Effects of post-acute multidisciplinary rehabilitation including exercise in out-of-hospital settings in the aged: systematic review and meta-analysis

Publication date: Available online 11 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Lotte Verweij, Eva van de Korput, Joost G. Daams, Gerben ter Riet, Ron J.G. Peters, Raoul H.H. Engelbert, Wilma J.M. Scholte op Reimer, Bianca M. Buurman
ObjectiveMany older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect on mobility and unplanned hospital readmission is unclear. Therefore a systematic review and meta-analysis were conducted on this topic.Data sourcesMedline OVID, Embase OVID, and Cinahl were searched from their inception until February 22, 2018.Study selectionOOHS (i.e., skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect of multidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age ≥ 65 years) after discharge from hospital following an acute illness.Data extractionTwo reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospital readmission within 3 months of discharge.Data synthesisFifteen studies (1255 patients) were included in the systematic review and twelve were included in the meta-analysis (seven assessing mobility using the 6-minute walk distance (6MWD) test and seven assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% CI: −1.34–48.32; I²: 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (RR: 0.93; 95% CI: 0.73–1.19; I²: 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in three studies, and seven studies scored this unclearly.ConclusionOOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge. However, the wide 95% confidence intervals indicate that the evidence is not robust.Prospero registration numberCRD42017058592.



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