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Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures
BACKGROUND: Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older pat...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617943/ https://www.ncbi.nlm.nih.gov/pubmed/31288750 http://dx.doi.org/10.1186/s12877-019-1201-4 |
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author | Heldmann, Patrick Werner, Christian Belala, Nacera Bauer, Jürgen M. Hauer, Klaus |
author_facet | Heldmann, Patrick Werner, Christian Belala, Nacera Bauer, Jürgen M. Hauer, Klaus |
author_sort | Heldmann, Patrick |
collection | PubMed |
description | BACKGROUND: Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients. The aim of this review was to describe primary outcome measures that have been used in randomized controlled trials (RCTs) on early rehabilitation in acutely hospitalized older patients, to analyze their matching, and to evaluate the effects of matching on the main findings of these RCTs. METHODS: A systematic literature search was conducted in PubMed, Cochrane CENTRAL, CINAHL, and PEDro databases. Additional studies were identified through reference and citation tracking. Inclusion criteria were: RCT, patients aged ≥65 years, admission to an acute hospital medical ward (but not to an intensive medical care unit), physical exercise intervention (also as part of multidisciplinary programs), and primary outcome measure during hospitalization. Two independent reviewers extracted the data, assessed the methodological quality, and analyzed the matching of primary outcome measures to the intervention, study sample, and setting. Main study findings were related to the results of the matching procedure. RESULTS: Twenty-eight articles reporting on 24 studies were included. A total of 33 different primary outcome measures were identified, which were grouped into six categories: functional status, mobility status, hospital outcomes, adverse clinical events, psychological status, and cognitive functioning. Outcome measures differed considerably within each category and showed a large heterogeneity in their matching to the intervention, study sample, and setting. Outcome measures that specifically matched the intervention contents were more likely to document intervention-induced benefits. Mobility instruments seemed to be the most sensitive outcome measures to reveal such benefits. CONCLUSIONS: This review highlights that the selection of outcome measures has to be highly specific to the intervention contents as this is a key factor to reveal benefits attributable to early rehabilitation in acutely hospitalized older patients. Inappropriate selection of outcome measures may represent a major cause of inconsistent findings reported on the effectiveness of early rehabilitation in this setting. TRIAL REGISTRATION: PROSPERO CRD42017063978. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-019-1201-4) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6617943 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-66179432019-07-22 Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures Heldmann, Patrick Werner, Christian Belala, Nacera Bauer, Jürgen M. Hauer, Klaus BMC Geriatr Research Article BACKGROUND: Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients. The aim of this review was to describe primary outcome measures that have been used in randomized controlled trials (RCTs) on early rehabilitation in acutely hospitalized older patients, to analyze their matching, and to evaluate the effects of matching on the main findings of these RCTs. METHODS: A systematic literature search was conducted in PubMed, Cochrane CENTRAL, CINAHL, and PEDro databases. Additional studies were identified through reference and citation tracking. Inclusion criteria were: RCT, patients aged ≥65 years, admission to an acute hospital medical ward (but not to an intensive medical care unit), physical exercise intervention (also as part of multidisciplinary programs), and primary outcome measure during hospitalization. Two independent reviewers extracted the data, assessed the methodological quality, and analyzed the matching of primary outcome measures to the intervention, study sample, and setting. Main study findings were related to the results of the matching procedure. RESULTS: Twenty-eight articles reporting on 24 studies were included. A total of 33 different primary outcome measures were identified, which were grouped into six categories: functional status, mobility status, hospital outcomes, adverse clinical events, psychological status, and cognitive functioning. Outcome measures differed considerably within each category and showed a large heterogeneity in their matching to the intervention, study sample, and setting. Outcome measures that specifically matched the intervention contents were more likely to document intervention-induced benefits. Mobility instruments seemed to be the most sensitive outcome measures to reveal such benefits. CONCLUSIONS: This review highlights that the selection of outcome measures has to be highly specific to the intervention contents as this is a key factor to reveal benefits attributable to early rehabilitation in acutely hospitalized older patients. Inappropriate selection of outcome measures may represent a major cause of inconsistent findings reported on the effectiveness of early rehabilitation in this setting. TRIAL REGISTRATION: PROSPERO CRD42017063978. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-019-1201-4) contains supplementary material, which is available to authorized users. BioMed Central 2019-07-09 /pmc/articles/PMC6617943/ /pubmed/31288750 http://dx.doi.org/10.1186/s12877-019-1201-4 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Heldmann, Patrick Werner, Christian Belala, Nacera Bauer, Jürgen M. Hauer, Klaus Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures |
title | Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures |
title_full | Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures |
title_fullStr | Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures |
title_full_unstemmed | Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures |
title_short | Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures |
title_sort | early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617943/ https://www.ncbi.nlm.nih.gov/pubmed/31288750 http://dx.doi.org/10.1186/s12877-019-1201-4 |
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