School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
Department of Physiotherapy, Monash Health, Melbourne, Australia.
J Geriatr Phys Ther. 2022;45(1):50-61. doi: 10.1519/JPT.0000000000000305.
To evaluate the effectiveness of multicomponent functional maintenance initiatives (MFMIs) on functional outcomes and adverse events associated with functional decline among acutely hospitalized older adults.
Studies were sourced from OVID Medline, PubMed, Embase, CINAHL, the Cochrane Library, and PEDro databases from inception to April 15, 2020, and their bibliographies.
Randomized controlled trials were included if they investigated multicomponent interventions comprising more than one nonpharmacological intervention targeting physical functional decline and another shared risk factor for geriatric syndromes in acutely hospitalized medical or nonelective surgical patients 65 years and older.
Two reviewers independently assessed for eligibility, extracted data, and conducted risk of bias assessments.
Eight studies involving 5534 patients were included. Multicomponent functional maintenance initiatives did not appear to confer significant effects on functional status, length of stay, or 30-day hospital readmissions; however, clinical heterogeneity limited meta-analysis for some specific functional outcomes. Patients who did not receive MFMIs were more likely to be discharged to a nursing staff facility (odds ratio = 1.53; 95% confidence interval, 1.23 to 1.90). No effect of MFMI on all-cause mortality was observed, and adverse events were rare and unlikely attributed to nonpharmacological interventions.
Data from a small number of studies suggest MFMIs reduce the likelihood of discharge to a nursing staff facility in acutely hospitalized older adults; however, this effect may not be driven via improvements in physical function. Standardized evaluation methods to determine MFMI effectiveness appear indicated to assist decision-making regarding their implementation in clinical practice.
评估多组分功能维持干预（MFMIs）对急性住院老年患者功能下降相关功能结局和不良事件的有效性。
研究资料来源于 OVID Medline、PubMed、Embase、CINAHL、Cochrane 图书馆和 PEDro 数据库，检索时间截至 2020 年 4 月 15 日，并查阅了其参考文献。
如果研究调查了多组分干预措施，包括针对急性住院内科或非择期外科患者 65 岁及以上的身体功能下降和老年综合征的另一个共同风险因素的超过一种非药物干预，则纳入随机对照试验。
两名评审员独立评估入选标准、提取数据并进行偏倚风险评估。
共纳入 8 项涉及 5534 例患者的研究。多组分功能维持干预似乎对功能状态、住院时间或 30 天内医院再入院没有显著影响；然而，由于临床异质性，一些特定的功能结局无法进行 meta 分析。未接受 MFMIs 的患者更有可能被转往护理人员设施（比值比=1.53；95%置信区间，1.23 至 1.90）。未观察到 MFMIs 对全因死亡率有影响，且不良事件罕见，不太可能归因于非药物干预。
少数研究的数据表明，MFMIs 降低了急性住院老年患者转往护理人员设施的可能性；然而，这种效果可能不是通过改善身体功能来实现的。需要采用标准化的评估方法来确定 MFMIs 的有效性，以协助在临床实践中实施此类干预的决策。
