARTICIPANTS Patients with hip fracture ( N=299 ) were r and omised into three groups : subacute care ( n=101 ) , comprehensive care ( n=99 ) , and usual care ( n=99 ) . METHODS Subacute care included geriatric consultation , continuous rehabilitation , and discharge planning . Comprehensive care consisted of subacute care plus health-maintenance interventions to manage depressive symptoms , manage malnutrition , and prevent falls . Usual care included only 1 - 2 in-hospital rehabilitation sessions , discharge planning without environmental assessment , no geriatric consultation , and no in-home rehabilitation .  HRQoL was measured using the Medical Outcomes Study Short-Form 36 Taiwan version at 1 , 3 , 6 , and 12 months after discharge . RESULTS Participants in the comprehensive care group improved more in physical function , role physical , general health and mental health than those in the usual care group . The subacute care group had greater improvement in physical function , role physical , vitality , and social function than the usual care group . The intervention effects for both comprehensive and subacute care increased over time , specifically from 6 months after hip fracture onward , and reached a maximum at 12 months following discharge . CONCLUSIONS Both comprehensive care and subacute care programmes may improve health outcomes of elders with hip fracture . Our results may provide a reference for health care providers in countries using similar programmes with Chinese/Taiwanese immigrant population BACKGROUND Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation , depression management , and fall prevention in older persons with hip fracture . The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture . METHODS A r and omized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models : interdisciplinary care ( n = 101 ) , comprehensive care ( n = 99 ) , and usual care ( n = 99 ) .  Interdisciplinary care included geriatric consultation , continuous rehabilitation , and discharge planning with post-hospital services . Comprehensive care consisted of interdisciplinary care plus nutrition consultation , depression management , and fall prevention . Usual care included only in-hospital rehabilitation without geriatric consultation , in-home rehabilitation , and home environmental assessment . RESULTS Participants in the comprehensive care group had better self-care ability ( odds ratio , OR = 3.19 , p < .01 ) and less risk of depression ( OR = 0.48 , p < .01 ) than those who received usual care . The comprehensive care group had less risk of depression ( OR = 0.51 , p < .05 ) and of malnutrition ( OR = 0.48 , p < .05 ) than the interdisciplinary care group during the first year following discharge . Older persons with hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care . CONCLUSIONS Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation , depression management , and fall prevention than simply interdisciplinary care
Overall , moderate evidence suggests that nerve blockades are effective for relieving acute pain and reducing delirium .
Low-level evidence suggests that preoperative traction does not reduce acute pain .
Nerve blockade seems to be effective in reducing acute pain after hip fracture .
Sparse data preclude firm conclusions about the relative benefits or harms of many other pain management interventions for patients with hip fracture .
BACKGROUND  Pain management  is integral to the management of hip fracture .
PURPOSE To review the benefits and harms of pharmacologic and nonpharmacologic interventions for managing pain  after hip fracture .