Background
Method
Search strategy
Data extraction and analysis
Methodological quality
Results
Selected studies
Methodological quality
Study | Randomized | Treatment allocation concealed | Groups similar at baseline | Eligibility criteria specified | Outcome assessor blinded | Care provider blinded | Patient blinded | Variability measures | Intention-to-treat analysis | Total (max 9) |
---|---|---|---|---|---|---|---|---|---|---|
Abizanda [16] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 7 |
Asplund [17] | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 4 |
Blanc-Bisson [18] | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 5 |
Counsell [19] | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 6 |
1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 7 | |
De Morton [22] | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 5 |
Jones [23] | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 5 |
Landefeld [24] | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 3 |
Laver [14] | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 7 |
Nikolaus [25] | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 6 |
1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 5 | |
Siebens [28] | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 5 |
Slaets [29] | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 4 |
Inclusion criteria and patient characteristics
Study | Population & Setting | Intervention | Time of assessment | |||||
---|---|---|---|---|---|---|---|---|
(I)ADL | Physical Performance | Mortality (%) | LOS (days) | Discharge ICF (%) | ||||
Multidisciplinary care with an exercise component
| ||||||||
Asplund 2000 [17] |
Intervention (n=190) | Multidisciplinary team, with physical and occupational therapy. Discharge planning and early rehabilitation. | T0 Admission | BI ≥ 19 points | NA | T1 4.2 | 5.9*
| T1 11.6 |
Mean age 80.9 years | T1 Discharge | T0 52% | T2 11.1 | T2 11.6 | ||||
58% female, AGU, UH | T2 3 months post-discharge | T2 44% | ||||||
Control (n=223) | General medical unit care | BI ≥ 19 points | T1 2.7 | 7.3*
| T1 19.3 | |||
Mean age 81.0 years | T0 44% | T2 7.6 | T2 18.4 | |||||
63% female, MU, UH | T2 43% | |||||||
Counsell 2000 [19] |
Intervention (n=767) † | Multidisciplinary team, with daily assessment of physical functioning and protocols to improve self-care and mobility. Early discharge planning. | T0 2 weeks pre-admission | ADL decline | PPME score | T1 2.7 | 6.1 | T1 12.9 |
Mean age 80 years | T1 Discharge | T1 30% | T1 5.6*
| T2 9.0 | T2 10.3 | |||
60% female, CH | T2 1 months post-discharge | T2 27% | T3 15.9 | T3 8.9 | ||||
T3 3 months post-discharge | T3 26% | T4 22.6 | T4 7.5 | |||||
T4 6 months post-discharge | T4 22% | T5 31.4 | T5 6.7 | |||||
T5 1 year post-discharge | T5 25% | |||||||
Control (n=764) † | Usual physician and nursing staff care | ADL decline | PPME score | T1 3.7 | 6.3 | T1 15.6 | ||
Mean age 79 years | T1 34% | T1 5.0*
| T2 11.3 | T2 10.1 | ||||
61% female, CH | T2 29% | |||||||
T3 26% | T3 17.4 | T3 7.2 | ||||||
T4 30% | ||||||||
T5 30% | T4 22.5 | T4 8.0 | ||||||
T5 29.2 | T5 7.3 | |||||||
Landefeld 1995 [24] |
Intervention (n=327) | Multidisciplinary program, with daily assessment of physical functioning and protocols to improve self-care and mobility | T0 Admission | ADL score: | NA | T1 7.3 | 7.3 | T1 5.8*
|
Mean age 80.2 years | T1 Discharge | T0 3.0 | T2 20.8 | T2 13.1*
| ||||
68% female, MU, CH | T2 3 months post-discharge | T1 3.6*
| ||||||
T2 4.0 | ||||||||
IADL score: | ||||||||
T0 2.8 | ||||||||
T1 3.3*
| ||||||||
T2 3.9 | ||||||||
Control (n=324) | Usual care services provided by physicians and nurses | ADL score: | T1 7.4 | 8.3 | T1 11.7*
| |||
Mean age 80.1 years | T0 3.0 | T2 19.8 | T2 18.8*
| |||||
65% female, MU, CH | ||||||||
T2 3.8 | ||||||||
IADL score: | ||||||||
T0 2.8 | ||||||||
T2 3.8 | ||||||||
Intervention (n=127) † | Interdisciplinary program to prevent complications, with early mobilization, rehabilitation and discharge planning | T0 Admission | ADL dependence | NA | T1 11.8*
| 15*
| NA | |
Mean age 81.8 years | T1 3 months post-discharge | T1 21% | T3 26.8*
| |||||
81% female, GU, UH | T2 6 months post-discharge | T2 13% | ||||||
T3 1 year post-discharge | T3 25% | |||||||
IADL dependence | ||||||||
T1 46% | ||||||||
T2 44% | ||||||||
T3 45% | ||||||||
Control (n=127) † | Usual care | ADL dependence | T1 27.6*
| 7*
| ||||
Mean age 82.4 years | T1 12% | T2 33.9*
| ||||||
84% female, MU, UH | T2 13% | |||||||
T3 23% | ||||||||
IADL dependence | ||||||||
T1 39% | ||||||||
T2 40% | ||||||||
T3 44% | ||||||||
Slaets 1997 [29] |
Intervention (n=140) | Multidisciplinary program added to the usual care. Geriatrician, physiotherapist and liaison nurse obtained optimal ADL and mobility in 2 hours training a day. | T0 Admission | Improved ADL | Improved mobility | NA | 19.7*
| T2 18*
|
Mean age 82.5 years | T1 Discharge | T1 61%*
| T1 48%*
| |||||
67% female , MU, CH | T2 1 year post-discharge | |||||||
Control (n=97) | Usual care: services provided by physicians and nurses. | Improved ADL | Improved mobility | 24.8*
| T2 27*
| |||
Mean age 83.2 years | T1 46%*
| T1 44%*
| ||||||
75% female, MU, CH | ||||||||
Usual care programs with an exercise intervention
| ||||||||
Abinzanda 2011 [16] |
Intervention (n=198) | Conventional treatment plus occupational therapy: 5 days per week, 30 - 45 min a day | T0 Admission | 55.6% improved ≥ 10 BI points | NA | T1 7.6 | 9.1 | NA |
Mean age 83.7 years | T1 Discharge | |||||||
56.6% female, AGU, UH | ||||||||
Control (n=202) | Conventional treatment: medical treatment, nursing care, physical therapy, and social assistance according with the usual practice of the unit. | 36.7% improved ≥ 10 BI points | T1 11.9 | 8.7 | ||||
Mean age 83.3 years | ||||||||
56.9% female, AGU, UH | ||||||||
Blanc-Bisson 2008 [18] |
Intervention (n=38) | Usual care plus early intensive physical therapy program: start day 1-2, strength training twice a day half an hour, 5 days a week until T1 | T0 Admission | Mean Katz index | NA | T1 5.3 | T1 12.6 | NA |
Mean age 85.5 years | T1 Clinical stability | T0 6.7 | T2 7.9 | |||||
66% female, AGU, UH | T2 1 month after clinical stability | T1 5.3 | ||||||
T2 4.5 | ||||||||
Control (n=38) | Usual care: transferred to arm-chair asap. Start day 3-6 walking 3 times a week with human help or without assistance. Physical therapy at home for 1 month | Mean Katz index | T1 5.3 | T1 12.6 | ||||
Mean age 85.4 years | T0 6.0 | T1 5.3 | ||||||
79% female, AGU, UH | T1 4.7 | |||||||
T2 3.0 | ||||||||
Intervention (n=64) † | Individual exercise program and nursing visits, performed daily or several times a week. The intervention continued at home with home visits and regular telephone follow-up by a nurse. | T0 Admission | ADL: Mean score | WIQ distance*
| T1 1.6 | 4.6 | NA | |
Mean age 78.1 years | T1 4 weeks post-discharge | index of ADL*
| T0 23.54 | T2 3.1 | ||||
62% female, MU, CH | T2 12 weeks post-discharge | T0 0.36 | T1 53.62 | T3 3.1 | ||||
T3 24 weeks post-discharge | T1 0.07 | T2 54.83 | ||||||
T2 0.18 | T3 62.89 | |||||||
T3 0.16 | WIQ speed*
| |||||||
IADL: Mean IADL scale*
| T0 16.21 | |||||||
T0 2.16 | T1 41.30 | |||||||
T1 1.47 | T2 44.62 | |||||||
T2 1.27 | T3 48.56 | |||||||
T3 1.13 | WIQ stairs*
| |||||||
T0 27.70 | ||||||||
T1 46.73 | ||||||||
T2 51.23 | ||||||||
T3 57.20 | ||||||||
Control (n=64) † | Routine care, discharge planning and rehabilitation advice. If necessary, in-home follow-up. | ADL: Mean score index of ADL*
| WIQ distance*
| T1 4.7 | 4.7 | |||
Mean age 79.4 years | T0 0.35 | T0 20.22 | T2 4.7 | |||||
63% female, MU, CH | T1 0.69 | T1 28.90 | T3 4.7 | |||||
T2 0.75 | T2 21.59 | |||||||
T3 1.27 | T3 19.93 | |||||||
IADL: Mean IADL scale*
| WIQ speed*
| |||||||
T0 2.62 | T0 14.43 | |||||||
T1 3.29 | T1 22.09 | |||||||
T2 3.56 | T2 17.89 | |||||||
T3 4.33 | T3 16.58 | |||||||
WIQ stairs*
| ||||||||
T0 24.12 | ||||||||
T1 26.06 | ||||||||
T2 24.40 | ||||||||
T3 22.18 | ||||||||
De Morton 2007 [22] |
Intervention (n=110) † | Usual care plus an individual exercise program. Twice daily, 5 days a week, for 20-30 minutes. | T0 Admission | Mean BI: | Mean TUG (s): | T1 1.8 | 5.0 | T1 18.2 |
Mean age 78 years | T1 Discharge | T0 66 | T0 35 | |||||
54% female, MU, ACH | T1 79 | T1 36 | ||||||
Mean FAC: | ||||||||
T0 4.0 | ||||||||
T1 4.8 | ||||||||
Control (n=126) † | Usual care: daily medical assessment, 24 hour nursing assistance, and allied health service on referral from medical, nursing or other allied health staff. | Mean BI: | Mean TUG (s): | T1 1.6 | 6.0 | T1 20.6 | ||
Mean age 80 years | T0 68 | T0 30 | ||||||
56% female, MU, ACH | T1 75 | T1 26 | ||||||
Mean FAC: | ||||||||
T0 3.9 | ||||||||
T1 4.7 | ||||||||
Jones 2006 [23] |
Intervention (n=80) † | Usual care plus an individual exercise program Twice daily for approximately 30 minutes. | T0 Admission T1 Discharge | Mean change mBI: 11 points | Mean change TUG: 5.4 sec*
| T1 5.0 | 9 | T1 32.5 |
Mean age 81.9 years | ||||||||
54% female, MU, ACH | ||||||||
Control (n=80) † | Usual care: medical, nursing and allied health intervention and discharge planning consistent with the patient’s diagnosis and resources available on the acute general medical wards. | Mean change mBI: 9 points | Mean change TUG: 1.2 sec*
| T1 2.5 | 11 | T1 51.3 | ||
Mean age 82.9 years | ||||||||
61% female, MU, ACH | ||||||||
Laver 2012 [14] |
Intervention (n=22) | Individual interactive video game program (Wii Fit) 25 min/day, 5 days/week supervised by a physiotherapist | T0 Admission | IADL | TUG | T1 0 | 12.3 | NA |
Mean age 85.2 years | T1 Discharge | T0 181 | T0 38 | |||||
86% female GU, ACH | T1 205 | T1 28 | ||||||
Control (n=22) | Conventional physiotherapy, matching the patients abilities and treatment needs 25 min/day, 5 days/week | IADL | TUG | T1 0 | 14.95 | NA | ||
Mean age 84.6 years | T0 141 | T0 35 | ||||||
73% female GU, ACH | T1 190 | T1 29 | ||||||
Nikolaus 1999 [25] |
Intervention with follow-up (n=181) † | In-hospital and post-discharge follow-up treatment by an interdisciplinary team. Physical or occupational therapy twice a week up to twice a day for 30 min | T0 Admission | Mean BI score: | NA | T2 18.2 | 33.5*
| T1 4.4*
|
Mean age 81.4 years | T1 Discharge | T0 71.0 | T2 16.6 | |||||
Female 73.4%, GU, UH | T2 1 year post-discharge | T1 91.8 | ||||||
T2 81.2 | ||||||||
Mean LB score: | ||||||||
T1 5.7 | ||||||||
T2 5.6*
| ||||||||
Intervention without follow-up (n=179) † | In-hospital treatment by an interdisciplinary team, followed by usual care at home | Mean score BI: | T2 16.8 | 40.7*
| T1 7.3*
| |||
Mean age 81.4 years | T0 71.0 | T2 18.4 | ||||||
Female 73.4%, GU, UH | T1 92.6 | |||||||
T2 82.3 | ||||||||
Mean LB score: | ||||||||
T1 5.5 | ||||||||
T2 4.1*
| ||||||||
Control (n=185) † | Usual care in hospital | Mean score BI: | T2 17.3 | 42.7*
| T1 8.1*
| |||
Mean age 81.4 years | T0 71.0 | T2 22.7 | ||||||
Female 73.4%, GU, UH | T1 91.1 | |||||||
T2 80.9 | ||||||||
Mean LB score: | ||||||||
T1 5.5 | ||||||||
T2 4.3 | ||||||||
Siebens 2000 [28] |
Intervention (n=149) † | Hospital-based exercise program twice a day. Encouragement to continue the program at home | T0 2 weeks pre-admission | Mean number of independent IADL | Independent walking | T1 6.7 | 12.0 | NA |
Mean age 78.2 years | T1 1 month post-discharge | T0 5.3 | T0 59.7% | |||||
62% female, ACH | T1 5.1*
| T1 64.2% | ||||||
Control (n=151) † | Usual care | Mean number of IADL independence | Independent walking | T1 6.6 | 10.5 | |||
Mean age 78.5 years | T0 5.3 | T0 50.3% | ||||||
59% female, ACH | T1 4.6*
| T1 65.5% |
Setting and intervention
Physical functioning
Activities of daily living
Instrument | Study | Assessment | Score | ||
---|---|---|---|---|---|
Min | Max | Interpretation | |||
Katz index/ADL index | Courtney [20] | Ability to perform: Bathing, eating, dressing, continence, transfer to toilets and locomotion | 0 | 6 | 0 independent - 6 dependent |
Bizon-Blanc [18] | 0 | 12 | 0 independent - 12 dependent | ||
Ability to perform: Bathing, dressing, using the toilet, moving from a bed to a chair, and eating | 0 | 5 | 0 independent – 5 dependent | ||
(modified) Barthel index | Feeding, urinary and faecal continence, personal toilet, dressing, toilet use, transferring, walking outdoors, climbing stairs and bathing | 0 | 20 | 1 dependent – 20 independent | |
0 | 100 | 0 dependent - 100 independent | |||
Lawton index/IADL index | Ability to use telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for medication and ability to handle finances | 0 | 8 | 0 dependent - 8 independent | |
Ability to use telephone, shopping, food preparation, housekeeping, mode of transportation, responsibility for medication and ability to handle finances | 0 | 7 | 0 dependent - 7 independent | ||
Timed IADL | Laver [14] | The time needed to complete tasks addressing five IADL domains: | Lower scores indicates greater ability | ||
(1) communication, (2) finance, (3) cooking, (4) shopping, and (5) medicine. | |||||
SIVIS dependency scales | Sleats [29] | SIVIS independency scale: 20 questions relating to orientation, communication, mobility, transfers, ADL, continence, catheter use, and decubitus | NA | ||
Functional Independence Measure (FIM) | Measures the level of a patient’s disability and indicates how much assistance is required for the individual to carry out activities of daily living: Eating, Grooming, Bathing, Upper and lower body dressing, Toileting, Bladder and bowel management, Bed to chair transfer, Toilet and shower transfer, Locomotion, Stairs, Cognitive comprehension, Expression, Social interaction, Problem solving, Memory | 18 | 126 | 18 dependent – 126 independent | |
Walking Impairment Questionnaire (WIQ) | Courtney [20] | Walking distance, walking speed and climbing stairs | 0 | 100 | Higher scores indicates greater ability |
Timed Up and Go (TUG) | Time taken for the patient to rise from a chair, walk 3 m, turn and walk back to the chair | Lower scores indicates greater ability | |||
Functional Ambulation Classification | De Morton [22] | Ability to ambulate over a 10 foot distance and 4 m length of foam | 0 | 6 | 0 dependent - 6 independent |
Physical activity scale | Siebens [28] | Questionnaire about walking ¼ mile, walking up 10 steps, crouching/kneeling, lifting/carrying 10 lbs | NA | ||
Mobility | Counsell [19] | Walking to a table, walking inside the house, walking a block, walking uphill or upstairs, and running a short distance | NA | ||
Physical Performance and Mobility Examination | Counsell [19] | Bed mobility, transfer skills, multiple stands, standing balance, step up one step and timed 6 m walk | 0 | 6 | 0 dependent – 6 independent |
Short Physical Performance Battery | Laver [14] | Three standing balance measures (tandem, semi-tandem, and side-by-side stands), five continuous chair stands, and a 2.44-meter walk. | 0 | 12 | 0 dependent – 12 independent |
Modified Berg Balance Scale | Laver [14] | NA |
Physical performance
Length of stay and discharge destination
Feasibility
Study | Population & setting | Intervention | Feasibility |
---|---|---|---|
Brown 2006 [30] |
Intervention (n=7) | Exercise sessions twice a day, 7 days a week. After discharge 20-30 min walk each day and resistance exercise every other day | n=605 admitted, n=76 included |
Mean age 70.2 years, 0% female | n=66 declined participation | ||
Control (n=2) | Usual care which included physical therapy if a consult was initiated by the physician | ||
Mean age 70.2 years, 0% female | |||
Mallery 2003 [31] |
Intervention (n=19) | Usual care plus resistance exercise 3 times per week, 30-40 min, assisted by a physiotherapist | n=395 admitted, n=39 included |
Mean age 82.7 years | Participation 71%, | ||
74% female, GU, UH | Adherence 63% | ||
No adverse events | |||
Control (n=20) | Usual care plus passive range of motion training 3 times per week, 30-40 min, assisted by a physiotherapist | Participation 96%, | |
Mean age 81.4 years | Adherence 95% | ||
45% female, GU, UH | No adverse events | ||
Nolan 2008 [32] |
Intervention (n=196) | Participated in the Functional Maintenance Exercise Program, 6 times per week, 30 min | n=1021 admitted, n= 220 included |
Mean age 83.6 years, | 33 withdrawn | ||
68% female, GU, UH | |||
Control (n=24) | Usual care with usual physiotherapy | ||
Mean age 85.4 years | |||
67% female, GU, UH | |||
Laver 2012 [14] |
Intervention (n=22) | Individual interactive video game program (Wii Fit) 25 min/day, 5 days/week supervised by a physiotherapist | n=235 admitted, n=44 included |
Mean age 85.2 years | 90% adherence rate | ||
86% female GU, ACH | No adverse events | ||
Control (n=22) | Conventional physiotherapy, matching the patients abilities and treatment needs 25 min/day, 5 days/week | 91% adherence rate | |
Mean age 84.6 years | 1 adverse event, conscious collapse | ||
73% female GU, ACH |