Etayo-Urtasun Paula, Sáez de Asteasu Mikel L, Izquierdo Mikel
Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdisNA, Department of Health Sciences, C/ de Irunlarrea, s/n, 31008 Pamplona, Navarra, Spain.
CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11, Planta 0, 28029 Madrid, Spain.
Age Ageing. 2025 Feb 2;54(2). doi: 10.1093/ageing/afaf035.
Inpatient hospitalisation is associated with adverse outcomes in older adults, including hospital-associated deconditioning. The hospital-at-home (HaH) model may promote physical activity. This systematic review and meta-analysis compares functional outcomes between inpatient and HaH settings and evaluates the efficacy of exercise interventions in both settings.
Systematic searches of PubMed, Scopus, Web of Science and ScienceDirect were conducted on 27 April 2024. Three distinct searches were performed: (i) studies comparing HaH and inpatient hospitalisation, (ii) trials evaluating inpatient exercise interventions and (iii) research on HaH exercise interventions. Two reviewers independently selected studies published from 2014 onwards using the PICOS framework and they assessed quality using PEDro scale. A meta-analysis was performed using a random effects model to analyse exercise interventions. This systematic review with meta-analysis was conducted according to PRISMA 2020 guidelines and was registered on PROSPERO (CRD42024598286).
Among the 9470 studies identified, nine studies comparing acute-care settings and 21 studies on exercise interventions (one in HaH) were included. Findings suggest that HaH may positively affect functional and cognitive outcomes. Inpatient exercise interventions significantly improved physical performance [standardised mean difference (SMD) = 0.42, 95% confidence interval (CI) = 0.12-0.72] and functional independence (SMD = 0.45, 95% CI = 0.14-0.77) at discharge.
HaH may contribute to preserving physical and cognitive status. Supervised exercise interventions during inpatient hospitalisation are safe and effective for improving older adults' functional status, although further research in the HaH model is needed.
住院治疗与老年人的不良后果相关，包括与医院相关的身体机能下降。居家医院（HaH）模式可能会促进身体活动。本系统评价和荟萃分析比较了住院和居家医院环境下的功能结局，并评估了两种环境下运动干预的效果。
于2024年4月27日对PubMed、Scopus、Web of Science和ScienceDirect进行系统检索。进行了三项不同的检索：（i）比较居家医院和住院治疗的研究；（ii）评估住院运动干预的试验；（iii）关于居家医院运动干预的研究。两名 reviewers 使用PICOS框架独立选择了2014年以后发表的研究，并使用PEDro量表评估质量。使用随机效应模型进行荟萃分析以分析运动干预。本系统评价和荟萃分析按照PRISMA 2020指南进行，并在PROSPERO（CRD42024598286）上注册。
在识别出的9470项研究中，纳入了9项比较急性护理环境的研究和21项关于运动干预的研究（其中1项在居家医院）。研究结果表明，居家医院可能对功能和认知结局产生积极影响。住院运动干预在出院时显著改善了身体表现[标准化均数差（SMD）=0.42，95%置信区间（CI）=0.12 - 0.72]和功能独立性（SMD =0.45，95% CI =0.14 - 0.77）。
居家医院可能有助于保持身体和认知状态。住院期间的监督运动干预对于改善老年人的功能状态是安全有效的，尽管需要对居家医院模式进行进一步研究。
