La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, School of Allied Health(Physiotherapy), Melbourne.
La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, School of Allied Health(Physiotherapy), Melbourne; Northern Health, Northern Centre for Health Education and Research, Epping.
Arch Phys Med Rehabil. 2018 Nov;99(11):2299-2312. doi: 10.1016/j.apmr.2018.03.005. Epub 2018 Apr 7.
To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, and are safe and cost-effective for patients with acute or subacute conditions.
Electronic database (AMED, CINAHL, EMBASE, MEDLINE, Physiotherapy Evidence Database [PEDro], PubMed) searches were updated from 2010 through June 2017.
Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay, or cost-effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review.
Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale, and the Grading of Recommendation Assessment, Development, and Evaluation approach was applied to each meta-analysis.
Postintervention data were pooled with an inverse variance, random-effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate-quality evidence that additional physical therapy services reduced length of stay by 3 days in subacute settings (mean difference [MD]=-2.8; 95% CI, -4.6 to -0.9; I=0%), and low-quality evidence that it reduced length of stay by 0.6 days in acute settings (MD=-0.6; 95% CI, -1.1 to 0.0; I=65%). Additional physical therapy led to small improvements in self-care (SMD=.11; 95% CI, .03-.19; I=0%), activities of daily living (SMD=.13; 95% CI, .02-.25; I=15%), and health-related quality of life (SMD=.12; 95% CI, .03-.21; I=0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in subacute rehabilitation.
Additional physical therapy services improve patient activity and participation outcomes while reducing hospital length of stay for adults. These benefits are likely safe, and there is preliminary evidence to suggest they may be cost-effective.
更新一篇关于额外的物理治疗服务是否可以缩短住院时间、改善健康结果以及对急性或亚急性患者是否安全和具有成本效益的综述。
从 2010 年到 2017 年 6 月，对电子数据库（AMED、CINAHL、EMBASE、MEDLINE、物理治疗证据数据库 [PEDro]、PubMed）进行了检索。
纳入评估额外物理治疗服务对患者健康结果、住院时间或成本效益影响的随机对照试验。检索出 1524 篇可能相关的文章，其中有 11 篇新文章来自 8 项新的随机对照试验，共纳入 1563 名参与者。总共纳入 24 项随机对照试验，共 3262 名参与者。
使用原始系统评价中使用的表格提取数据。使用 PEDro 量表评估方法学质量，并应用推荐评估、制定与评价分级方法对每项荟萃分析进行评估。
采用逆方差、随机效应模型对干预后数据进行合并，计算标准化均数差（SMD）和 95%置信区间（CI）。有中等质量证据表明，亚急性环境下的额外物理治疗服务可将住院时间缩短 3 天（平均差值 [MD]=-2.8；95%CI，-4.6 至-0.9；I=0%），而低质量证据表明急性环境下的额外物理治疗服务可将住院时间缩短 0.6 天（MD=-0.6；95%CI，-1.1 至 0.0；I=65%）。额外的物理治疗可使自我护理（SMD=.11；95%CI，.03-.19；I=0%）、日常生活活动（SMD=.13；95%CI，.02-.25；I=15%）和健康相关生活质量（SMD=.12；95%CI，.03-.21；I=0%）有较小的改善，而不良事件并未增加。行走能力没有显著变化。一项试验报告称，亚急性康复中额外的物理治疗可能具有成本效益。
额外的物理治疗服务可改善成人患者的活动和参与结果，同时缩短住院时间。这些益处可能是安全的，并且有初步证据表明它们可能具有成本效益。
