Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review

BMC Geriatrics

Claudine JC Lamoth¹  Jürgen M Bauer²  Lena Dasenbrock²  Alisa L Dutmer¹  Nienke M Kosse¹ 

[1] University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands;Geriatrics Center Oldenburg, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany

关键词: Physical performance;    ADL;    Feasibility;    Functional outcomes;    Aged;    Hospital;    Rehabilitation;    Acute care;   

Others  :  856739
DOI  :  10.1186/1471-2318-13-107

 received in 2013-05-15, accepted in 2013-10-08,  发布年份 2013

【 摘 要 】

Background

Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs.

Methods

Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added.

Results

Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved physical functioning after discharge. The feasibility search yielded four articles. The feasibility results showed that early physical rehabilitation for acutely hospitalized old adults was safe. Adherence rates differed between studies and the recruitment of patients was sometimes challenging.

Conclusions

Early physical rehabilitation care for acutely hospitalized old adults leads to functional benefits and can be safely executed. Further research is needed to specifically quantify the physical component in early physical rehabilitation programs.

【 授权许可】

   
2013 Kosse et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]OECD: Health at a Glance: Europe 2012. OECD Publishing; 2012. [http://dx.doi.org/10.1787/9789264183869-en webcite]
• [2]Creditor MC: Hazards of Hospitalization of the Elderly. Ann Intern Med 1993, 118(3):219.
• [3]Sager MA, Franke T, Inouye SK, Landefeld CS, Morgan TM, Rudberg MA, Sebens H, Winograd CH: Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med 1996, 156(6):645-652.
• [4]Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003, 51(4):451-458.
• [5]McVey LJ, Becker PM, Saltz CC, Feussner JR, Cohen HJ: Effect of a geriatric consultation team on functional status of elderly hospitalized patients. Ann Intern Med 1989, 110(1):79.
• [6]Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS: Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci 1999, 54(10):M521-M526.
• [7]Rudberg MA, Sager MA, Zhang J: Risk factors for nursing home use after hospitalization for medical illness. J Gerontol A Biol Sci Med Sci 1996, 51(5):M189-M194.
• [8]Kortebein P, Symons TB, Ferrando A, Paddon-Jones D, Ronsen O, Protas E, Conger S, Lombeida J, Wolfe R, Evans WJ: Functional impact of 10 days of bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci 2008, 63(10):1076-1081.
• [9]Mendez-Tellez PA, Nusr R, Feldman D, Needham DM: Early physical rehabilitation in the ICU: a review for the neurohospitalist. The Neurohospitalist 2012, 2(3):96-105.
• [10]Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J, Rodriguez-Manas L, Rodriguez-Artalejo F: Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ 2009, 338:b50.
• [11]de Morton NA, Keating JL, Jeffs K: The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials. Clin Rehabil 2007, 21(1):3-16.
• [12]Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG: The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 1998, 51(12):1235-1241.
• [13]Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ: Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther 2008, 88(2):156-175.
• [14]Laver K, George S, Ratcliffe J, Quinn S, Whitehead C, Davies O, Crotty M: Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial. Disabil Rehabil 2012, 34(21):1802-1808.
• [15]Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009, 62(10):e1-e34.
• [16]Abizanda P, Leon M, Dominguez-Martin L, Lozano-Berrio V, Romero L, Luengo C, Sanchez-Jurado PM, Martin-Sebastia E: Effects of a short-term occupational therapy intervention in an acute geriatric unit. A randomized clinical trial. Maturitas 2011, 69(3):273-278.
• [17]Asplund K, Gustafson Y, Jacobsson C, Bucht G, Wahlin A, Peterson J, Blom JO, Angquist KA: Geriatric-based versus general wards for older acute medical patients: a randomized comparison of outcomes and use of resources. J Am Geriatr Soc 2000, 48(11):1381-1388.
• [18]Blanc-Bisson C, Dechamps A, Gouspillou G, Dehail P, Bourdel-Marchasson I: A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes. J Nutr Health Aging 2008, 12(6):395-399.
• [19]Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, Quinn LM, Allen KR, Covinsky KE, Landefeld CS: Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc 2000, 48(12):1572-1581.
• [20]Courtney MD, Edwards HE, Chang AM, Parker AW, Finlayson K, Bradbury C, Nielsen Z: Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. J Eval Clin Pract 2012, 18(1):128-134.
• [21]Courtney M, Edwards H, Chang A, Parker A, Finlayson K, Hamilton K: Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. J Am Geriatr Soc 2009, 57(3):395-402.
• [22]de Morton NA, Keating JL, Berlowitz DJ, Jackson B, Lim WK: Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial. Aust J Physiother 2007, 53(2):105-111.
• [23]Jones CT, Lowe AJ, MacGregor L, Brand CA, Tweddle N, Russell DM: A randomised controlled trial of an exercise intervention to reduce functional decline and health service utilisation in the hospitalised elderly. Australas J Ageing 2006, 25(3):126-133.
• [24]Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J: A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med 1995, 332(20):1338-1344.
• [25]Nikolaus T, Specht-Leible N, Bach M, Oster P, Schlierf G: A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients. Age Ageing 1999, 28(6):543-550.
• [26]Saltvedt I, Jordhoy M, Opdahl Mo ES, Fayers P, Kaasa S, Sletvold O: Randomised trial of in-hospital geriatric intervention: impact on function and morale. Gerontology 2006, 52(4):223-230.
• [27]Saltvedt I, Mo ES, Fayers P, Kaasa S, Sletvold O: Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. J Am Geriatr Soc 2002, 50(5):792-798.
• [28]Siebens H, Aronow H, Edwards D, Ghasemi Z: A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. J Am Geriatr Soc 2000, 48(12):1545-1552.
• [29]Slaets JP, Kauffmann RH, Duivenvoorden HJ, Pelemans W, Schudel WJ: A randomized trial of geriatric liaison intervention in elderly medical inpatients. Psychosom Med 1997, 59(6):585-591.
• [30]Brown CJ, Peel C, Bamman MM, Allman RM: Exercise program implementation proves not feasible during acute care hospitalization. J Rehabil Res Dev 2006, 43(7):939-946.
• [31]Mallery LH, MacDonald EA, Hubley-Kozey CL, Earl ME, Rockwood K, MacKnight C: The feasibility of performing resistance exercise with acutely ill hospitalized older adults. BMC Geriatr 2003, 3:3.
• [32]Nolan J, Thomas S: Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project. BMC Health Serv Res 2008, 8:250.
• [33]Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM: Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 2010, 340:c1718.
• [34]Hutchinson AM, Johnston L: Bridging the divide: a survey of nurses’ opinions regarding barriers to, and facilitators of, research utilization in the practice setting. J Clin Nurs 2004, 13(3):304-315.