The Effect of Caregiver-Mediated Mobility Interventions in Hospitalized Patients on Patient, Caregiver, and Health System Outcomes: A Systematic Review

Abstract

Objective To synthesize the evidence examining caregiver-mediated mobility interventions in a hospital setting and whether they improve patient, caregiver, or health system outcomes. Data Sources We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to September 7, 2018. Study Selection Two reviewers independently selected original research in inpatient settings that reported on an intervention delivered by a caregiver (eg, family, friend, paid worker) and directed to the patient’s mobility. Mobility interventions were categorized based on the level of caregiver engagement using a 3-category framework: inform (provision of education on patient’s condition and management), activate (prompting caregivers to take action in patient care), and collaborate (encouraging interaction with providers or other caregivers). Data Extraction One reviewer extracted data, and another checked the data. Quality was assessed using the Cochrane Collaboration’s risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation approach. Data Synthesis Forty studies met the inclusion criteria; most were randomized controlled trials (n=16/40, 40.0%) and investigated older adults (n=18/40, 45.0%) with stroke (n=20/40, 50.0%). Inform (n=2) and activate (n=4) interventions and combined inform-activate (n=5/6, 83.3%) and inform-activate-collaborate (n=6/10, 60.0%) interventions were reported to improve patient mobility. Inform-activate and inform-collaborate interventions were reported to improve caregiver outcomes (eg, burden) (n=13/19, 68.4%). Studies that engaged caregivers in all 3 strategies ( inform-activate-collaborate ) were reported to improve health system outcomes (eg, hospital readmission) (n=4/6, 66.7%). Most studies were of unclear (n=22/40, 55.0%) or low risk of bias (n=11/40, 27.5%) for most domains. Conclusions Engaging caregivers in mobility of hospitalized patients may improve patient mobility as well as caregiver and health system outcomes.

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

“…Overall, seven systematic reviews were assigned a moderate rating for overall confidence in review results (more than one non-critical weakness but no critical flaws) [ 15 , 40 , 42 , 45 , 47 – 49 ], four a low rating (one critical flaw – study selection not in duplication or failure to consider risk of bias for interpretation) [ 17 , 41 , 43 , 46 ], and one a critically low rating (more than one critical flaw) [ 44 ]. Almost all included systematic reviews met the requirements for defining an appropriate research question ( n = 12) [ 15 , 17 , 40 – 49 ], search strategy ( n = 11) [ 15 , 17 , 40 – 43 , 45 – 49 ], study selection ( n = 11) [ 15 , 17 , 40 – 45 , 47 – 49 ], risk of bias assessment ( n = 11) [ 15 , 17 , 40 – 43 , 45 – 49 ], explanation of heterogeneity in analyses ( n = 9) [ 15 , 17 , 40 – 42 , 45 , 46 , 48 , 49 ], and declaring sources of conflicts of interest ( n = 12) [ 15 , 17 , 40 – 49 ]. Most systematic reviews failed to explain their selection of the study designs for inclusion ( n = 11) [ 15 , 17 , 40 – 42 , 44 – 49 ], declare sources of funding for studies included in the review ( n = 11) [ 15 , 40 – 49 ] and/or carry out an adequat...…”

“…Almost all included systematic reviews met the requirements for defining an appropriate research question ( n = 12) [ 15 , 17 , 40 – 49 ], search strategy ( n = 11) [ 15 , 17 , 40 – 43 , 45 – 49 ], study selection ( n = 11) [ 15 , 17 , 40 – 45 , 47 – 49 ], risk of bias assessment ( n = 11) [ 15 , 17 , 40 – 43 , 45 – 49 ], explanation of heterogeneity in analyses ( n = 9) [ 15 , 17 , 40 – 42 , 45 , 46 , 48 , 49 ], and declaring sources of conflicts of interest ( n = 12) [ 15 , 17 , 40 – 49 ]. Most systematic reviews failed to explain their selection of the study designs for inclusion ( n = 11) [ 15 , 17 , 40 – 42 , 44 – 49 ], declare sources of funding for studies included in the review ( n = 11) [ 15 , 40 – 49 ] and/or carry out an adequate investigation of potential publication bias ( n = 5) [ 40 , 42 , 43 , 46 , 47 ].…”

“…Most systematic reviews failed to explain their selection of the study designs for inclusion ( n = 11) [ 15 , 17 , 40 – 42 , 44 – 49 ], declare sources of funding for studies included in the review ( n = 11) [ 15 , 40 – 49 ] and/or carry out an adequate investigation of potential publication bias ( n = 5) [ 40 , 42 , 43 , 46 , 47 ].…”

Can telerehabilitation services combined with caregiver-mediated exercises improve early supported discharge services poststroke? A study protocol for a multicentre, observer-blinded, randomized controlled trial

“…Telerehabilitation and CME may be resource-efficient strategies to augment exercise therapy and continue rehabilitation in the home setting. The current evidence suggests that telerehabilitation and CME are at least equally effective, when compared to usual care [ 13 , 79 – 81 ]. However, we would like to stress the importance of using these strategies to augment or extend rehabilitation instead of replacing traditional rehabilitation.…”

Comparing two identically protocolized, multicentre, randomized controlled trials on caregiver-mediated exercises poststroke: Any differences across countries?

“…In a recent collaboration, we simultaneously conducted two RCT’s in Australia (ACTRN12613000779774) and the Netherlands (NTR4300). Both studies investigated the effect of a Caregiver-Mediated Exercises (CME) intervention with e-health support [ 8 , 9 ], which may be a valuable intervention to augment exercise therapy and improve functional outcome after stroke [ 10 , 11 ]. Although the primary outcome of both trials was neutral with respect to patients’ self-reported mobility, different significant results regarding secondary psychosocial outcomes were found.…”