ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Arch Phys Med Rehabil. 2019 Mar;100(3):530-550. doi: 10.1016/j.apmr.2018.05.010. Epub 2018 Jun 11.
Many 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.
Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018.
OOHS (ie, 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 ≥65y) after discharge from hospital after an acute illness.
Two 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.
A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7 assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]=: -1.34 to 48.32; I: 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I: 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly.
OOHS-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% CIs indicate that the evidence is not robust.
许多老年人在急性住院后会在院外环境（OOHS）接受康复治疗；然而，其对移动能力和非计划性住院再入院的影响尚不清楚。因此，对这一主题进行了系统评价和荟萃分析。
从创建到 2018 年 2 月 22 日，在 Medline OVID、Embase OVID 和 CINAHL 中进行了检索。
选择了 OOHS（即熟练护理机构、门诊或社区内居家）的随机试验，研究了多学科康复的效果，包括评估急性疾病后出院的老年患者（平均年龄≥65 岁）的运动情况。
两名审查员独立选择研究，进行独立的数据提取，并评估了偏倚风险。根据需要，使用固定或随机效应模型汇总结果。主要结果是出院后 3 个月内的移动能力和非计划性住院再入院。
系统评价共纳入 15 项研究（1255 名患者），荟萃分析纳入 12 项研究（7 项评估使用 6 分钟步行距离[6MWD]测试的移动能力，7 项评估非计划性住院再入院）。基于 6MWD，接受康复治疗的患者比对照组多走 23 米（95%置信区间[CI]=：-1.34 至 48.32；I：51%）。康复并没有降低 3 个月内非计划性住院再入院的风险（风险比：0.93；95%CI：0.73-1.19；I：34%）。存在偏倚风险，主要是由于 3 项研究的结局评估未设盲，7 项研究的评估不明确。
在急性疾病住院后，基于 OOHS 的多学科康复可改善老年患者出院后 3 个月的移动能力，且与出院后 3 个月内非计划性住院再入院的风险降低无关。然而，较宽的 95%CI 表明证据不稳健。
