Effects of postacute multidisciplinary rehabilitation including exercise in out-of-hospital settings in the aged: systematic review and meta-analysis

Lotte Verweij, Eva van de Korput, Joost G. Daams, Gerben Ter Riet, Ron J.G. Peters, Raoul H.H. Engelbert, Wilma J.M. Scholte op Reimer, Bianca M. Buurman

Research output: Contribution to journalReview articleAcademicpeer-review

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Abstract

Abstract
Objective: Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect on
mobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic.
Data Sources: Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018.
Study Selection: OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect of
multidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age 65y) after discharge from hospital
after an acute illness.
Data Extraction: Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias.
Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospital
readmission within 3 months of discharge.
Data Synthesis: A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7
assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patients
receiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]Z: 1.34 to 48.32; I2: 51%). Rehabilitation
did not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I2: 34%). The risk of bias was present,
mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly.
Conclusion: OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from
hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge.
However, the wide 95% CIs indicate that the evidence is not robust.
Original languageEnglish
Pages (from-to)530-550
Number of pages21
JournalArchives of physical medicine and rehabilitation
Volume100
Issue number3
DOIs
Publication statusPublished - Mar 2019

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