Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
BMC Geriatr. 2022 Jun 11;22(1):501. doi: 10.1186/s12877-022-03169-2.
To synthesise the evidence for the effectiveness of inpatient rehabilitation treatment ingredients (versus any comparison) on functioning, quality of life, length of stay, discharge destination, and mortality among older adults with an unplanned hospital admission.
A systematic search of Cochrane Library, MEDLINE, Embase, PsychInfo, PEDro, BASE, and OpenGrey for published and unpublished systematic reviews of inpatient rehabilitation interventions for older adults following an unplanned admission to hospital from database inception to December 2020. Duplicate screening for eligibility, quality assessment, and data extraction including extraction of treatment components and their respective ingredients employing the Treatment Theory framework. Random effects meta-analyses were completed overall and by treatment ingredient. Statistical heterogeneity was assessed with the inconsistency-value (I).
Systematic reviews (n = 12) of moderate to low quality, including 44 non-overlapping relevant RCTs were included. When incorporated in a rehabilitation intervention, there was a large effect of endurance exercise, early intervention and shaping knowledge on walking endurance after the inpatient stay versus comparison. Early intervention, repeated practice activities, goals and planning, increased medical care and/or discharge planning increased the likelihood of discharge home versus comparison. The evidence for activities of daily living (ADL) was conflicting. Rehabilitation interventions were not effective for functional mobility, strength, or quality of life, or reduce length of stay or mortality. Therefore, we did not explore the potential role of treatment ingredients for these outcomes.
Benefits observed were often for subgroups of the older adult population e.g., endurance exercise was effective for endurance in older adults with chronic obstructive pulmonary disease, and early intervention was effective for endurance for those with hip fracture. Future research should determine whether the effectiveness of these treatment ingredients observed in subgroups, are generalisable to older adults more broadly. There is a need for more transparent reporting of intervention components and ingredients according to established frameworks to enable future synthesis and/or replication.
PROSPERO Registration CRD42018114323 .
综合评估非计划性住院的老年患者接受住院康复治疗成分（与任何对照相比）对功能、生活质量、住院时间、出院去向和死亡率的有效性。
从数据库建立到 2020 年 12 月，系统检索 Cochrane Library、MEDLINE、Embase、PsychInfo、PEDro、BASE 和 OpenGrey 中关于非计划性住院的老年患者住院康复干预的已发表和未发表的系统评价。对纳入研究进行重复筛选，评估纳入研究的质量，并提取治疗成分及其组成部分的数据，采用治疗理论框架进行分析。对整体治疗和按治疗成分进行随机效应荟萃分析。采用不一致值（I）评估统计异质性。
纳入 12 项质量为中低水平的系统评价，其中包括 44 项非重叠的相关 RCT。当将耐力运动、早期干预和塑造知识等治疗成分纳入康复干预措施时，与对照组相比，这些治疗成分可显著提高患者在住院期间后的步行耐力。早期干预、重复练习活动、目标和计划、增加医疗护理和/或出院计划可提高患者出院回家的可能性。在日常生活活动（ADL）方面，证据相互矛盾。康复干预对功能性移动、力量或生活质量没有改善作用，也不能减少住院时间或死亡率。因此，我们没有探讨这些治疗成分对这些结局的潜在作用。
观察到的益处往往是老年人群体的亚组获益，例如，耐力运动对慢性阻塞性肺疾病患者的耐力有效，早期干预对髋部骨折患者的耐力有效。未来的研究应确定这些治疗成分在亚组中观察到的有效性是否可推广至更广泛的老年人群体。根据既定框架，需要更透明地报告干预成分和成分，以促进未来的综合评估和/或复制。
PROSPERO 注册 CRD42018114323。
