Effectiveness of nonpharmacological therapeutic interventions on pain and physical function in adults with rib fractures during acute care: A systematic review and meta-analysis.

Only cohort studies could be combined for the three main outcomes, and these carry a higher risk of bias than randomised trials. The three randomised trials in the review each studied a different single intervention and could not be pooled. Results for pain and for breathing function could not be combined at all, because the studies used different measures and different interventions, so those conclusions rest on single small studies rather than on pooled evidence. The review planned to look at hospital readmission for chest trauma pain and at quality of life, and found no study reporting either. Only studies from 2000 onwards and in or translated into English were included, and studies where rib fractures were not confirmed on imaging were excluded. Because rib fractures can be missed on chest X-ray, some studies may have been left out. Patients were mostly in their fifties or sixties or over 65, and length of stay in older people is driven by many things besides the treatment given, so the null length-of-stay result may not apply to younger patients. The study rated the evidence moderate for length of stay and very low for mortality. It does not report a certainty rating for pneumonia in the text supplied.

Do not read the 63% fall in pneumonia as proof that care bundles themselves prevent it. That pooled result comes from two cohort studies rather than randomised trials, and the same review's pooled analyses of hospital stay and deaths found no significant difference.