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Background: Musculoskeletal trauma at midlife and beyond imposes significant impact on function and quality of life: Rehabilitation is key to support early and sustained recovery. There are frequent barriers to attending in-person rehabilitation that may be overcome by the recent advances in technology (telerehabilitation). Therefore, we conducted a systematic review of published evidence on telerehabilitation as a delivery mode for adults and older adults with musculoskeletal trauma. Methods: We followed established guidelines for conducting and reporting systematic reviews. We searched the following databases up to June 23, 2018: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, Google Scholar, MEDLINE (Ovid and PubMed), PsycINFO, and SportDiscus. We included publications across all available years and languages for community-dwelling adults (50 years and older) with musculoskeletal trauma; and interventions using the following delivery modes: Apps, computer, telephone, videophone, videoconference, webcam, webpage, or similar media. Results: Six studies met the inclusion criteria: Five studies for hip fracture (n = 260) and one study for proximal humeral fracture rehabilitation (n = 17). Four of the studies used telephone as the delivery mode, one used computer and another used video-conferencing. Two of the studies were pre-post with no comparator group, and the remaining four studies were randomized controlled trials with low or unclear risk of bias. Studies established some modes of remote delivery as feasible, but the generalizability of the findings were limited. Two studies observed significant between-group differences (favoring the intervention) for physical activity, quality of life, and self-efficacy. Conclusion: Very few studies exist that tested the effect of telerehabilitation for recovery after musculoskeletal trauma later in life. Given the global burden imposed by musculoskeletal trauma, this review underscores an important gap in clinical knowledge.

Purpose: To evaluate the effect of comprehensive geriatric management on physical function after hip fracture. Materials and methods: This was a parallel-group 1:1 single-blinded randomized controlled trial. Fifty-three older adults (≥ 65 years) 3 to 12 months after hip fracture were randomized through a web-based system (independent statistical company) into usual care or usual care plus intervention (B4). The B4 group received management by a geriatrician, physical therapist and other health professionals. Outcomes were: Leg (knee extension) and grip strength, timed up and go; and self-report function at baseline, 6 and 12 months (blinded assessment). We estimated between-group differences at 6 and 12 months using linear mixed models, and compared function between groups with a global statistical test (incorporating the five measures). Results: There were no statistically significant differences between groups. For the combined sample, strength on the fractured leg (2.63, 95% CI: 0.86, 4.40 kg) and non-fractured leg (1.36, 95% CI: 0.12, 2.70 kg) were statistically higher than baseline values. Conclusions: There were no between group differences in physical function. Overall, older adults from both groups had small significant improvements in bilateral leg strength at final assessment, but below age-matched normative values.