Wöhl Caroline, Siebert Hendrik, Blättner Beate
Fachbereich Pflege und Gesundheit, Hochschule Fulda, Fulda, Deutschland.
Fachbereich Pflege und Gesundheit, Hochschule Fulda, Fulda, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2021 Apr;161:66-76. doi: 10.1016/j.zefq.2020.12.006. Epub 2021 Feb 6.
Interventions to promote physical activity in nursing homes are among the priorities of German long-term care insurance funds. We summarized the evidence on the effectiveness of such interventions.
We conducted a systematic literature search in five electronic databases in November 2019, which was complemented by searching reference lists and trials registries. Eligible studies included individually (RCTs) or cluster randomized trials or non-randomized comparative studies that investigated the effectiveness of interventions to promote physical activity in nursing home residents and their impact on the ability to perform activities of daily living. Results were synthesized using random effects meta-analysis.
Meta-analysis of 19 included studies with high risk of bias showed a small yet statistically significant effect on activities of daily living (SMD = 0.40, 95 % CI 0.08-0.72); heterogeneity was substantial (I = 77 %, p < 0.0001). Sensitivity analysis excluding two non-randomized comparative studies did not alter the results (SMD = 0.40, 95 % CI 0.03-0.76). The effect attenuated but was still statistically significant in a meta-analysis which excluded five studies that were largely responsible for the heterogeneity (SMD = 0.27, 95 % CI 0.12-0.43, I=34 %, p = 0.10). Subgroup analyses did not demonstrate any statistically significant results in favour of physical activity.
We found evidence for a beneficial effect on activities of daily living in favour of interventions that aim to promote physical activity. Due to the high overall risk of bias and substantial heterogeneity of the included studies the results should be interpreted with caution, though.
Methodologically sound studies are needed to strengthen the evidence base on the topic.
促进养老院身体活动的干预措施是德国长期护理保险基金的优先事项之一。我们总结了此类干预措施有效性的证据。
2019年11月，我们在五个电子数据库中进行了系统的文献检索，并通过检索参考文献列表和试验注册库进行补充。符合条件的研究包括个体随机对照试验（RCT）或整群随机试验或非随机对照研究，这些研究调查了促进养老院居民身体活动的干预措施的有效性及其对日常生活活动能力的影响。结果采用随机效应荟萃分析进行综合。
对19项偏倚风险高的纳入研究进行荟萃分析，结果显示对日常生活活动有微小但具有统计学意义的影响（标准化均数差[SMD]=0.40，95%可信区间[CI]0.08 - 0.72）；异质性很大（I² = 77%，p < 0.0001）。排除两项非随机对照研究的敏感性分析未改变结果（SMD = 0.40，95% CI 0.03 - 0.76）。在排除五项主要导致异质性的研究的荟萃分析中，该效应减弱但仍具有统计学意义（SMD = 0.27，95% CI 0.12 - 0.43，I² = 34%，p = 0.10）。亚组分析未显示任何支持身体活动的具有统计学意义的结果。
我们发现有证据表明，旨在促进身体活动的干预措施对日常生活活动有有益影响。然而，由于纳入研究的总体偏倚风险高且异质性大，对结果的解释应谨慎。
需要方法学上可靠的研究来加强该主题的证据基础。
