Rehabilitation interventions with deconditioned older adults following an acute hospital admission: a systematic review.
OBJECTIVE
To determine effectiveness of inpatient rehabilitation interventions with older deconditioned adults following an acute hospital admission.


METHODS
Systematic review of randomised controlled trials (RCTs) from 14 electronic databases from their inception to February 2014.


METHODS
Studies selected concerned inpatient rehabilitation, single or multi-factorial interventions, conducted by any discipline, where participants were aged 55 years or older and 50% or more could be classed as deconditioned. Studies were excluded if they focused on acute onset of disability conditions. Data were extracted using the McMaster Quantitative Review Form and appraised using the PEDro Rating Scale.


RESULTS
No RCTs were found that specifically addressed the aim. Four studies were reviewed describing multi-disciplinary rehabilitation programs that aimed to reduce functional decline in older adults, with inconsistent findings. However, in two studies participants showed a positive improvement in completing basic activities of daily living (ADL) following multi-disciplinary rehabilitation, one at discharge (median change score Intervention (I)0.23:Control (C)0.15,P=<0.001) and one at 12-months post discharge (I-48.4%: C-25.4% (P‹0.001) Relative Risk (RR)1.90 95%CI: 1.15-3.16 (reviewer calculated)). Discharge to home was also measured in two studies with participants in the intervention groups having a higher probability of going home (I-55.6%: C-36.7 %, RR 1.52 95%CI: 1.02-2.26 (reviewer calculated) and I-60%: C-20%, RR 3.00 95%CI: 1.16-7.73(reviewer calculated)).


CONCLUSIONS
No RCTs have been conducted to examine the effectiveness of specific recondition-ing interventions in rehabilitation, and there is currently insufficient evidence to support the use of geriatric rehabilitation programs to reduce functional decline in older adults who are deconditioned.
School of Allied Health, La Trobe University, Melbourne, Victoria, Australia Donvale Rehabilitation Hospital, Ramsay Healthcare, Donvale, Victoria, Australia ajtimmer@students.latrobe.edu.au.
Amanda J
AJ
Timmer
School of Allied Health, La Trobe University, Melbourne, Victoria, Australia School of Health Sciences, Department of Rehabilitation, Jönköping University, Sweden.
Carolyn A
CA
Unsworth
School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.
Nicholas F
NF
Taylor
D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome
Functional decline; geriatric rehabilitation; hospital inpatient; reconditioning