School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada.
Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Trials. 2022 Mar 28;23(1):235. doi: 10.1186/s13063-022-06172-5.
Physical rehabilitation (PR) interventions can improve physical function for adults with frailty; however, participant retention rates in randomized controlled trials (RCTs) are unknown. Objective is to summarize participant retention rates in RCTs of PR for adults with frailty. Design is a systematic review and meta-analysis (DOI:10.17605/OSF.IO/G6XR2). Participants are adults ≥ 18 years with frailty. Setting consists of inpatient, outpatient and community-based interventions. Intervention includes any PR intervention.
We searched 7 electronic databases from inception to April 15, 2020 for published RCTs. Our primary outcome was participant retention rate to primary outcome measurement. Secondary outcomes included retention by study group, participant retention to intervention completion, reported reasons for attrition and reported strategies for maximizing retention. We completed screening, data extraction and risk of bias (ROB) assessments independently and in duplicate. We conducted a meta-analysis, calculating retention rates and 95% confidence intervals (CIs) using fixed or random-effects models, as appropriate.
We included 21 RCTs, enrolling 1685 adults with frailty (median age 82.5 years (79.0, 82.2), 59.8% female (57.5, 69.8)). Twenty RCTs reported retention data, of which 90.0% (n = 18) had high ROB. The pooled participant retention rate to primary outcome measurement was 85.0% [95%CI (80.0, 90.0), I = 83.9%, p < 0.05]. There were no differences by group for retention to the primary outcome [intervention 87.0% (83.0, 91.0), p < 0.05, comparator 85.0% (79.0, 90.0), p < 0.05] or in retention to intervention completion [83.0% (95.0% CI (78.0-87.0), p < 0.05]. Of the 18 studies reporting 24 reasons for attrition, 51.3% were categorized as potentially modifiable by the research team (e.g. low motivation). Only 20.0% (n = 4) of studies reported strategies for maximizing retention.
In this review of 21 RCTs of PR, we identified acceptable rates of retention for adults with frailty. High retention in PR interventions appears to be feasible in this population; however, our results are limited by a high ROB and heterogeneity.
物理康复（PR）干预可以改善虚弱成年人的身体功能；然而，随机对照试验（RCT）中的参与者保留率尚不清楚。目的是总结虚弱成年人 PR 的 RCT 中参与者保留率。设计为系统评价和荟萃分析（DOI：10.17605/OSF.IO/G6XR2）。参与者为年龄≥18 岁的虚弱成年人。设置包括住院、门诊和社区干预。干预包括任何 PR 干预。
我们从成立到 2020 年 4 月 15 日在 7 个电子数据库中搜索已发表的 RCT。我们的主要结局是参与者对主要结局测量的保留率。次要结局包括按研究组、参与者对干预完成的保留率、报告的失访原因和报告的最大限度保留策略进行保留。我们独立并重复进行筛选、数据提取和偏倚风险（ROB）评估。我们使用固定或随机效应模型，根据需要进行荟萃分析，计算保留率和 95%置信区间（CI）。
我们纳入了 21 项 RCT，共纳入 1685 名虚弱成年人（中位年龄 82.5 岁（79.0，82.2），59.8%为女性（57.5，69.8%））。20 项 RCT 报告了保留数据，其中 90.0%（n=18）的 ROB 较高。主要结局测量的参与者总体保留率为 85.0%[95%CI（80.0，90.0），I=83.9%，p<0.05]。在保留主要结局方面，各组之间没有差异[干预组 87.0%（83.0，91.0），p<0.05，对照组 85.0%（79.0，90.0），p<0.05]或在保留干预完成方面[83.0%（95.0%CI（78.0-87.0），p<0.05]。在报告 24 个失访原因的 18 项研究中，51.3%被研究小组归类为潜在可修改（例如低动机）。只有 20.0%（n=4）的研究报告了最大限度保留的策略。
在这项对 21 项 PR RCT 的综述中，我们确定了虚弱成年人的可接受保留率。虚弱人群中 PR 干预的高保留率似乎是可行的；然而，我们的结果受到高 ROB 和异质性的限制。
