Rehabilitation interventions with deconditioned older adults following an acute hospital admission: a systematic review

Abstract

Objective: To determine effectiveness of inpatient rehabilitation interventions with older deconditioned adults following an acute hospital admission. Data sources: Systematic review of randomised controlled trials (RCTs) from 14 electronic databases from their inception to February 2014. Review methods: Studies selected concerned inpatient rehabilitation, single or multi-factorial interventions, conducted by any discipline, where participants were aged 55 years or older and 50% or more could be classed as deconditioned. Studies were excluded if they focused on acute onset of disability conditions. Data were extracted using the McMaster Quantitative Review Form and appraised using the PEDro Rating Scale. Results: No RCTs were found that specifically addressed the aim. Four studies were reviewed describing multi-disciplinary rehabilitation programs that aimed to reduce functional decline in older adults, with inconsistent findings. However, in two studies participants showed a positive improvement in completing basic activities of daily living (ADL) following multi-disciplinary rehabilitation, one at discharge (median change score Intervention (I)0.23:Control (C)0.15, P=<0.001) and one at 12-months post discharge (I-48.4%: C-25.4% ( P‹0.001) Relative Risk (RR)1.90 95%CI: 1.15-3.16 (reviewer calculated)). Discharge to home was also measured in two studies with participants in the intervention groups having a higher probability of going home (I-55.6%: C-36.7 %, RR 1.52 95%CI: 1.02-2.26 (reviewer calculated) and I-60%: C-20%, RR 3.00 95%CI: 1.16-7.73(reviewer calculated)). Conclusion: No RCTs have been conducted to examine the effectiveness of specific recondition-ing interventions in rehabilitation, and there is currently insufficient evidence to support the use of geriatric rehabilitation programs to reduce functional decline in older adults who are deconditioned.