Interventions for reducing hospital-associated deconditioning: A systematic review and meta-analysis

Abstract

To determine the effectiveness of hospital-based interventions designed to reduce Hospital-Associated Deconditioning (HAD) for people in inpatient hospital settings.Materials & Methods: Systematic literature search of published and unpublished databases was conducted from (inception to 01 June 2020). Randomised and non-randomised controlled trials investigating the effectiveness of enhanced inpatient programmes aimed to reduce HAD in adults admitted to a hospital ward were included. Evidence was appraised using the Cochrane Risk of Bias tool and outcomes evaluated against the GRADE criteria. Where appropriate, data were pooled in meta-analyses and presented as risk difference (RD) or standardised mean difference with 95% confidence intervals (CI).Results: Seven studies recruiting 12,597 participants (7864 enhanced programmes; 4349 usual care) were included. There was low-quality evidence for reduced risk of decline in physical performance for those in the enhanced programmes compared to usual care (RD: -0.04; 95% CI: -0.08 to -0.01; N=2085). There was low-or very-low quality evidence reporting no benefit of enhanced programmes for mobility on discharge, length of hospital stay, hospital readmission, and mortality within the first three-months post-admission (p>0.05). There was low-quality evidence that nursing home placement and mortality at 12-months was superior through enhanced inpatient programmes compared to usual care. Conclusion:Enhanced inpatient programmes targeted at HAD may offer benefit over usual care for some outcomes. There remain uncertainty in relation to how applicable the findings are to non-North American countries, which elements of an enhanced programme are most important to reduce HAD, and longer-term sequelae.

Hospital‐associated deconditioning: Not only physical, but also cognitive

“…A recent meta-analysis focused on different interventions to reduce HAD. 114 The authors showed that enhanced inpatient programs reduced the risk of declining ADL ability by 4% at discharge, reduced nursing home residence by 8% at one to 3 months post-discharge and reduced 1-month mortality by 23%. However, the level of evidence remains low and it is important to design robust clinical trials with clear target populations.…”

“…Regarding interventions, studies were scarce and highlighted the need for more research. A recent meta‐analysis focused on different interventions to reduce HAD 114 . The authors showed that enhanced inpatient programs reduced the risk of declining ADL ability by 4% at discharge, reduced nursing home residence by 8% at one to 3 months post‐discharge and reduced 1‐month mortality by 23%.…”

“…However, we used a variety of sources and databases from non‐English speaking areas as well. Our review also has the advantage of addressing overall aspects of HAD, whereas existing reviews have generally focused on just one aspect of HAD 113,114 . The aim of this review was to be all‐encompassing, to narratively outline the current evidence and highlight the main research gaps.…”

Nutritional Orthopedics and Space Nutrition as Two Sides of the Same Coin: A Scoping Review

“…Summary IV. A total of 20 references ( [10,33,53,90,[116][117][118][119][120][121][122][123][124][125][127][128][129][130]133,134]) were used to scope the following nutritional commonalities between hospital-associated vs. space-associated deconditioning/resilience. The significance of having an efficient food system that contributes to the maintenance of the individual's good nutritional status; the goal of reducing nutritional deficits and the intake of counterproductive substances; the importance of meal timing; the need to balance the musculoskeletal involution; the goal to avoid the recurrence of osteosarcopenia-related traumas.…”

“…It is of paramount importance to overcome a pre-existing/hospital-derived osteosarcopenia, as it is known to be associated with poor outcome after surgery and increased risk of new fall-related traumas [120]. Undesirably, there remains uncertainty on how to defy this decay [121], and (with current knowledge) the further we move away from the peak of bone mass the more we are destined to fall.…”