Department of Physical Medicine and Rehabilitation, UZ Leuven - University Hospitals Leuven, campus Pellenberg, Weligerveld 1, 3212, Pellenberg, Belgium.
Department of Public Health and Primary Care, Geriatrics and Gerontology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
BMC Geriatr. 2020 Sep 22;20(1):362. doi: 10.1186/s12877-020-01769-4.
Regaining pre-hospitalization activity levels is only achieved in 30-50% of older patients. Extra physiotherapy time has been proven to improve functional outcome and shorten length of stay, but is costly. Considering their key role in caring for older people, involving informal caregivers in rehabilitation might further improve functional performance.
To determine if in-hospital or post discharge caregiver involvement can increase functional performance in older adults. The secondary aim was to determine if caregiver involvement can influence, quality of life of patient and caregiver, medical costs, readmission rate, discharge location, and mortality.
Systematic review with narrative synthesis.
The electronic bibliographic databases MEDLINE, Embase, CINAHL, Cochrane and Web of Science were searched for (quasi) experimental and observational studies, with the following inclusion criteria; caregiver involvement regarding functional performance, mean age over 65 years, admitted to a hospital unit and subsequently discharged to their home setting. Risk of bias was assessed with the Rob 2 (randomized trials) and the ROBINS-1 tool (non-randomized studies).
Eight studies of an initial 4683 were included: four randomized controlled trials, one prospective cohort study, one non-randomized controlled trial, one subgroup analysis of an RCT and one prospective pre-post study. All but one study included patients with stroke. Three types of caregiver interventions could be distinguished: a care pathway (inclusion of caregivers in the process of care), education on stroke and teaching of bed-side handling-skills, and caregiver-mediated exercises. The one study evaluating the care pathway reported 24.9% more returns home in the intervention group. Studies evaluating the effect of education and bed-side handling-skills reported higher effect sizes for several outcomes with increasing session frequency. All studies with caregiver-mediated exercises showed beneficial effects on functional performance, immediately after the intervention and within 3 months follow-up.
The findings of this review suggest that involvement of caregivers in the rehabilitation of older adults leads to better functional performance up to 3 months after initiation. However, evidence is low and mainly focusing on stroke.
仅有 30-50%的老年患者能够恢复住院前的活动水平。已经证明增加额外的物理治疗时间可以改善功能预后并缩短住院时间，但成本较高。考虑到他们在照顾老年人方面的关键作用，让非正式照顾者参与康复可能会进一步提高功能表现。
确定住院期间或出院后照顾者的参与是否可以提高老年人的功能表现。次要目的是确定照顾者的参与是否会影响患者和照顾者的生活质量、医疗费用、再入院率、出院地点和死亡率。
系统评价和叙述性综合。
检索电子文献数据库 MEDLINE、Embase、CINAHL、Cochrane 和 Web of Science，以查找（准）实验和观察性研究，纳入标准为：照顾者参与功能表现、平均年龄超过 65 岁、住院后出院回家。使用 Rob 2（随机试验）和 ROBINS-1 工具（非随机研究）评估偏倚风险。
最初 4683 项研究中有 8 项符合纳入标准：4 项随机对照试验、1 项前瞻性队列研究、1 项非随机对照试验、1 项 RCT 的亚组分析和 1 项前瞻性前后研究。除了一项研究外，所有研究都纳入了患有中风的患者。可以区分三种类型的照顾者干预措施：护理途径（将照顾者纳入护理过程中）、中风教育和床边处理技能教学以及照顾者介导的锻炼。唯一一项评估护理途径的研究报告称，干预组中有 24.9%的患者返回家中。评估教育和床边处理技能效果的研究报告称，随着会议频率的增加，几种结局的效果大小更高。所有进行照顾者介导的锻炼的研究都显示出对功能表现的有益影响，在干预后立即和 3 个月随访时都如此。
本综述的研究结果表明，让照顾者参与老年患者的康复可以在开始后的 3 个月内提高功能表现。然而，证据水平较低，主要集中在中风方面。
