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Evidence Summary

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Early physical rehabilitation programs are beneficial for hospitalized older patients and are safe and feasible to implement.

Kosse NM, Dutmer AL, Dasenbrock L, et al.  Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: A systematic review BMC Geriatrics. 2013;13(1):107.

Review question

Are early physical rehabilitation programs effective for improving physical functioning among older adults admitted to the hospital (and are they feasible to implement)?

Background

Older adults admitted to the hospital are at severe risk of functional decline, both during their hospital stay and after being discharged.

Physical rehabilitation programs such as physical therapy, occupational therapy and exercise, may preserve physical function, but are often not part of usual treatment.

Physical rehabilitation programs that are delivered by teams of care providers and include exercise have been found to improve physical functioning when introduced to older adults within 1 or 2 days of hospitalization.

How the review was done

The review identified all relevant studies published up to and including August 2013.

15 articles describing 13 studies of rehabilitation programs were included in the review, as well as four additional studies that assessed the safety and feasibility of implementing these programs.

The study was co-funded by INTERREG IV Program, the Regional Development Fund and the Ministries of Economic Affairs of the Netherlands and German states of Nordrhein-Westfalen and Niedersachsen.

What the researchers found

Improvements in physical function for older adults were found when: 1) physical rehabilitation programs were delivered by teams that included a mix of different care providers and an exercise component; and 2) an exercise component was added to usual care.

Engaging in early physical rehabilitation programs can prevent a rapid decline in physical functioning among older adults admitted to hospital, reduce the length of hospital stay, and reduce the chance of being discharged to a nursing home.

Compared to usual care without exercise, patients that exercised had better physical functioning at the time of discharge, but these improvements were reduced after discharge if no follow-up care was provided.

Early rehabilitation programs were found to be both safe and feasible to provide to hospitalized older adults.

Conclusion

Early physical rehabilitation programs for hospitalized older adults can improve physical function, reduce length of stay, and prevent patients from being discharged to a nursing home. They are also safe and feasible.

Follow-up care is important to maintain the benefits of early rehabilitation programs.


Influence of early rehabilitation programs on older patients’ care outcomes

Program Types

PHYSICAL FUNCTION

LENGTH OF HOSPITAL STAY

DISCHARGE OUTCOMES

SAFE/FEASIBLE

Multidisciplinary w/exercise

Improved

Reduced

Positive

Yes

Usual care w/exercise

Improved

-

-

Yes

 

This summary is based on a review that was determined to be of medium methodological quality based on an assessment using the AMSTAR tool.




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DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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