School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Am Med Dir Assoc. 2021 Oct;22(10):2063-2073.e6. doi: 10.1016/j.jamda.2020.12.008. Epub 2021 Jan 10.
Mobility interventions have been shown to mitigate functional decline in various clinical populations; however, the effects of mobility programs in older hospitalized patients are unclear. The objective of this study was to determine the effects of unstructured mobility programs on physical activity, physical function, length of stay (LOS), and quality of life (QOL) in older (≥60 years) general medicine inpatients.
In this systematic review and meta-analysis, we systematically searched MEDLINE, Embase, CINAHL, and AMED databases from inception to March 2020, plus hand screening references of relevant studies.
We included randomized controlled trials (RCTs) and quasi-experimental studies assessing the effects of mobility programs compared to usual care in older adults admitted to general medicine units.
Teams of 2 reviewers independently extracted data, assessed risk of bias, and evaluated quality of evidence. Where study population, intervention, and outcomes were similar, results from RCTs were combined by meta-analysis.
Three RCTs and 10 quasi-experimental studies met eligibility criteria. Interventions mainly included ambulation and staff, patient, or caregiver education. Meta-analyses showed that mobility interventions had a moderate effect on physical activity [step count standardized mean difference 0.60, 95% confidence interval (CI) 0.23-0.97] and a nonsignificant effect on LOS (mean difference -0.36, 95% CI -1.92 to 1.21), both favoring mobility. Narrative synthesis showed consistent evidence for improvement in physical function, potential decrease in LOS, and no increase in adverse events with mobility interventions.
Unstructured mobility interventions in general medicine units may improve older hospitalized patients' physical activity and physical function; however, the quality of evidence was low. More RCTs are needed to evaluate the effectiveness of mobility interventions, particularly on LOS and QOL.
已证实，运动干预措施可减轻各种临床人群的功能下降；然而，针对老年住院患者的运动方案的效果尚不清楚。本研究旨在确定非结构化运动方案对老年（≥60 岁）综合内科住院患者的身体活动、身体功能、住院时间（LOS）和生活质量（QOL）的影响。
在本系统评价和荟萃分析中，我们系统性地检索了 MEDLINE、Embase、CINAHL 和 AMED 数据库，检索时间从建库至 2020 年 3 月，并辅以相关研究的手工筛选参考文献。
我们纳入了比较运动方案与常规护理对综合内科单元收治的老年人影响的随机对照试验（RCT）和准实验研究。
由 2 名评审员组成的团队独立提取数据、评估偏倚风险并评估证据质量。若研究人群、干预措施和结局相似，则对 RCT 的结果进行荟萃分析。
3 项 RCT 和 10 项准实验研究符合纳入标准。干预措施主要包括活动、工作人员以及患者或照护者教育。荟萃分析结果显示，运动干预措施对身体活动具有中等影响[步计数标准化均数差 0.60，95%置信区间（CI）0.23-0.97]，对 LOS 无显著影响（平均差-0.36，95%CI-1.92 至 1.21），均有利于运动。叙述性综合分析显示，运动干预措施可改善身体功能，潜在缩短 LOS，且不会增加不良事件。
综合内科单元中的非结构化运动干预措施可能会改善老年住院患者的身体活动和身体功能；然而，证据质量较低。需要更多的 RCT 来评估运动干预措施的有效性，尤其是针对 LOS 和 QOL。
