Comparative Effectiveness Review Number 30 Pain Management Interventions for Hip Fracture Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Comparative Effectiveness Review Number 30 Pain Management Interventions for Hip Fracture Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-02-0023 Prepared by: University of Alberta Evidence-based Practice Center Edmonton, Alberta, Canada Research Team: Ahmed M. Abou-Setta, M.D., Ph.D. Lauren A. Beaupre, P.T., Ph.D. C. Allyson Jones, P.T., Ph.D. Saifee Rashiq, MB, MSc, FRCPC Michele P. Hamm, M.Sc. Cheryl A. Sadowski, B.Sc.(Pharm), Pharm.D. Matthew R.G. Menon, MD, F.R.C.S.C., M.H.Sc. Sumit R. Majumdar, M.D., M.P.H. Donna M. Wilson, R.N., Ph.D. Mohammad Karkhaneh, M.D., Ph.D. (Candidate) Kai Wong, M.Sc. Shima S. Mousavi, M.D. Lisa Tjosvold, M.L.I.S. Donna M. Dryden, Ph.D. AHRQ Publication No. 11-EHC022-EF May 2011 Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. This report is based on research conducted by the University of Alberta Evidence-based Practice Center (UAEPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0023). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement toos, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products or actions may not be stated or implied. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. The investigators have no relevant financial interests in the report. The investigators have no employment, consultancies, honoraria, or stock ownership or options, or royalties from any organization or entity with a financial interest or financial conflict with the subject matter discussed in the report. Suggested citation: Abou-Setta AM, Beaupre LA, Jones CA, Rashiq S, Hamm MP, Sadowski CA, Menon MR, Majumdar SR, Wilson MD, Karkhaneh M, Wong K, Mousavi SS, Tjosvold L, Dryden DM. Pain Management Interventions for Hip Fracture. Comparative Effectiveness Review No. 30. (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-02-0023.) AHRQ Publication No. 11-EHC022-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2011. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm. Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Preface The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to organize knowledge and make it available to inform decisions about health care. As part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress directed AHRQ to conduct and support research on the comparative outcomes, clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services to meet the needs of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). AHRQ has an established network of Evidence-based Practice Centers (EPCs) that produce Evidence Reports/Technology Assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care. The EPCs now lend their expertise to the Effective Health Care Program by conducting Comparative Effectiveness Reviews (CERs) of medications, devices, and other relevant interventions, including strategies for how these items and services can best be organized, managed, and delivered. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews are useful because they define the strengths and limits of the evidence, clarifying whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about systematic reviews, see http://effectivehealthcare.ahrq.gov/reference/purpose.cfm. AHRQ expects that CERs will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. In addition, AHRQ is committed to presenting information in different formats so that consumers who make decisions about their own and their family’s health can benefit from the evidence. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an e-mail list to learn about new program products and opportunities for input. Comparative Effectiveness Reviews will be updated regularly. We welcome comments on this CER. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by e-mail to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. CAPT Karen Lohmann Siegel, P.T., M.A. Director Task Order Officer Evidence-based Practice Program Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Acknowledgments We are grateful to members of the technical expert panel, Dr. Paul Arnstein (Massacheusetts General Hospital, MA), Dr. Mohit Bhandari (McMaster University, ON), Dr. Cary Brown (University of Alberta and Glenrose Hospital, AB), Dr. Jeffrey Fudin (Albany College of Pharmacy & Health Sciences, NY), Dr. Jay Magaziner (University of Maryland Medical Center, MD), Dr. Kathleen Mangione (Arcadia University, PA), Dr. R. Sean Morrison (Mount Sinai School of Medicine, NY), and Dr. Richard Rosenquist (Anesthesia Pain Clinic, IA) who provided direction for the scope and content of the review. The authors gratefully acknowledge the following individuals for their contributions to this project: Ms. Annabritt Chisholm (article retrieval), Ms. Teodora Radisic (article retrieval), Mr. Ben Vandermeer (data analysis), Ms. Andrea Milne (literature searching), Ms. Amy Beaith (literature searching), Ms. Carol Spooner (data verification), Dr. Lisa Hartling (French translation), Ms. Jennifer Seida (German translation), Dr. Susan Armijo-Olivo (Spanish translation), and Dr. Liliane Zorzela (Portuguese, Spanish translation). Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Pain Management Interventions for Hip Fracture Structured Abstract Objectives. To review and synthesize the evidence on pain management interventions in nonpathological hip fracture patients following low-energy trauma. Outcomes include pain management (short and long term), mortality, functional status, pain medication use, mental status, health-related quality of life, quality of sleep, ability to participate in rehabilitation, return to pre-fracture living arrangements, health services utilization, and adverse effects. Data Sources. Comprehensive literature searches were conducted in 25 electronic databases from 1990 to present. Searches of the grey literature, trial registries, and reference lists of previous systematic reviews and included studies were conducted to identify additional studies. Methods. Study selection, quality assessment, data extraction, and grading of the evidence were conducted independently and in duplicate. Discrepancies were resolved by consensus or third- party adjudication. Meta-analyses were conducted where data were available and deemed appropriate. Results. In total, 83 studies were included (69 trials, 14 cohort studies). Most participants were females older than 75 with no cognitive impairment. The methodological quality of cohort studies was generally moderate; most trials were at high or unclear risk of bias. Included studies were grouped into eight intervention categories: systemic analgesia, anesthesia, complementary and alternative