Background
Methods
Search strategy
Study selection
Data extraction and analysis
Results
Author | Yeara | Reason for hospitalization Setting (acute/ subacute, ward) | Group | Moment of measurement | Outcomesc# | PEDro scaled | |
---|---|---|---|---|---|---|---|
Intervention Nb, type, age (y) | Control Nb, type, age (y) | ||||||
Bürge [21] | 2017 | Dementia Acute, psychogeriatric ward | 78, Physical exercise program, 81.7 (7.7) | 82, Usual care, 81.1 (7.7) | A, 4 weeks after A |
BI
e
, FIM
f
| Sufficient |
Czyzewski [17] | 2013 | Major abdominal surgery Subacute, general and colorectal surgery ward | 18, Physiotherapy based on elements of proprioceptive neuromuscular facilitation, 75 (5.8) | 16, Usual care, 76 (5.6) | 3 days before surgery, 4 days after surgery |
10MWT
g
, TUG
h
, SAP
i
| Sufficient |
Haines [23] | 2007 | Various diagnoses (e.g. orthopaedic, geriatric management, stroke) Subacute, NG | 93, Additional exercise program, 83 (IQR 77,88) | 80, Usual care, 81 (IQR 75,86) | A, D | Number of falls, FRTj, TUGh, 6MWTk, Gait velocity, Step length, Muscle strength | Good |
Hegerova [22] | 2014 | Various diagnoses (e.g. cardiovascular, infection, kidney) Acute, internal medicine ward | 100, Rehabilitation and nutritional intervention, 83.6 (3.8) | 100, Usual care, 83.2 (3.8) | Day 2 of A, D | Lean body Mass, BIe, | Good |
Jones [25] | 2006 | NG Acute, general ward | 80, Exercise program, 81.9 (8.0) | 80, Usual care, 82.9 (7.6) | Within 2 days of A, D |
ModifiedBI
e
, TUG
h
| Sufficient |
Kim [15] | 2013 | NG Subacute, NG | 15, Horse riding simulation, 78.4 (6.2) | 15, Ball exercise, 78.5 (6.6) | A, 8 weeks after A |
Romberg test, FRT
j
TUG
h
, 10MWT
g
| Good |
Laver [24] | 2012 | Various diagnoses (e.g. medical, pain, fall or fracture) Subacute, geriatric rehabilitation ward | 22, Interactive gaming program, 85.2 (4.7) | 22, Usual care, 84.6 (4.4) | Day 2 of A, D | TUGh, ModifiedBBSl, SPPBm, IADLn, FIMf, ABCo | Good |
Maggioni [37] | 2009 | Various diagnoses (e.g. cardiovascular, orthopaedic, neurological) Subacute, rehabilitation ward | 1. 10, Kinesiotherapy (KT), 81.2 (5.9) 2. 10, Electrical stimulation (ES), 84.1 (3.4) 3. 10, KT + ES, 82.2 (7.4) | 10, Usual care, 82.1 (5.4) | A, D | Muscle strength, 6MWTk, Tinetti balance and gait test | Good |
de Morton [19] | 2007 | Various diagnoses (e.g. respiratory, circulatory, digestive) Acute, medical ward | 110, Exercise program, 80 (8.0) | 126, Usual care, 78 (7.0) | A, D | Discharge destination, TUGh, BIe, FACp, | Good |
Oesch [28] | 2017 | Musculoskeletal impairment Subacute, geriatric rehabilitation ward | 26, Self-regulated exergames, 73.8 (IQR 67.9, 79.1) | 28, Self-regulated conventional exercises, 74.3 (IQR 66.1, 79.3) | A, 10 days after A | Adherence, objective dynamic balance | Good |
Parsons [16] | 2016 | Various diagnoses (e.g. cardiovascular, musculoskeletal, neurological) Subacute, rehabilitation ward | 26, Physical therapy and vibration training, 82.1 (6.4) | 24, Usual care, 81.8 (8.0) | A, D | PPAq(muscle strength), FIMf | Good |
Raymond [26] | 2017 | Various diagnoses (e.g. fracture, fall, respiratory) Subacute, rehabilitation ward | 231, High-intensity functional exercise, 84.5 (7.3) | 223, Usual care, 84.1 (6.9) | A, < 48 before D | EMSr, BBSl, gait speed, TUGh | Good |
Said [20] | 2012 | Various diagnoses (e.g. musculoskeletal, cardiovascular, falls) Subacute, rehabilitation ward | 22, Exercise program, 80.8 (4.6) | 25, Usual care, 81.6 (6.5) | Within 2 days of A, < 48 h before D | DEMMIs, EMSr, TUGh, BIe | Good |
Tibaek [27] | 2013 | Various diagnoses (e.g. falls, respiratory, medicine) Subacute, geriatric rehabilitation ward | 29, Progressive resistance strength training, 80 (6.5) | 27, Usual care, 79 (7.5) | Within 3 days of A, D | TUGh, 30s-chair stand test, 10MWTg, BIe, Modified FACp | Good |
Wnuk [18] | 2016 | Abdominal aortic aneurysm surgery Subacute, general and vascular surgery ward | 1. 15, Backward walking training, 68 (3) 2. 16, Forward walking training, 70 (3) | 16, Usual care, 69 (4) | A, 7 days after surgery |
6MWT
k
| Good |
Characteristics of the physical interventions
Author | Yeara | Intervention | Characteristics of the intervention | ||||
---|---|---|---|---|---|---|---|
Patient tailored (yes, intermediate, nob and a brief description) | Frequency per week | Duration of one session (min) | Duration of intervention (days) | Adherence (%)c | |||
Bürge [21] | 2017 | Physical exercise program: group training including strength, flexibility, walking and balance. | Yes, intensity of the exercises increased gradually during the training and was adapted to individual patient abilities. | 5 | 30 | 20 | 66 |
Czyzewski [17] | 2013 | Physiotherapy based on elements of proprioceptive neuromuscular facilitation: respiratory exercises and change of position using manual resistance on sternum, upper and lower limbs, repeated initial stretch and bilateral symmetric moving standards of shoulder girdle and upper limbs. | Yes, exercises were individualized with an intensity in the range of 40–50% of maximal frequency of heart rate, and instructions for individual practice were provided. | 5 | 30 | 7 | NG |
Haines [23] | 2007 | Additional exercise program: by applying therapeutic principles of tai chi with functional movements an activity visualization. | Intermediate, exercises could be tailored to match individual patient abilities. | 3 | 45 | 27.9 | 75 |
Hegerova [22] | 2014 | Rehabilitation and nutritional intervention: including training of the lower limbs and therapeutic physical training. | Yes, training of lower limbs and therapeutic physical training were tailored to individual patient abilities. Intensity was determined by an increase of heart rate by a maximum of 15 beats. The heart rate was continuously monitored. | 24 | 5 and 15 | 11 (7) | NG |
Jones [25] | 2006 | Exercise program: for the upper limb, lower limb, and trunk including four levels: 1. bed exercise; 2. sitting exercise; 3. standing/walking exercise; 4. stair exercise. | Intermediate, level of an exercise program was dependent of baseline functional status of the patient. The exercise program was tailored to the individual patient abilities. | 14 | NG | Median (IQR) 9 (4, 16) | NG |
Kim [15] | 2013 | Horse riding simulation: imitation of three-dimensional movements (forward and backward, left and right, and up and down) of a live horse. | Yes, the speed of the simulator was adjusted to individual patient abilities while the simulator was moving. | 5 | 20 | 56 | NG |
Laver [24] | 2012 | Interactive gaming program: Nintendo Wii Fit activities on balance, strength or developing aerobic capacity. | Intermediate, activities were selected based on individual patient abilities and treatment needs. | 5 | 25 | 12.3 (5.6) | 90 |
Maggioni [37] | 2009 | Three lower limb rehabilitation programs:1. Kinesiotherapy (KT); 2. Electrical stimulation (ES); 3. KT + ES | Intermediate, for KT, load of isotonic exercises was adjusted based on the ability to perform a series of 15–20 repetitions and contractions of isometric exercises were kept for 6–10 s for 10–15 repetitions. For ES, stimulation amplitude was set to the patient’s point of discomfort. Stimulation frequency increased from 35 Hz to 75 Hz to 85 Hz per six sessions. | 3 | 45 | 42 | NG |
de Morton [19] | 2007 | Exercise program: for the upper limb, lower limb, and trunk including four levels. 1. bed exercise; 2. sitting exercise; 3. standing exercise; 4. stair exercise. | Yes, level of an exercise program was prescribed by the project physiotherapist and exercises were tailored to the individual patient abilities. Exercise resistance was increased when patients could do 10 repetitions. | 10 | 20–30 | Median (IQR) 5 (3.0, 9.8) | NG |
Oesch [28] | 2017 | Exergames: Seven mini-games for balance, leg strength and flexibility including three levels: 1. sitting exercise, 2. standing exercise 3. walking exercise. | Intermediate, exercise level could be tailored to match individual patient balance abilities. | 10 | 60 | 10 | 58 |
Parsons [16] | 2016 | Physiotherapy and vibration training: group based physiotherapy and individualized progressive walking programs and whole body vibration consisting of six static exercises targeting lower limb muscles. | Yes, load of the vibrating platform was set at 30–50 Hz and the amplitude was adjusted to individual patient abilities so that the heart rate remained below 85% age-predicted maximal heart rate. Volume and intensity increased progressively according to the overload principle. | 5 and 3 | 30–45 and NG | 8.8 | NG |
Raymond [26] | 2017 | Progressive resistance strength training, exercises lower limb in supported and unsupported positions, and balance exercises challenging postural stability. | Intermediate, exercises targeted varying levels of mobility. Average intensity level was rated by a staff member after each training. | 5 | 45–60 | Median (IQR) 12.3 (11.0, 13.5) | NG |
Said [20] | 2012 | Exercise program: for the upper limb, lower limb, and trunk to improve lower limb strength and balance including four levels. 1. bed exercise; 2: sitting exercise; 3: standing / walking exercise; 4: stair exercise. | Yes, exercises were tailored to the individual patient abilities. Progress was monitored during each session and the intervention was modified based on improvements in the patient’s function. | 5–10 | NG | Median (IQR) 15 (11.5, 20) | 90 |
Tibaek [27] | 2013 | Progressive resistance strength training: 1.Exercises in sitting position; 2. Stand up from sitting to standing position; 3.Walking sideways; 4. Elevation up and down on the toes performed in standing position; 5. Training in stair-stepping machine. | Intermediate, load of exercises was determined based on 60–70% of one repetition maximum. Load was increased by a 0.5 kg sandbag and by an elastic band with different resistance when the patient reported that the load was easy or moderate on the modified Borg Scale and could do more than 15 repetitions. | 4 | 50 | 28 (15) | 62.5 |
Wnuk [18] | 2016 | Physiotherapy program: consisted of education, active exercises of the upper and lower extremities and backward or forward walking on an interval training cycle. | Yes, intensity of the interval training cycle was adjusted to individual patient abilities based on a stress test and a calculated training heart rate. The heart rate and blood pressure were continuously monitored. Workload increased gradually during the training. | 18 | 1–24 | 7 | NG |
Effects of the physical interventions
Author | Yeara | Outcomeb# | Group | Pe | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Intervention | Control | |||||||||
Pre | Δcd | Pre | Δcd | |||||||
Bürge [21] | 2017 |
Barthel Index
| 13.4 (4.4) | 0 (6.0) | 13.3 (4.1) | −0.8 (6.4) | – | |||
Functional Independence Measure
| 79.7 (21.5) | −0.7 (30.7) | 77.7 (19.3) | −3.3 (29.6) | – | |||||
Czyzewski [17] | 2013 |
10-Meter Walk Test, sec
| NG | 4.2 | NG | 4.6 | – | |||
Time Up and Go, sec
| NG | 2.8 | NG | 3.7 | – | |||||
Scale of independent postoperative patient’s activity
| NG | 36.9 (6.9)f | NG | 28.3 (6.7)f | +++ | |||||
Haines [23] | 2011 |
Falls, falls/1000 patient-days
| NG | 10.0 - pre | NG | 21.2 - pre | +++ | |||
Absolute improvement FRTg, cm, median, IQR | 10 (6, 14.8) | 9.3 (4, 14.9) | 10,8 (2.8, 19) | 0.3 (2.5, 7.6) | +++ | |||||
Rate of improvement FRTg, cm, median, IQR | NG | 0.4 (0.2, 0.8) | NG | 0.0 (0.1, 0.5) | ++ | |||||
Time Up and Go, sec, median, IQR | 34 (23, 48) | 11.1 (3.7, 22.1) | 29 (21, 48) | 8.1 (1.9, 14.2) | – | |||||
6-Minute Walking Test, m, median, IQR | 130 (80, 203) | 45 (7.5, 91.3) | 140 (85, 204) | 65 (23.8, 111.2) | – | |||||
Gait velocity, m/s, median, IQR | 0.5 (0.3, 0.6) | 4.7 (0.7, −10.8) | 0.5 (0.3, 0.6) | 3 (0.7, 7.8) | – | |||||
Step length, cm, median, IQR | 35 (22, 43) | 0.2 (0.8, 6) | 33 (26, 43) | 2 (1.1, 12) | – | |||||
Step test-left, steps, median, IQR | 1.5 (0, 6.8) | 2 (0, 5.3) | 1 (0, 8) | 2 (0. 7) | – | |||||
Step test-right, steps, median, IQR | 0 (0, 7) | 2 (0,5) | 2,5 (0, 7.8) | 2 (0. 6) | – | |||||
Knee extension – right, kg, median, IQR | 10 (7, 16) | 2 (0, 4) | 11 (9, 15) | 1 (−1, 3) | – | |||||
Knee extension – left kg, median, IQR | 10 (8, 15) | 1 (−1, 3) | 12 (9, 16) | 0 (−1, 3) | – | |||||
Knee flexion – right kg, median, IQR | 8 (6, 11) | 1 (0, 4) | 8 (6, 11) | 1 (−1, 3) | – | |||||
Knee flexion – left kg, median, IQR | 8 (6, 10) | 2 (0, 4) | 8 (6, 10) | 0 (−1, 3) | – | |||||
Hip abduction – right kg, median, IQR | 6 (4, 8) | 1 (0, 3) | 6 (5, 8) | 1 (−1, 4) | – | |||||
Hip abduction – left kg, median, IQR | 5 (3.8, 6) | 2 (0, 4) | 5 (4, 7) | 0.5 (−1, 3.8) | – | |||||
Ankle dorsiflexion – right kg, median, IQR | 6 (4, 9) | 1 (0, 3) | 7 (5, 8.8) | 0.5 (−1, 2) | – | |||||
Ankle dorsiflexion – left kg, median, IQR | 6 (4,8) | 2 (0, 4) | 6 (5, 8) | 1 (−0.3, 2) | – | |||||
Hegerova [22] | 2014 |
Lean Body Mass, kg
| NG | 30.6 (9.1) – pre | NG | 30.9 (10.9) – pre | – | |||
Barthel Index | NG | 93.2 (7.7) – pre | NG | 91.3 (10.0) – pre | – | |||||
Jones [25] | 2006 |
Modified Barthel Index – median, IQR
| 71 (51.5, 83.0) | 11 (3.2) | 61 (40.5, 82.5) | 9 (2.2) | – | |||
Time Up and Go, decrease in s, median, IQR | 24.2 (15.8,37,3) | 5.4 (1.0, 12.4) | 21.5 (16.9, 25.9) | 1.2 (−0.9, 4.3) | + | |||||
Kim [15] | 2013 |
Romberg test (eyes open)
| 48.9 (11.6) | −3.7 (17.1) | 51.4 (15.3) | −13.0 (18.7) | – | |||
Romberg test (eyes closed)
| 64.2 (21.0) | −18.1 (26.2) | 62.3 (20.3) | −20.4 (23.4) | – | |||||
Functional Reach Test, cm
| 14.8 (5.0) | 14.0 (7.4) | 15.3 (5.0) | 6.9 (7.0) | + | |||||
Time Up and Go, sec
| 18.9 (8.2) | −6.1 (9.3) | 20.0 (7.1) | −3.5 (8.4) | + | |||||
10-Meter Walk Test, sec
| 13.5 (6.9) | −6.3 (7.2) | 12.4 (5.8) | −2.7 (7.4) | + | |||||
Laver [24] | 2012 |
Time Up and Go, sec
| 38.0 (18.8) | −10.1 (33.6) | 35.4 (19.1) | −6.6 (22.4) | + | |||
Modified Berg Balance Scale | 28.1 (9.6) | 4.0 (11.6) | 28.7 (9.8) | 1.6 (13.2) | + | |||||
Short Physical Performance Battery | 4.0 (2.9) | −0.7 (4.0) | 3.4 (2.4) | −0.2 (3.6) | – | |||||
Instrumental Activities of Daily Living Scale, sec | 181.0 (110.0) | 24.1 (149.1) | 141.5 (77.1) | 48.1 (120.7) | – | |||||
Functional Independence Measure | 100.5 (16.7) | 8.2 (23.0) | 93.9 (21.3) | 14.8 (26.1) | – | |||||
Activities-patient tailored Balance Confidence scale | 41.1 (18.0) | 0.6 (25.9) | 41.8 (20.2) | 4.5 (27.7) | – | |||||
Maggioni [37] | 2009 |
Maximal Voluntary Contraction
| NG | KT 3.4 (7.0) | ES 7.8 (5.9) | KT + ES 10.5 (7.3) | NG | −0.3 (6.8) | -* | |
30°/BW quadriceps, N/kg, % of A
Maximal Voluntary Contraction
| NG | 8.2 (6.7) | 25.8 (11.3) | 16.3 (5.2) | NG | 4.9 (5.9) | -* | |||
60°/BW quadriceps, N/kg, % of A
Maximal Voluntary Contraction, finger flexur. N/kg, % of A
| NG | 2.7 (3.0) | 4.0 (11.1) | 7.9 (6.1) | NG | −0.5 (3.0) | -* | |||
6-min Walk Test, m, % of A
| NG | 14.9 (6.5) | 14.0 (4.6) | 9.6 (4.3) | NG | 8.1 (4.0) | -* | |||
Balance, Tinetti test, % of A
| NG | 11.3 (4.6) | 9.4 (3.7) | 11.3 (3.0) | NG | 2.0 (4.6) | -* | |||
Gait, Tinetti test, % of A
| NG | 8.2 (4.2) | 9.8 (6.9) | 0.8 (3.3) | NG | 0.9 (3.2) | -* | |||
de Morton [19] | 2007 |
Time Up and Go, sec
| 35 (30) | −10 (19) | 30 (28) | −5 (10) | – | |||
Barthel Index | 66 (26) | 12 (16) | 68 (26) | 10 (14) | – | |||||
Functional Ambulation Categories | 4.0 (1.5) | 0.7 (1.0) | 3.9 (1.6) | 0.8 (1.3) | – | |||||
Oesch [28] | 2017 | Objective dynamic balance | 1.4 (0.2) | −0.0 (95% CI -0.1, 0.1) | 1.4 (0.2) | 0.0 (95% CI -0.0, 0.1) | – | |||
Parsons [16] | 2016 |
Physiological Profile Assessment Score, Quadriceps strength, kg
| 28.4 (15.5) | 2.6 | 29.52 (19.1) | 2.0 | – | |||
Functional Independence Measure | 91.7 (14.6) | 12.0 | 93.2 (13.2) | 19.7 | + | |||||
Raymond [26] | 2017 |
Elderly Mobility Scale, median, IQR
| 11 (7.0, 15) | 5 | 11 (8.0, 15) | 5 | – | |||
Berg Balance Scale, median, IQR | 30 (20, 4) | 8 | 32 (19, 38) | 6 | + | |||||
Gait speed (m/s), median, IQR | 0.4 (0.3, 0.6) | 0.1 | 0.5 (0.3, 0.6) | 0.1 | – | |||||
Time Up and Go, sec, median, IQR | 29 (20, 42) | −7 | 29 (23, 42) | −5 | – | |||||
Functional Reach Test, cm, median, IQR | 8.0 (0, 14) | 4 | 10 (1.5, 15) | 4 | – | |||||
Said [20] | 2012 |
de Morton Mobility Index
| 41.4 (12.9) | 9.6 (8.8) | 43.2 (16.2) | 7.2 (9.2) | – | |||
Elderly Mobility Scale, median, IQR | 15 (7, 17) | NG | NG | 12 (7,17) | NG | |||||
Time up and Go, participants | 35.5 (11.8) | NG | NG | 31.3 (12.4) | NG | |||||
Barthel Index, median, IQR | 66 (55, 76) | 85.0 (73, 95) | 68, (60, 78) | 86.5 (68, 98) | – | |||||
Tibaek [27] | 2013 |
Time Up and Go, sec
| 25.8 (11.8) | −6 (14.9) | 25.7 (14.6) | 4.3 (17.7) | – | |||
30s-chair stand test, n
| 5.0 (3.3) | 2.5 (5.2) | 4.5 (3.8) | 2.3 (4.9) | – | |||||
10-Meter Walk Test, sec
| 19.1 (7.8) | −5.4 (9.1) | 18.6 (12.2) | −4.5 (13.1) | – | |||||
Barthel Index transfer | 13.1 (3.3) | 1.8 (3.4) | 13.9 (2.1) | 0.3 (3.3) | – | |||||
Barthel Index walking | 12.0 (4.5) | 2.0 (4.9) | 12.4 (3.3) | 1.2 (5.2) | – | |||||
Barthel Index stairs | 4.2 (4.2) | 3.8 (5.4) | 5.9 (4.4) | 3.3 (4.9) | + | |||||
Modified Functional Ambulatory Categories | 11.6 (5.8) | 1.6 (9.0) | 11.3 (6.8) | 3.5 (8.7) | – | |||||
Wnuk [18] | 2016 |
6-min Walk Test, m
| BW 362.3 (41.7) | FW 338.3 (70.8) | BW −39.9 (76.9) | FW −34.0 (101.6) | 324.2 (64.0) | −66.2 (88.0) | +** |