重新思考老年在住养老院人群的康复策略：范围综述。
Re-thinking reablement strategies for older adults in residential aged care: a scoping review.
机构信息
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia.
出版信息
BMC Geriatr. 2021 Nov 30;21(1):667. doi: 10.1186/s12877-021-02627-7.
BACKGROUND
The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness).
METHOD
This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored.
RESULTS
Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness.
CONCLUSIONS
There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted.
TRIAL REGISTRATION
Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).
背景
居住在养老院的老年人数量正在增加。研究表明，养老院的老年人大部分时间都处于久坐状态，且患有多种合并症。本综述旨在系统地探讨居住在养老院的老年人重新适应能力策略对其身体功能、生活质量和心理健康的有效性，以及有效干预措施的特点和可行性（依从性、可接受性、不良事件和成本效益）。
方法
本范围综述根据 PRISMA 指南（扩展用于范围综述）进行。从 2010 年开始，在五个电子数据库（Medline、Embase、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库和 CINAHL）中进行了搜索。纳入了针对居住在养老院的身体功能下降的老年人（平均年龄≥65 岁）的重新适应能力策略的随机对照试验，这些策略旨在改善身体功能、生活质量或心理健康。探讨了干预措施的可行性（依从性、可接受性、满意度、不良事件和成本效益）。
结果
共检索到 5631 条引文，纳入了 63 项研究。样本量从 15 到 322 不等，干预持续时间从 1 到 12 个月不等。锻炼课程最常每周进行两到三次（44 项研究），由物理治疗师主导（27 项研究）。干预措施主要是多组分的（28 项研究，包括力量、平衡、有氧运动、功能锻炼的组合）。有 5 项干预措施使用了技术。60%的研究测量身体功能，发现干预组与对照组相比有显著改善，40%的研究测量生活质量，发现干预组有显著改善，26%的研究测量心理健康，发现干预组有显著获益。超过一半的研究测量了依从性和不良事件，四项研究测量了可接受性，没有研究报告成本效益。
结论
关于居住在养老院的重新适应能力策略的研究已经出现了激增，但策略的类型和特点以及结果测量指标存在很大差异。很少有研究测量可接受性或成本效益。需要探索核心结果、绘制利益相关者图谱并共同设计可扩展的干预措施。
注册
前瞻性注册综述方案（Open Science Framework：DOI https://doi.org/10.17605/OSF.IO/7NX9M）。
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