# Effects of Digital Health Interventions on Functional and Psychological Outcomes in Older Patients With Hip Fractures: Systematic Review and Meta-Analysis of Randomized Controlled Trials

## TL;DR

Digital health interventions may help older patients recover better after hip fractures, but results vary widely and need more research.

## Contribution

This study is the first to comprehensively assess both functional and psychological outcomes of digital health interventions in older hip fracture patients.

## Key findings

- Digital health interventions significantly improved hip function and functional independence in older patients.
- Results showed substantial variability in real-world effectiveness, indicated by wide prediction intervals.
- No significant improvements were observed in balance, fall risk, or quality of life.

## Abstract

Hip fractures in older adults increasingly challenge public health, making traditional rehabilitation very challenging. Digital health interventions (DHIs) have emerged as a promising solution for postoperative rehabilitation. However, evidence on DHIs’ effects on functional and psychological outcomes remains insufficient.

This systematic review aimed to comprehensively examine the effects of DHIs on functional and psychological outcomes in older adults with hip fractures.

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 9 databases (PubMed, Embase, CENTRAL, APA PsycINFO, Web of Science, PEDro, CNKI, WANFANG, and SinoMed) from inception to November 13, 2025. Included studies enrolled adults aged 60 years and older with hip fractures, delivered DHIs, assessed functional and psychological outcomes, set usual care or no intervention as the control, and had a randomized controlled trial design. Studies were excluded if they enrolled nonhospitalized patients in the emergency department, patients discharged to nonhome settings, or had inaccessible full text or insufficient data. Study quality was evaluated using the Cochrane Risk of Bias tool 2.0 (Cochrane Collaboration), and evidence certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). The literature screening, data extraction, and quality assessment were independently conducted by 2 researchers, and any disputes were resolved by the third researcher. We performed analysis using R version 4.0.3 (R Foundation for Statistical Computing) with a random-effects model.

Of 17,723 studies screened, 13 met the inclusion criteria. DHIs, compared to the control, significantly improved hip function (standardized mean difference [SMD] 0.80, 95% CI 0.33-1.26; 95% prediction interval [PI] –0.24 to 1.83; P=.007) and functional independence (SMD 1.23, 95% CI 0.34-2.11; 95% PI –0.98 to 3.34; P=.02). Despite favorable pooled effects, a wide 95% PI spanning positive or negative values signals substantial heterogeneity. No significant difference was observed in balance function, risk of falling, and quality of life. Only a single available study reported a 70% adherence rate in the DHIs group. Subgroup analyses stratified by intervention duration revealed no significant intersubgroup differences for hip function (χ12=0.1; P=.75) or functional independence (χ12=2.93; P=.09). For hip function, the point estimate favored the 3 months subgroup (SMD 0.89, 95% CI 0.36-1.41; I2=7%; P=.41) over the <3 months subgroup. Conversely, for functional independence, the point estimate favored shorter intervention duration (SMD 0.67, 95% CI 0.12-1.23; I²=0%; P=.72).

This review incorporates the latest randomized controlled trials and comprehensively assesses functional and psychological outcomes of DHIs in older patients with hip fractures, distinct from prior studies focusing solely on functional outcomes. While the 95% CI supports the potential of DHIs to improve hip function and functional independence, the wide 95% PI indicating substantial real-world response variability, which calls for cautious interpretation, informs the design of targeted DHI-based rehabilitation regimens, warranting further research into optimal techniques and dosages in clinical practice.

PROSPERO CRD42024626186; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024626186