Effect of inpatient rehabilitation treatment ingredients on functioning, quality of life, length of stay, discharge destination, and mortality among older adults with unplanned admission: an overview review

Abstract

Background 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. Methods A systematic search of Cochrane Library, MEDLINE, Embase, PsychInfo, PEDro, BASE, and OpenGrey for published and unpublished systematic reviews of inpatient rehabilitation interventions for older adults following an unplanned admission to hospital from database inception to December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 (I2). Results 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. Conclusion 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. Trial registration PROSPERO Registration CRD42018114323.

Changes in physical activity in older adult patients with postoperative hip fractures in convalescent rehabilitation wards during rehabilitation time and during daily activities in the ward: a prospective cohort study

“…The increase in physical activity may have resulted from the improvement in ADL. Second, since leisure time outside the daily routine is free living, patients' physical It has been reported that among rehabilitation interventions for older adult patients admitted to emergency (unscheduled) hospitalizations, endurance exercise greatly improves walking endurance during hospitalization [24]. The increase in physical activity during rehabilitation seems to confirm that personalized instruction by professionals is effective in older adult inpatients with subacute musculoskeletal disease.…”

Effects of surgical treatment modalities on postoperative cognitive function and delirium in elderly patients with extremely unstable hip fractures

“…In this study, the new treatment model was based on MDT diagnosis and treatment + individualized surgical plan + risk prediction, with holistic sequential trauma treatment as the concept[ 17 ]. However, the conventional treatment model included general consultation + fracture type-guided internal fixation as the main program and local trauma theory as the main guidance[ 18 ].…”

Relationship between independence in activities of daily living at discharge and physical activity at admission of older postoperative hip fracture rehabilitation inpatients: A retrospective case‐control study

“…Potential confounders included age, sex, body mass index (Armstrong et al., 2011), length of hospital stay (Lambe et al., 2022), prehospital frailty level (Soukkio et al., 2018), femoral fracture site (Vrignaud et al., 2018), comorbidities (Zhu et al., 2022), walkability (Handoll et al., 2021), and residence, including home, a nursing home, or another hospital (Walsh et al., 2023). For this study, the outcome was the need for ADL assistance at discharge, and the predictor was the physical activity (Amaral Gomes et al., 2021) at the time of rehabilitation admission.…”