Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials
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Open Access
- 20 April 2010
- Vol. 340 (apr20 2), c1718
- https://doi.org/10.1136/bmj.c1718
Abstract
To assess the effects of inpatient rehabilitation specifically designed for geriatric patients compared with usual care on functional status, admissions to nursing homes, and mortality.Systematic review and meta-analysis.Medline, Embase, Cochrane database, and reference lists from published literature. Review methods Only randomised controlled trials were included. Trials had to report on inpatient rehabilitation and report at least one of functional improvement, admission to nursing homes, or mortality. Trials of consultation or outpatient services, trials including patients aged <55, trials of non-multidisciplinary rehabilitation, and trials without a control group receiving usual care were excluded. Data were double extracted. Odds ratios and relative risks with 95% confidence intervals were calculated.17 trials with 4780 people comparing the effects of general or orthopaedic geriatric rehabilitation programmes with usual care were included. Meta-analyses of effects indicated an overall benefit in outcomes at discharge (odds ratio 1.75 (95% confidence interval 1.31 to 2.35) for function, relative risk 0.64 (0.51 to 0.81) for nursing home admission, relative risk 0.72 (0.55 to 0.95) for mortality) and at end of follow-up (1.36 (1.07 to 1.71), 0.84 (0.72 to 0.99), 0.87 (0.77 to 0.97), respectively). Limited data were available on impact on health care or cost. Compared with those in control groups, weighted mean length of hospital stay after randomisation was longer in patients allocated to general geriatric rehabilitation (24.5 v 15.1 days) and shorter in patients allocated to orthopaedic rehabilitation (24.6 v 28.9 days).Inpatient rehabilitation specifically designed for geriatric patients has the potential to improve outcomes related to function, admission to nursing homes, and mortality. Insufficient data are available for defining characteristics and cost effectiveness of successful programmes.This publication has 54 references indexed in Scilit:
- Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysisBMJ, 2009
- Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial.2002
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Reduced Mortality in Treating Acutely Sick, Frail Older Patients in a Geriatric Evaluation and Management Unit. A Prospective Randomized TrialJournal of the American Geriatrics Society, 2002
- A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and ManagementThe New England Journal of Medicine, 2002
- Home Visits to Prevent Nursing Home Admission and Functional Decline in Elderly PeopleJAMA, 2002
- Direction and impact of language bias in meta-analyses of controlled trials: empirical studyInternational Journal of Epidemiology, 2002
- Funnel plots for detecting bias in meta-analysis: Guidelines on choice of axisJournal of Clinical Epidemiology, 2001
- Systematic reviews in health care: Assessing the quality of controlled clinical trialsBMJ, 2001
- Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementiaBMJ, 2000