title: The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis.
abstract: BACKGROUND
  the worldwide population is ageing. One expected consequence of this is an increase in morbidity and an associated increased demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects in residents of long-term care facilities.
  
  
  OBJECTIVE
  to examine the effects of physical rehabilitation on activities of daily living (ADL) in elderly residents of long-term care facilities.
  
  
  METHODS
  systematic review with meta-analysis of randomised controlled trials. We included studies that compared the effect of a physical rehabilitation intervention on independence in ADL with either no intervention or an alternative intervention in older people (over 60 years) living in long-term care facilities. We searched 19 databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, Web of Knowledge and Google Scholar. Two researchers independently screened papers and extracted data. Outcomes of included studies were combined in a standardised mean difference random-effects meta-analysis.
  
  
  RESULTS
  thirteen of 14 studies identified were included in the meta-analysis. Independence in ADL was improved by 0.24 standard units (95% CI: 0.11-0.38; P = 0.0005). This is equivalent to 1.3 points on the Barthel Index (0-20 scale). No significant differences in effect were found based on participant or intervention characteristics. Larger sample size and low attrition were associated with smaller estimates of effect. All studies were assessed to be at risk of bias.
  
  
  CONCLUSIONS
  physical rehabilitation may improve independence for elderly long-term care facility residents, but mean effects are small. It is unclear which interventions are most appropriate.
authors.affiliation: Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Crocker
authors.forename: John
authors.initials: J
authors.lastname: Young
authors.forename: Anne
authors.initials: A
authors.lastname: Forster
authors.forename: Lesley
authors.initials: L
authors.lastname: Brown
authors.forename: Seline
authors.initials: S
authors.lastname: Ozer
authors.forename: Darren C
authors.initials: DC
authors.lastname: Greenwood
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016009:Chi-Square Distribution; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008875:Middle Aged; D009735:Nursing Homes; D026741:Physical Therapy Modalities
keywords: disability; functional independence; nursing home; older people; physical therapy; senior citizen