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Corresponding author Lotte Verweij, RN, MSc, Academic Medical Center, Department of Cardiology and Geriatric Medicine, University of Amsterdam, Tafelbergweg 51, 1105 BD, Amsterdam, the Netherlands.
ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the NetherlandsDepartment of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the NetherlandsDepartment of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the NetherlandsDepartment of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the NetherlandsDepartment of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the NetherlandsDepartment of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect on mobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic.
Data Sources
Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018.
Study Selection
OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect of multidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age ≥65y) after discharge from hospital after an acute illness.
Data Extraction
Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospital readmission within 3 months of discharge.
Data Synthesis
A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7 assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]=: −1.34 to 48.32; I2: 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I2: 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly.
Conclusion
OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge. However, the wide 95% CIs indicate that the evidence is not robust.
Every year, approximately 10% of the population aged ≥65 years is acutely admitted to hospital because of a variety of diseases, such as cardiovascular, pulmonary, and infectious diseases.
Many of these patients suffer from disabilities and limitations in activities of daily living that are associated with adverse health outcomes after hospitalization.
Of those alive at 3 months, many develop new limitations in activities of daily living when compared to their abilities 2 weeks before hospitalization.
Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review.
These patients are at risk of ending up in a vicious circle because these increased disabilities are in turn associated with increased all-cause 30-day hospital readmission.
Longitudinal studies in community-dwelling older patients showed that many were able to recover from limitations in activities of daily living and frailty and that it is not an inherently irreversible process.
Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up.
A recent systematic review and meta-analysis of hospital-based inpatient geriatric rehabilitation, including exercise training, demonstrated that rehabilitation strategies cannot only restore functioning but also prevent disabilities.
Many studies focus on a diagnosis-based population despite other factors (ie, level of frailty) playing an important role in determining rehabilitation needs.
Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up.
The medical diagnosis often insufficiently correlates with disease-related functional consequences. To restore or prevent disabilities in older individuals, rehabilitation programs need to apply a broader multifactorial approach rather than focusing only on body function.
Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis.
This is often implemented using a comprehensive geriatric assessment to assess a patient’s health status, geriatric condition, body function, and personal goals and results in a multidisciplinary care and rehabilitation plan.
There is currently no aggregated evidence available regarding multidisciplinary rehabilitation treatment in an out-of-hospital setting (OOHS) (ie, skilled nursing facilities, outpatient clinics, or community-based at home) for older adults after hospital discharge following an acute illness. Current evidence on this type of rehabilitation has mainly focused on patients’ poststroke
Therefore, this systematic review and meta-analysis analyzed the effectiveness of multidisciplinary rehabilitation (including exercise compared to usual care or other forms of rehabilitation) on mobility (as a measure of body function) and unplanned hospital readmission in older patients (mean age ≥65y) 3 months after hospital discharge following an acute illness.
Methods
This systematic review is registered in the PROSPERO register of systematic reviews (registration number: CRD42017058592). It has been reported according to the PRISMA guidelines.
Inclusion criteria for studies were as follows: design: randomized controlled trials published in peer-reviewed journals. Population: mean age ≥65 years; discharged from hospital following an acute illness (ie, myocardial infarction, exacerbation of chronic obstructive pulmonary disease, or dysregulated diabetes mellitus). Intervention: rehabilitation in an OOHS (ie, a skilled nursing facility, outpatient clinic, or community-based at home); rehabilitation programs starting in hospital and continuing in an OOHS; rehabilitation containing at least exercise therapy, because this is an important contributing intervention to recover from or prevent a decline in body function,
and including treatment from at least 2 disciplines; intervention compared to care as usual or other forms of rehabilitation. Outcome: primary: mobility (as a measure of body function) and unplanned hospital readmission within 3 months of the initial hospitalization; secondary: mobility (as a measure of body function) and unplanned hospital readmission within 6 and 12 months of the initial hospitalization.
The focus of the primary and secondary outcome measures at 3 and 6 months after discharge was based on the rationale that older patients are at increased risk of adverse events and declining body function in the first 6 months after hospital discharge.
The effect of rehabilitation at 12 months was included to present the long-term effects of the interventions.
Studies were excluded if the intervention was offered after planned hospitalization, was situated within an emergency department, or focused on institutionalized long-term care. Studies on patients with neurologic and traumatic injuries (eg, hip fractures) were excluded because there is sufficient evidence that rehabilitation programs are effective in these populations.
According to the International Classification of Functioning, functioning consists of 3 main functions: body functions, activities, and involvement in life situations.
This systematic review focuses on mobility (eg, a 6-minute walk distance [6MWD] test) as a measure of body function.
The 6MWD test reflects the functional capacity level and is an indicator of activities of daily living as part of body function according to the International Classification of Functioning.
A clinical librarian (J.G.D.) conducted a systematic literature search in Medline OVID, Embase OVID, and CINAHL selecting articles that were published between their inception and February 22, 2018. A scoping search was initially performed to identify relevant references in Medline OVID. Reference lists of eligible studies were searched by hand to identify studies potentially missed in the database searches. Appendix 1 shows the full search strategy.
Study selection
The studies identified in the scoping search were managed in EndNotea and subsequently exported to Covidence
,b and Review Manager (version 5.3) software,c which were used for the screening process, data collection, and analysis. Two authors (L.V. and E.V.D.K.) independently screened the titles, abstracts of the identified studies, and full texts after the first screening. After selection, they subsequently extracted data from these studies. In case of a discrepancy, a consensus was reached through discussion with a third reviewer (B.M.B.).
data were extracted on the following basis: (1) study characteristics (eg, authors, publication year, journal, country, study setting, study population, sample size, follow-up); (2) patient characteristics (eg, mean age and gender distribution); (3) description of the intervention based on TIDieR guidelines (eg, what [intervention components either exercise, diet, or education], who [multidisciplinary], how, where, and how much)
In the case of missing data, the authors were contacted by e-mail and asked for the additional information. One reminder e-mail was sent after 4 weeks.
Assessment of risk of bias
The Cochrane Collaboration’s risk of bias tool was used to evaluate the quality of the included studies.
Two reviewers (L.V. and E.V.D.K.) independently assessed each study based on the sequence generation, allocation concealment, blinding of participants, personnel and outcome assessors, incomplete outcome data, selective outcome reporting, and other sources of bias.
In the evaluation, a distinction was made between the mobility and unplanned hospital readmission outcomes considering the effect of blinding the outcome assessors. Not blinding the outcome assessors to the rehabilitation intervention was unlikely to have influenced the unplanned hospital readmission rates but could have influenced the measurement of mobility.
Publication bias
A plan was made to assess small study bias using the Egger regression asymmetry test if at least 10 studies were included in the meta-analysis.
Review Manager software was used to pool study data regarding mobility and unplanned hospital readmissions. The mean difference (MD) and 95% CI were calculated for the continuous mobility outcome from the 6MWD data, which were reported in most studies included on the topic. The pooled risk ratio (RR) and its 95% CI were calculated for the unplanned hospital readmission outcome. Heterogeneity across studies was evaluated using the I2 statistic.
A fixed-effects model was used for I2 values ≤40%, and a random-effects model (according to the DerSimonian and Laird method to account for substantial statistical heterogeneity) was used for I2 values >40%.
A sensitivity analysis of the meta-analysis was also performed to assess the influence of sequentially omitting individual studies on pooled estimates.
Results
Online database searches in Medline OVID, Embase OVID, and CINAHL identified 6187 references. The review process is summarized in fig 1. After removing duplicates, the titles and abstracts of 4355 studies were screened. A total of 143 studies were considered for a full-text review, whereas 128 studies were excluded due to inadmissible patient populations (n=68); nonrandomization of the trial (n=19); no rehabilitation intervention, lack of exercise components, or no multidisciplinary approach (n=14); no acute hospitalization (n=12); the study protocol description (n=8); other outcomes (n=5); or excluded settings (n=2) (appendix 2). Ultimately, 15 studies were eligible for inclusion in the systematic review, 7 were eligible for inclusion in the 6MWD meta-analysis, and 7 were eligible for the meta-analysis on unplanned hospital readmission.
The number of participants in the included studies collectively totaled 1255 (624 in the intervention group and 631 in the control group). The mean participant age was 74 years (range: 65-85). Four studies reported on a general patient population,
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
The exercise component of the included studies consisted of intensity training (ie, walking and endurance exercises), strengthening exercises, and balance and stretching exercises and was mainly performed by physical therapists, occupational therapists, or a multidisciplinary team that was not further specified (table 2). In general, each study included an educational component in the intervention (ie, written or verbal exercise instructions) and counseling and teaching strategies for coping with dyspnea and stress, which were provided by those with expertise on the topic (see table 2). Dieticians were mainly involved in studies on cardiac patients in the context of dietary counseling,
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Each study included a multidisciplinary team made up of, for example, registered nurses, physical therapists, occupational therapists, and dieticians (see table 2). Three studies performed a comprehensive baseline geriatric assessment
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
All studies defined usual care as providing information and advice on lifestyle and exercise and providing follow-up visits or telephone calls by a physician or nurse (specialist). In addition to this usual care, 2 studies described rehabilitation advice as usual care but did not elaborate on the details of this advice.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Another study described standard rehabilitation as an in-hospital multidisciplinary approach by physical therapists and occupational therapists during weekdays with a training schedule based on an individual assessment.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Figure 2 summarizes the risk of bias assessment in the included studies. Sequence generation was clearly described in all studies with the exception of the studies by Oerkild et al
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Oerkild introduced selection bias by inviting patients to participate in another program, and those who declined were invited to participate in the study program. Sahota did not describe the process of sequence generation. Five studies did not report the allocation concealment process,
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
reported that patients living too far from the municipality were included in the control group. Blinding of the outcome assessors to the mobility outcome was poorly described or, in the case of 3 studies, poorly performed.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
To assess the risk of bias due to incomplete outcome data, studies were evaluated on the registration or publication of the study protocol and attrition rates with a cutoff point of 20%. Three studies reported a high attrition rate.
All studies reported on predefined outcomes; therefore, reporting bias was scored as a low risk. Other possible introduced biases were caused by financial incentives to participants,
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
The limited number of studies in the meta-analyses (seven 6MWD studies and 7 unplanned hospital readmission studies) meant that the minimal requirement of 10 studies for testing publication bias was not met.
Mobility
Twelve studies assessed the mobility outcome: 2 included a general population,
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
counted the number of steps walked using a pedometer and reported a positive trend (see table 1) in the intervention group compared to the control group.
Seven studies provided sufficient data for a meta-analysis of the 6MWD (fig 3A). The overall MD was 23 m at 3 months (95% CI: −1.34 to 48.32; I2: 51%); however, the I2 test result suggests substantial heterogeneity between studies. The study by Oerkild
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
appeared to be an influential trial because its omission led to a larger pooled effect in favor of OOHS rehabilitation (MD: 31.3; 95% CI: 8.06-54.68), whereas omission of the Davidson et al
study led to a smaller pooled effect (MD: 10.76; 95% CI: −7.29 to 28.81) (table 3).
Fig 3(A) Meta-analysis mobility (6MWD in meters) at 3 months after hospital discharge. (B) Meta-analysis unplanned hospital readmission within 3 months after hospital discharge.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
showed a favorable effect of the rehabilitation program on the 6MWD in the intervention group (330m) than in the control group (316m), and Behnke et al
also reported a favorable effect at 6 months (P<.001) in the intervention group but did not provide any detailed information. Two studies reported the effect of rehabilitation on mobility at 12 months after hospital discharge measured by the 6MWD.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
The pooled RR based on a fixed-effects model was 0.93 (95% CI: 0.73-1.19) (fig 3B). Within 6 months of hospitalization, only 1 study reported significantly fewer hospital readmissions in the intervention group than the control group,
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Within 12 months of hospital discharge, Davidson reported lower hospital readmission rates in the intervention group (odds ratio: 0.20; 95% CI: 0.07-0.58; relative risk: 0.63).
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
substantially influenced the pooled effect size. When the study of Sahota was excluded from the meta-analysis, the pooled RR changed to 0.77 (95% CI: 0.54-1.10), and omission of the study of Seymour changed the pooled RR to 1.02 (95% CI: 0.79-1.31) (table 4).
Table 4Sensitivity analysis unplanned hospital readmission within 3 months after discharge
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
The randomized trials used in this systematic review support the idea that rehabilitation of older patients in an OOHS improves mobility, which was reflected in an average increase of 23 m on the 6MWD test at 3 months after discharge from hospital following an acute illness. The review also indicates that rehabilitation of older patients in an OOHS after discharge from hospital following an acute illness does not lower the risk of unplanned hospital readmission after 3 months. However, the wide 95% CI and the instability of the pooled effect on mobility indicate that this evidence is not robust.
In the United States, rehabilitation programs after hospitalization have gained importance due to the recent introduction of payment penalties for hospitals with higher than average 30-day readmission rates.
Does it pay to penalize hospitals for excess readmissions? Intended and unintended consequences of Medicare’s Hospital Readmissions Reductions Program.
is a multifactorial phenomenon that occurs after acute hospitalization and increases the risk of rehospitalization. The association of functional impairment and readmission rates after hospitalization has increased awareness of the importance of rehabilitation.
However, in this systematic review and meta-analysis, a positive trend was observed for mobility when treated by a multidisciplinary rehabilitation program but not for unplanned hospital readmission. Although most of the studies continued rehabilitation programs from 1 care setting to another, it was often not as coordinated as in a transitional care system. Transitional care is effective at reducing hospital readmission rates when the care continues between health care settings and contains elements of care coordination, communication between primary care and hospitals, and includes intensive follow-up after hospital discharge.
Only 4 of the included studies described a transitional care system including the effective elements, of which only 2 reported the hospital readmission outcome.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
who defined clinical relevance as a change of 14-30.5 m against a background of 295-551 m on the 6MWD test. In the sensitivity analysis, omitting the study of Oerkild et al
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
increased the pooled effect on the 6MWD test from 23 to 31 m. Their intervention was compared with usual care, which was outpatient cardiac rehabilitation. This could partly explain the favorable effect in the control group in contrast to the results obtained by other studies in the meta-analysis and thus the improved effect in the meta-analysis upon omission. Omitting the study of Davidson et al
resulted in a smaller pooled effect (MD: 10.76), which could be because the study was stopped prematurely and could have led to the wrong conclusions being drawn because of the smaller sample size.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
changed the preventive effect from 7% to a 2% increased risk. Sahota included an older and frailer patient population with a higher risk of adverse events, which could have influenced the effect.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Another contributing factor could be their large sample size when compared to other included studies, which may have led to this study having a greater influence in the meta-analysis. The small sample size of the Seymour study (intervention group: 30; control group: 30) could have led to an overestimation of the effect.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
The content of the rehabilitation programs provided in the studies did not differ much between these populations. All interventions consisted of multiple rehabilitation components, such as exercise and education. Nevertheless, the execution of the rehabilitation components varied between the studies or a thorough description of the content was missing in the manuscript; for example, 1 study failed to use the frequency, intensity, time, and therapy criteria to report items in the description of an exercise intervention.
American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
Using the TIDieR guidelines would make the aggregation and comparison of interventions possible on a level of what was provided by whom, how, where, and when. Therefore, it was not feasible to analyze the effectiveness of the different components of the intervention, neither was it possible to perform subanalysis on the dose of the intervention.
Nutritional status is an important factor for optimal physical training results and physical recovery (eg, intake of proteins). It is also relevant in acutely hospitalized patients where 52% experience malnutrition
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
stated that exercise programs should comprise balance exercises, muscle strengthening, transfer exercises, and functional exercises to be beneficial in frail older patients. The studies used in this manuscript mainly focused on intensity training and 4 of these were combined with strengthening exercises.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
described an individual approach. This could have influenced the effect in the meta-analysis.
The location of the intervention in the included studies varied between an outpatient setting, a community-based at-home setting, and a temporary inpatient setting (eg, a skilled nursing facility). The influence of the rehabilitation location and environment on the outcome was studied previously and showed no significant effects in traditional center-based inpatient approaches and alternative models such as telehealth and home-based rehabilitation.
To the author’s knowledge, this is the first systematic review to examine the effectiveness of multidisciplinary rehabilitation in an OOHS in older patients after they are discharged from hospital following an acute illness. Three large international databases (Medline OVID, Embase OVID, CINAHL) were screened. No publication was excluded based on language due to the availability of English abstracts in these databases. Although most of the international publications were covered in these databases, some specific language publications may possibly have been omitted due to their only being available in databases such as Bireme (a Latin American database). The included studies were all randomized trials. The blinding issues in patients and personnel in the included studies were caused by the nature of the intervention; however, the quality of the included studies was limited due to a lack of blinding of the outcome assessors. This could have introduced bias and could have led to an overestimation of the effects. Different studies used different types of outcome measures to report mobility; therefore, it was not possible to include all studies in the meta-analysis. The sensitivity analysis in both meta-analyses provided an insight into the contribution of each study, in the estimate of the true value of unplanned hospital readmissions (fixed effect) or the mean of all possible values for the 6MWD (random effect).
Implications for further research
Many studies focus on a diagnosis-based population despite other factors (ie, level of frailty) playing an important role in determining rehabilitation needs.
Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up.
The medical diagnosis often correlates badly with the disease-related functional consequences. These needs may be better determined through a comprehensive geriatric assessment that focuses on a patient’s disease, geriatric condition, functional status, and the patient’s own preferences rather than being determined solely from a disease perspective. This would create a more homogeneous patient population and enable tailored rehabilitation interventions to be tested. In addition, patients also transfer back and forth between health care settings; therefore, transitional care rehabilitation interventions should be considered to ensure continuity of care and reduce adverse outcomes such as hospital readmissions.
Furthermore, a clear definition of functional capacity is often lacking in rehabilitation intervention manuscripts and should be integrated according to the definition of the International Classification of Functioning. Functional capacity is often described when only physical performance is reported instead of the 3 main domains of functioning: body function, activities, and involvement in life situations.
A clear definition and a detailed description of the intervention according to the frequency, intensity, time, and therapy criteria and TIDieR guidelines would help to improve comparability and determine the effectiveness of each component of the intervention.
Conclusions
This review shows that OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients (aged ≥65y) 3 months after discharge from hospital following an acute illness; however, this type of rehabilitation is not associated with a lower risk of unplanned hospital readmission within 3 months of hospital discharge. Nevertheless, the wide 95% CI and the instability of the pooled effect on mobility illustrated by the sensitivity analysis indicate that the evidence is not robust.
Suppliers
a.
EndNote; Clarivate Analytics.
b.
Covidence; Covidence.
c.
Review Manager, version 5.3; The Cochrane Collaboration.
Supplementary Data
Appendix 1Search strategy
No.
Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) <1946 to Present> Search date: 22 February 2018
Searches
1
exp aging/ or exp aged/ or exp nursing homes/ or homes for the aged/ or frail elderly/
2
(older person? or older patient? or seniors or senior citiz* or elder or elders or elderly or geriatric* or frailty or postmenopausal women or community-dwelling or nursing home? or resident* or old* people or old* person? or old* patient? or old* client?).ab,kf,ti.
3
(geriatr* or age or aging or elderl*).jw.
4
or/1-3 [geriatric]
5
rehabilitation/ or "activities of daily living"/ or exp exercise therapy/ or telerehabilitation/ or rehabilitation centers/ or geriatric assessment/
6
(rehabilitation or exercise? oradl or iadl or (daily adj2 (activit* or living or function*)) or barthel index or katz index or alds or amsterdam linear or living indepently or living alone or (function* adj3 (status or capacit* or physical or decline or disabil*)) or geriatric assessment).ab,kf,ti.
7
or/5-6 [rehabilitation]
8
4 and 7 [geriatric rehabilitation]
9
home care services/ or outpatients/ or patient compliance/
10
(nursing facilit* or home based or patient home or (home adj2 care) or outpatient or transitional care or home visit or (intervention adj3 home?) or (patient? adj3 complian*)).ab,kf,ti.
11
or/9-10 [outpatient care]
12
hospitalization/ or patient admission/ or patient readmission/
13
(hospital* or admission or readmission or discharge or centre based or center based).ab,kf,ti.
14
12 or 13 [hospitalization]
15
(acute* or rehabilitation).ab,kf,ti.
16
rehabilitation.fs.
17
15 or 16 [acute]
18
pulmonary disease, chronic obstructive/ or exp myocardial infarction/ or exp chest pain/ or heart aneursym/ or exp endocarditis/ or exp heart failure/
19
(copd or chronic obstructive or pulmonary rehabilitation or myocardial infarction or cardiac rehabilitation or (pain adj3 chest) or angina pectoris or heart aneurysm? or cardiac aneurysm? or endocarditis or heart failure or myocardial failure or cardiac failure).ab,kf,ti.
20
18 or 19 [acute specific disorders]
21
14 and 17
22
14 and 20
23
acute hospital*.ab,kf,ti.
24
((acute* adj2 ill*) or (acute adj2 disease?) or (acute adj2 assessment units) or (acute* adj2 admi*) or (acute* adj2 readmi*) or (acute adj2 care) or (stabiliz* adj4 condition) or (stabiliz* adj2 patient?)).ab,kf,ti.
25
or/21-24 [acute hospitalization]
26
and/8,11,25
27
animals/ not humans/
28
26 not 27
29
(trial? or stud* or blind* or random* or experimental or control or placebo?).ab,kf,ti.
30
comparative study/
31
(clinical study or clinical trial or controlled clinical trial or randomized controlled trial).pt.
32
exp clinical trials as topic/
33
or/29-32 [RCT's]
34
28 and 33
35
remove duplicates from 34
No.
Ovid Embase Classic+Embase <1947 to 2018 February 22> Search date: 22 February 2018
Searches
1
exp aging/ or exp aged/ or nursing home/ or exp elderly care/
2
(older person? or older patient? or seniors or senior citiz* or elder or elders or elderly or geriatric* or frailty or postmenopausal women or community-dwelling or nursing home? or resident* or old* people or old* person? or old* patient? or old* client?).ab,kw,ti.
3
(geriatr* or age or aging or elderl*).jx.
4
or/1-3 [geriatric]
5
rehabilitation/ or exp exercise/ or daily life activity/ or exp kinesiotherapy/ or rehabilitation center/ or geriatric assessment/
6
(rehabilitation or exercise? oradl or iadl or (daily adj2 (activit* or living or function*)) or barthel index or katz index or alds or amsterdam linear or living indepently or living alone or (function* adj3 (status or capacit* or physical or decline or disabil*)) or geriatric assessment).ab,kw,ti.
7
or/5-6 [rehabilitation]
8
4 and 7 [geriatric rehabilitation]
9
home care/ or outpatient/ or outpatient care/ or outpatient department/ or patient compliance/
10
(nursing facilit* or home based or patient home or (home adj2 care) or outpatient or transitional care or home visit or (intervention adj3 home?) or (patient? adj3 complian*)).ab,kw,ti.
11
or/9-10 [outpatient care]
12
hospitalization/ or hospital admission/ or hospital discharge/ or hospital readmission/
13
(hospital* or admission or readmission or discharge or centre based or center based).ab,kw,ti.
14
12 or 13 [hospitalization]
15
(acute* or rehabilitation).ab,kw,ti.
16
rh.fs.
17
15 or 16 [acute]
18
chronic obstructive lung disease/ or exp heart infarction/ or thorax pain/ or heart aneursym/ or exp endocarditis/ or exp heart failure/
19
(copd or chronic obstructive or pulmonary rehabilitation or myocardial infarction or cardiac rehabilitation or (pain adj3 chest) or angina pectoris or heart aneurysm? or cardiac aneurysm? or endocarditis or heart failure or myocardial failure or cardiac failure).ab,kw,ti.
20
18 or 19 [acute specific disorders]
21
14 and 17
22
14 and 20
23
acute hospital*.ab,kw,ti.
24
((acute* adj2 ill*) or (acute adj2 disease?) or (acute adj2 assessment units) or (acute* adj2 admi*) or (acute* adj2 readmi*) or (acute adj2 care) or (stabiliz* adj4 condition) or (stabiliz* adj2 patient?)).ab,kw,ti.
25
or/21-24 [acute hospitalization]
26
and/8,11,25
27
(animal/ or animal experiment/ or animal model/ or nonhuman/ or rat/ or mouse/ or (rat or rats or mouse or mice).ti.) not human/
28
26 not 27
29
(trial? or stud* or blind* or random* or experimental or control or placebo?).ab,kw,ti.
30
exp controlled clinical trial/ or clinical study/ or "clinical trial (topic)"/ or comparative study/
31
or/29-30 [RCT's]
32
28 and 31
33
remove duplicates from 32
No.
CINAHL Plus with Full Text Search date: 22 February 2018
Query
S23
s7 and s10 and s21
S22
7 AND S10 AND S21
S21
S15 OR S19 OR S20
S20
AB (acute hospital* OR (acute* NEAR/2 ill*) or (acute NEAR/2 disease?) or (acute NEAR/2 assessment units) or (acute* NEAR/2 admi*) or (acute* NEAR/2 readmi*) or (acute NEAR/2 care) or (stabiliz* adj4 condition) or (stabiliz* NEAR/2 patient?)) OR TI (acute hospital* OR (acute* NEAR/2 ill*) or (acute NEAR/2 disease?) or (acute NEAR/2 assessment units) or (acute* NEAR/2 admi*) or (acute* NEAR/2 readmi*) or (acute NEAR/2 care) or (stabiliz* adj4 condition) or (stabiliz* NEAR/2 patient?)) OR SU (acute hospital* OR (acute* NEAR/2 ill*) or (acute NEAR/2 disease?) or (acute NEAR/2 assessment units) or (acute* NEAR/2 admi*) or (acute* NEAR/2 readmi*) or (acute NEAR/2 care) or (stabiliz* adj4 condition) or (stabiliz* NEAR/2 patient?))
S19
S13 AND S18
S18
S16 OR S17
S17
AB (copd or chronic obstructive or pulmonary rehabilitation or myocardial infarction or cardiac rehabilitation or (pain NEAR/2 chest) or angina pectoris or heart aneurysm? or cardiac aneurysm? or endocarditis or heart failure or myocardial failure or cardiac failure) OR TI (copd or chronic obstructive or pulmonary rehabilitation or myocardial infarction or cardiac rehabilitation or (pain NEAR/2 chest) or angina pectoris or heart aneurysm? or cardiac aneurysm? or endocarditis or heart failure or myocardial failure or cardiac failure) OR SU (copd or chronic obstructive or pulmonary rehabilitation or myocardial infarction or cardiac rehabilitation or (pain NEAR/2 chest) or angina pectoris or heart aneurysm? or cardiac aneurysm? or endocarditis or heart failure or myocardial failure or cardiac failure)
S16
(MH "Pulmonary Disease, Chronic Obstructive+") or (MH "Myocardial Infarction+") or (MH "Chest Pain+") or (MH "Coronary Aneurysm") or (MH "Endocarditis+") or (MH "Heart Failure+")
S15
S13 AND S14
S14
SU (acute* or rehabilitation)
S13
S11 OR S12
S12
AB (hospital* or admission or readmission or discharge or centre based or center based) OR TI (hospital* or admission or readmission or discharge or centre based or center based) OR SU (hospital* or admission or readmission or discharge or centre based or center based)
S11
(MH "Hospitalization+") OR (MH "Patient Admission") OR (MH "Readmission")
S10
S8 OR S9
S9
AB (nursing facilit* or home based or patient home or (home NEAR/1 care) or outpatient or transitional care or home visit or (intervention NEAR/2 home?) or (patient? NEAR/2 complian*)) OR TI (nursing facilit* or home based or patient home or (home NEAR/1 care) or outpatient or transitional care or home visit or (intervention NEAR/2 home?) or (patient? NEAR/2 complian*)) OR SU (nursing facilit* or home based or patient home or (home NEAR/1 care) or outpatient or transitional care or home visit or (intervention NEAR/2 home?) or (patient? NEAR/2 complian*))
S8
(MH "Home Nursing") OR (MH "Home Rehabilitation+") OR (MH "Home Health Care+") OR (MH "Outpatients") OR (MH "Outpatient Service")
S7
S3 AND S6
S6
S4 OR S5
S5
AB (rehabilitation or exercise? oradl or iadl or (daily NEAR/1 (activit* or living or function*)) or barthel index or katz index or alds or amsterdam linear or living indepently or living alone or (function* NEAR/2 (status or capacit* or physical or decline or disabil*)) or geriatric assessment) OR TI (rehabilitation or exercise? oradl or iadl or (daily NEAR/1 (activit* or living or function*)) or barthel index or katz index or alds or amsterdam linear or living indepently or living alone or (function* NEAR/2 (status or capacit* or physical or decline or disabil*)) or geriatric assessment) OR SU (rehabilitation or exercise? oradl or iadl or (daily NEAR/1 (activit* or living or function*)) or barthel index or katz index or alds or amsterdam linear or living indepently or living alone or (function* NEAR/2 (status or capacit* or physical or decline or disabil*)) or geriatric assessment)
S4
(MH "Physical Therapy+") OR (MH "Rehabilitation") OR (MH "Recreational Therapy") OR (MH "Telerehabilitation") OR (MH "Activities of Daily Living+") OR (MH "Therapeutic Exercise+") OR (MH "Rehabilitation Centers+") OR (MH "Geriatric Assessment+")
S3
S1 OR S2
S2
AB (older person? or older patient? or seniors or senior citiz* or elder or elders or elderly or geriatric* or frailty or postmenopausal women or community-dwelling or nursing home? or resident* or old* people or old* person? or old* patient? or old* client?) OR TI(older person? or older patient? or seniors or senior citiz* or elder or elders or elderly or geriatric* or frailty or postmenopausal women or community-dwelling or nursing home? or resident* or old* people or old* person? or old* patient? or old* client?) OR SU (older person? or older patient? or seniors or senior citiz* or elder or elders or elderly or geriatric* or frailty or postmenopausal women or community-dwelling or nursing home? or resident* or old* people or old* person? or old* patient? or old* client?)
Abbasi A. A study to reduce the re-admissions to the hospital following discharge to skilled nursing facilities in San Diego, Adil Abbasi, MD, FACP and Tahira Abbasi, MD. J Am Geriatr Soc 2013;61:S168.
Ali MS, Talwar D, Jain SK. The effect of a short-term pulmonary rehabilitation on exercise capacity and quality of life in patients hospitalised with acute exacerbation of chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2014;56:13-9.
Brown CJ, Peel C, Bamman MM, Allman RM. Exercise program implementation proves not feasible during acute care hospitalization. J Rehabil Res Dev 2006;43:939.
Chan C, Tang D, Jones A. Clinical outcomes of a cardiac rehabilitation and maintenance program for Chinese patients with congestive heart failure. Disabil Rehabil 2008;30:1245-53.
Choo J, Burke LE, Hong KP. Improved quality of life with cardiac rehabilitation for post-myocardial infarction patients in Korea. Eur J Cardiovasc Nurs 2007;6:166-71.
Escobar C, Jervis R, Silversmith G, Soones TN, De Cherrie L. Subacute rehabilitation at home: improving transitions from hospital to home with a multidisciplinary team and 30 day bundle. J Gen Intern Med 2016:S908-9.
Gurgun A, Korkmaz Ekren P, Karapolat H, Erdinc E. Efficacy of an eight-week outpatient pulmonary rehabilitation in chronic obstructive pulmonary disease patients Turkiye Klinikleri J Med Sci 2013;33:901-11.
Johnston KN, Young M, McEvoy C, Grimmer K, Seiboth C. Implementing care coordination plus early rehabilitation in COPD patients in transition from hospital to primary care: pilot study. Physiotherapy 2005;101:e687-8.
Johnston K, Young M, McEvoy C, et al. After hospital admission with COPD: care coordination plus early rehabilitation (pilot study) achieves patient-centred goals, increased physical activity and primary care collaboration. Respirology 2015;20:101.
Konick-McMahan J, Bixby B, McKenna C. Heart failure in older adults: providing nursing care to improve outcomes. J Gerontol Nurs 2003;29:35-41.
Kozu R, Jenkins S, Senjyu H. Effect of disability level on response to pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Respirology 2011;16:1196-202.
Lahham A, Burge A, McDonald C, et al. Participation in physical activity during hospital and home-based pulmonary rehabilitation for people with COPD. Eur Respir J 2016;48:PA2054.
Melin AL, Wieland D, Harker JO, Bygren LO. Health outcomes of post-hospital in-home team care: secondary analysis of a Swedish trial. J Am Geriatr Soc 1995;43:301-7.
Ortega L, Yassuda M, Nunes P, et al. The effects of a multiprofessional cognitive and functional rehabilitation program for patients with mild Alzheimer's disease. Alzheimers Dement 2011;7:S660-1.
Pratesi A, Baldasseroni S, Barucci R, et al. Effects of cardiac rehabilitation in maintaining physical performance of patients aged >75 years over the long-term period, after an acute coronary syndrome or heart surgery. Eur Geriatr Med 2016;7:S20.
Rao AV, Hsieh F, Feussner JR, Cohen HJ. Geriatric evaluation and management units in the care of the frail elderly cancer patient. J Gerontol A Biol Sci Med Sci 2005;60:798-803.
Scherwitz LW, Brusis OA, Kesten D, et al. [Life style changes in patients with myocardial infarct in the framework of intramural and ambulatory rehabilitation—results of a German pilot study] [German]. Z Kardiol 1995;84:216-21.
Schubert CC, Beaman P, Suelzer C, Rao N, Sutter B, Counsell S. Impact of GRACE team care on hospital readmissions at a VAMC. J Am Geriatr Soc 2012;60:S5-6.
Shibuta H, Abe T, Miyamoto H, Hagihara A. Interaction effects of in-hospital rehabilitation and the use of community-based services after hospital discharge on patients’ subsequent functional abilities. J Rehabil Med 2016;48:307-15.
Study protocol only (n=8)
Boxer RS, Dolansky MA, Bodnar CA, Singer ME, Albert JM, Gravenstein S. A randomized trial of heart failure disease management in skilled nursing facilities: design and rationale. J Am Med Dir Assoc 2013;14,710.e5.
Deer RR, Dickinson JM, Fisher SR, Ju H, Volpi E. Identifying effective and feasible interventions to accelerate functional recovery from hospitalization in older adults: a randomized controlled pilot trial. Contemp Clin Trials 2016;49:6-14.
Edmans J, Conroy S, Harwood R, et al. Acute medical unit comprehensive geriatric assessment intervention study (AMIGOS). Trials 2011;12:200.
Gade J, Beck AM, Bitz C, et al. Protein-enriched, milk-based supplement to counteract sarcopenia in acutely ill geriatric patients offered resistance exercise training during and after hospitalisation: study protocol for a randomised, double-blind, multicentre trial. BMJ Open 2018;8:e019210.
Koopman FS, Beelen A, Gerrits KH, et al. Exercise therapy and cognitive behavioural therapy to improve fatigue, daily activity performance and quality of life in postpoliomyelitis syndrome: the protocol of the FACTS-2-PPS trial. BMC Neurol 2010;10:1.
Lang CC, Smith K, Wingham J, et al. A facilitated home based rehabilitation intervention: impact on well-being and quality of life in patients with heart failure with preserved ejection fraction. Circulation 2017;136:A13929.
Mudge AM, Denaro CP, Scott AC, et al. Exercise training in recently hospitalized heart failure patients enrolled in a disease management programme: design of the EJECTION-HF randomized controlled trial. Eur J Heart Fail 2011;13:1370-5.
van Groenestijn AC, van de Port IG, Schröder CD, et al. Effects of aerobic exercise therapy and cognitive behavioural therapy on functioning and quality of life in amyotrophic lateral sclerosis: protocol of the FACTS-2-ALS trial. BMC Neurol 2011;11:1.
Patient population (n=68)
Anderson C, Deepak BV, Amoateng-Adjepong Y, Zarich S. Benefits of comprehensive inpatient education and discharge planning combined with outpatient support in elderly patients with congestive heart failure. Congest Heart Fail 2005;11:315-21.
Austin J, Williams R, Ross L, Moseley L, Hutchison S. Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. Eur J Heart Fail 2005;7:411-7.
Avlund K, Jepsen E, Vass M, Lundemark H. Effects of comprehensive follow-up home visits after hospitalization on functional ability and readmissions among old patients. A randomized controlled study. Scand J Occup Ther 2002;9:17-22.
Baxter SV, Hale LA, Stebbings S, Gray AR, Smith CM, Treharne GJ. Walking is a feasible physical activity for people with rheumatoid arthritis: a feasibility randomized controlled trial. Musculoskeletal Care 2016;14:47-56.
Bernocchi P, Vitacca M, La Rovere MT, et al. Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: a randomised controlled trial. Age Ageing 2018;47:82-8.
Blumenthal JA, Babyak MA, O’Connor C, et al. Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA 2012;308:465-74.
Brenner LA, Braden CA, Bates M, et al. A health and wellness intervention for those with moderate to severe traumatic brain injury: a randomized controlled trial. J Head Trauma Rehabil 2012;27:E57-68.
Brovold T, Skelton DA, Bergland A. Older adults recently discharged from the hospital: effect of aerobic interval exercise on health-related quality of life, physical fitness, and physical activity. J Am Geriatr Soc 2013;61:1580-5.
Carrieri-Kohlman V, Gormley JM, Douglas MK, Paul SM, Stulbarg MS. Exercise training decreases dyspnea and the distress and anxiety associated with it: monitoring alone may be as effective as coaching. Chest 1996;110:1526-35.
Chang FH, Latham NK, Ni P, Jette AM. Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized controlled trial. Arch Phys Med Rehabil 2015;96:1014-20.
Chen YW, Wang CY, Lai YH, et al. Home-based cardiac rehabilitation improves quality of life, aerobic capacity, and readmission rates in patients with chronic heart failure. Medicine 2018;97:e9629.
Cheng B, Zhang XUE, Peng W. Movement training for exercise tolerance and cardiac function in patients with chronic heart failure. Chin J Clin Rehabil 2005;9:241-3.
Chien CL, Lee CM, Wu YW, Wu YT. Home-based exercise improves the quality of life and physical function but not the psychological status of people with chronic heart failure: a randomised trial. J Physiother 2011;57:157-63.
Corvera-Tindel T, Doering LV, Woo MA, Khan S, Dracup K. Effects of a home walking exercise program on functional status and symptoms in heart failure. Am Heart J 2004;147:339-46.
Cowie A, Thow MK, Granat MH, Mitchell SL. A comparison of home and hospital-based exercise training in heart failure: immediate and long-term effects upon physical activity level. Eur J Cardiovasc Prev Rehabil 2011;18:158-66.
Cowie A, Thow MK, Granat MH, Mitchell SL. Effects of home versus hospital-based exercise training in chronic heart failure. Int J Cardiol 2012;158:296-8.
Crotty M, Giles LC, Halbert J, Harding J, Miller M. Home versus day rehabilitation: a randomised controlled trial. Age Ageing 2008;37:628-33.
Cunliffe AL, Gladman JR, Husbands SL, Miller P, Dewey ME, Harwood RH. Sooner and healthier: a randomised controlled trial and interview study of an early discharge rehabilitation service for older people. Age Ageing 2004;33:246-52.
Dalal HM, Evans PH, Campbell JL, et al. Home-based versus hospital-based rehabilitation after myocardial infarction: a randomized trial with preference arms—Cornwall Heart Attack Rehabilitation Management Study (CHARMS). Int J Cardiol 2007;119:202-11.
de Godoy DV, de Godoy RF. A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2003;84:1154-7.
Denehy L, Skinner EH, Edbrooke L, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care 2013;17:1.
de Sousa Pinto JM, Martín-Nogueras AM, Calvo-Arenillas JI, Ramos-González J. Clinical benefits of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 2014;34:355-9.
Dracup K, Evangelista LS, Hamilton MA, et al. Effects of a home-based exercise program on clinical outcomes in heart failure. Am Heart J 2007;154:877-83.
Eagle DJ, Guyatt GH, Patterson C, Turpie I, Sackett B, Singer J. Effectiveness of a geriatric day hospital. CMAJ 1991;144:699.
Elliott D, McKinley S, Alison J, et al. Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care 2011;15:1.
Evans RL, Connis RT, Haselkorn JK. Hospital-based rehabilitative care versus outpatient services: effects on functioning and health status. Disabil Rehabil 1998;20:298-307.
Evans RL, Connis RT, Haselkorn JK. Evaluating rehabilitation medicine: effects on survival, function, and home care. Home Health Care Serv Q 1997;16:35-53.
Fattirolli F, Cartei A, Burgisser C, et al. Aims, design and enrollment rate of the Cardiac Rehabilitation in Advanced Age (CR-AGE) randomized, controlled trial. Aging Clin Exp Res 1998;10:368-76.
Felker GM, Fiuzat M, Thompson V, et al. Soluble ST2 in ambulatory patients with heart failure association with functional capacity and long-term outcomes. Circ Heart Fail 2013;6:1172-9.
Fleming SA, Blake H, Gladman JR, et al. A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people. Age Ageing 2004;33:384-90.
Garrod R, Bestall JC, Garnham R, et al. Randomised controlled trial of hospital out-patient pulmonary rehabilitation in moderate COPD: early effects. Physiotherapy 1997;83:367.
Giallauria F, D’agostino M, Lucci R, et al. [La Telecardiologia come metodica per il miglioramento dell’adesione ai programmi di Riabilitazione Cardiologica nel paziente anziano]. G Gerontol 2006;54:17-23.
Greening NJ, Williams JE, Hussain SF, et al. An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ 2014;349:g4315.
Güell MR, de Lucas P, Gáldiz JB, et al. [Home vs hospital-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a Spanish multicenter trial]. Arch Bronconeumol 2008;44:512-8.
Gulanick M. Is phase 2 cardiac rehabilitation necessary for early recovery of patients with cardiac disease? A randomized, controlled study. Heart Lung 1991;20:9-15.
Haines TP, Russell T, Brauer SG, et al. Effectiveness of a video-based exercise programme to reduce falls and improve health-related quality of life among older adults discharged from hospital: a pilot randomized controlled trial. Clin Rehabil 2009;23:973-85.
Hambrecht R, Gielen S, Linke A, et al. Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: a randomized trial. JAMA 2000;283:3095-101.
Holmes-Rovner M, Stommel M, Corser WD, et al. Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome? J Gen Intern Med 2008;23:1464-70.
Houle J, Doyon O, Vadeboncoeur N, Turbide G, Diaz A, Poirier P. Innovative program to increase physical activity following an acute coronary syndrome: randomized controlled trial. Patient Educ Couns 2011;85:e237-44.
Hwang R, Bruning J, Mandrusiak A, Morris N, Russell T. Providing heart failure rehabilitation in the home via telerehabilitation. Heart Lung Circ 2016;25:S4.
Hwang R, Bruning J, Morris NR, Mandrusiak A, Russell T. Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial. J Physiother 2017;63:101-7.
Jolly K, Taylor RS, Lip GY, et al. A randomized trial of the addition of home-based exercise to specialist heart failure nurse care: the Birmingham Rehabilitation Uptake Maximisation study for patients with Congestive Heart Failure (BRUM-CHF) study. Eur J Heart Fail 2009;11:205-13.
Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME. Supervised fitness walking in patients with osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 1992;116:529-34.
Kraal JJ, Peek N, Van den Akker-Van ME, Kemps HM. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the [email protected] Home study. Eur J Prev Cardiol 2014;21(2 Suppl):26-31.
Latham NK, Anderson CS, Lee A, et al. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc 2003;51:291-9.
Lenze EJ, Host HH, Hildebrand MW, et al. Enhanced medical rehabilitation increases therapy intensity and engagement and improves functional outcomes in postacute rehabilitation of older adults: a randomized-controlled trial. J Am Med Dir Assoc 2012;13:708-12.
Lewin B, Robertson IR, Cay EL, Irving JB, Campbell M. Effects of self-help post-myocardial-infarction rehabilitation on psychological adjustment and use of health services. Lancet 1992;339:1036-40.
Maltais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med 2008;149:869-78.
Matos-Garcia BC, Rocco IS, Maiorano LD, et al. A home-based walking program improves respiratory endurance in patients with acute myocardial infarction: a randomized controlled trial. Can J Cardiol 2017;33:785-91.
Melin AL, Bygren LO. Efficacy of the rehabilitation of elderly primary health care patients after short-stay hospital treatment. Med Care 1992;30:1004-15.
Murphy N, Bell C, Costello RW. Extending a home from hospital care programme for COPD exacerbations to include pulmonary rehabilitation. Respir Med 2005;99:1297-302.
Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc 2004;52:675-84.
Nikolaus T, Specht-Leible, N, Bach M, Oster P, Schlierf G. A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients. Age Ageing 1999;28:543-50.
Parker SG, Oliver P, Pennington M, et al. Rehabilitation of older patients: day hospital compared with rehabilitation at home. A randomised controlled trial. Health Technol Assess 2009;13:1-143.
Parker SG, Oliver P, Pennington M, et al. Rehabilitation of older patients: day hospital compared with rehabilitation at home. Clinical outcomes. Age Ageing 2011;40:557-62.
Peixoto TC, Begot I, Bolzan DW, et al. Early exercise-based rehabilitation improves health-related quality of life and functional capacity after acute myocardial infarction: a randomized controlled trial. Can J Cardiol 2015;31:308-13.
Regensteiner JG, Meyer TJ, Krupski WC, Cranford LS, Hiatt WR. Hospital vs home-based exercise rehabilitation for patients with peripheral arterial occlusive disease. Angiology 1997;48:291-300.
Reid RD, Morrin LI, Beaton, LJ, et al. (2012). Randomized trial of an internet-based computer-tailored expert system for physical activity in patients with heart disease. Eur J Prev Cardiol 2012;19:1357-64.
Ringbaek TJ, Broendum E, Hemmingsen L, et al. Rehabilitation of patients with chronic obstructive pulmonary disease. Exercise twice a week is not sufficient! Respir Med 2000;94:150-54.
Savage P, Ricci MA, Lynn M, et al. Effects of home versus supervised exercise for patients with intermittent claudication. J Cardiopulm Rehabil Prev 2001;21:152-7.
Scalvini S, Bernocchi P, Baratti D, et al. Multidisciplinary telehealth program for patients affected by chronic heart failure and chronic obstructive pulmonary disease. Eur J Heart Fail 2016;18:94.
Sherrington C, Pamphlett PI, Jacka JA, et al. Group exercise can improve participants’ mobility in an outpatient rehabilitation setting: a randomized controlled trial. Clin Rehabil 2008;22:493-502.
Siebens H, Aronow H, Edwards D, Ghasemi Z. A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. J Am Geriatr Soc 2000;48:1545-52.
Vogler CM, Menant JC, Sherrington C, Ogle SJ, Lord SR. Evidence of detraining after 12-week home-based exercise programs designed to reduce fall-risk factors in older people recently discharged from hospital. Arch Phys Med Rehabil 2012;93:1685-91.
Wang W, Chair SY, Thompson DR, Twinn SF. Effects of home-based rehabilitation on health-related quality of life and psychological status in Chinese patients recovering from acute myocardial infarction. Heart Lung 2012;41:15-25.
Wedzicha JA, Bestall JC, Garrod R, Garnham R, Paul EA, Jones PW. Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale. Eur Respir J 1998;12:363-9.
Young L, Hertzog M, Barnason S. Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients: the PATCH randomized controlled trial. BMC Cardiovasc Disord 2016;16:176.
No acute admission (n=12)
Antonicelli R, Spazzafumo L, Scalvini S, et al. Exercise: a “new drug” for elderly patients with chronic heart failure. Aging 2016;8:860-72.
Fulton RL, Witham MD, Greig C, et al. A randomized controlled trial of exercise training for older heart failure patients. Age Ageing 2011;40:II9.
Gitlin LN, Hauck WW, Winter L, Dennis MP, Schulz R. Effect of an in-home occupational and physical therapy intervention on reducing mortality in functionally vulnerable older people: preliminary findings. J Am Geriatr Soc 2006;54:950-5.
Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 2000;355:362-8.
Maldonado-Martin S, Brubaker PH, Eggebeen J, Stewart KP, Kitzman DW. Association between 6-minute walk test distance and objective variables of functional capacity after exercise training in elderly heart failure patients with preserved ejection fraction: a randomized exercise trial. Arch Phys Med Rehabil 2017;98:600-3.
Nikoletou D, Man WD, Mustfa N, et al. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disabil Rehabil 2016;38:250-9.
O'Shea SD, Taylor NF, Paratz JD. A predominantly home-based progressive resistance exercise program increases knee extensor strength in the short-term in people with chronic obstructive pulmonary disease: a randomised controlled trial. Aust J Physiother 2007;53:229-37.
Romagnoli M, Dell’Orso D, Lorenzi C, et al. Repeated pulmonary rehabilitation in severe and disabled COPD patients. Respiration 2006;73:769-76.
Strijbos JH, Postma DS, van Altena R, Gimeno F, Koëter GH. Feasibility and effects of a home-care rehabilitation program in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 1996;16:386-93.
Strijbos JH, Postma DS, Van Altena R, Gimeno F, Koëter GH. A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD: a follow-up of 18 months. Chest 1996;109:366-72.
Tsai LL, McNamara R, Moddel C, McKenzie D, Alison J, McKeough Z. Telerehabilitation in people with chronic obstructive pulmonary disease (COPD): a randomised controlled trial. Eur Respir J 2016;48:PA2065.
Torres-Sánchez I, Valenza MC, Del Corral Nunez-Flores T, Garcia CM, Torres JR, Demet GV. Home-based rehabilitation program with superimposed neuromuscular electrical stimulation in stable COPD patients. Eur Respir J 2016;48:PA532.
Intervention (n=14)
Bertelsen JB, Refsgaard J, Kanstrup H, et al. Cardiac rehabilitation after acute coronary syndrome comparing adherence and risk factor modification in a community-based shared care model versus hospital-based care in a randomised controlled trial with 12 months of follow-up. Eur J Cardiovasc Nurs 2017;16:334-43.
Caplan GA, Coconis J, Board N, Sayers A, Woods J. Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial). Age Ageing 2006;35:53-60.
Cohen HJ, Feussner JR, Weinberger M, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med 2002;346:905-12.
Crotty M, Giles LC, Halbert J, Harding J, Miller M. Home versus day rehabilitation: a randomised controlled trial. Age Ageing 2008;37:628-33.
Eyres L, Unsworth CA. Occupational therapy in acute hospitals: the effectiveness of a pilot program to maintain occupational performance in older clients. Aust Occup Ther J 2005;52:218-24.
Hunger M, Kirchberger I, Holle R, et al. Does nurse-based case management for aged myocardial infarction patients improve risk factors, physical functioning and mental health? The KORINNA trial. Eur J Prev Cardiol 2015;22:442-50.
Kircher TT, Wormstall H, Müller PH, et al. A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients. Age Ageing 2007;36:36-42.
Li X, Yu H, Xu S, Li R, Gao Y. Effects of low-intensity exercise in older adults with chronic heart failure during the transitional period from hospital to home in china: a randomized controlled trial. Res Gerontol Nurs 2017;10:121-8.
Morrissey Y, Coxon K, Carpenter I. A comparison of outcomes of rehabilitation on a district general hospital ward with rehabilitation in “recuperative care,” a “stepdown” intermediate care facility. Age Ageing 2011;40:ii57.
Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA 1999;281:613-20.
Reeves GR, Whellan DJ, O'Connor CM, et al. A novel rehabilitation intervention for older patients with acute decompensated heart failure: the REHAB-HF pilot study. JACC Heart Fail 2017;5:359-66.
Schubert CC, Myers LJ, Allen K, Counsell SR. Implementing geriatric resources for assessment and care of elders team care in a veterans affairs medical center: lessons learned and effects observed. J Am Geriatr Soc 2016;64:1503-9.
Stevens-Lapsley JE, Loyd BJ, Falvey JR, et al. Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: a pilot randomized controlled trial. Clin Rehabil 2016;30:776-85.
Thygesen LC, Fokdal S, Gjørup T, Taylor RS, Zwisler AD. Can municipality-based post-discharge follow-up visits including a general practitioner reduce early readmission among the fragile elderly (65+ years old)? A randomized controlled trial. Scand J Prim Health Care 2015;33:65-73.
Outcomes (n=5)
Hansen D, Dendale P, Raskin A, et al. Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume. Clin Rehabil 2010;24:319-27.
Marchionni N, Fattirolli F, Fumagalli S, et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction results of a randomized, controlled trial. Circulation 2013;107:2201-6.
Parsons M, Parsons J, Rouse P, et al. Supported Discharge Teams for older people in hospital acute care hospital: a randomised controlled trial. Age Ageing 2018;47:288-94.
Pratesi A, Baldasseroni S, Burgisser C, et al. Reduction of functional decline in the first year after cardiac rehabilitation in a large cohort of very old coronary patients. Eur J Prev Cardiol 2014;21(1 Suppl 1):S47.
Timonen L, Rantanen T, Timonen TE, Sulkava R. Effects of a group-based exercise program on the mood state of frail older women after discharge from hospital. Int J Geriatr Psychiatry 2002;17:1106-11.
Timonen L, Rantanen T, Makinen E, Timonen TE, Tormakangas T, Sulkava R. Effects of a group-based exercise program on functional abilities in frail older women after hospital discharge. Aging Clin Exp Res 2006;18:50-6.
Setting (n=2)
Brown M, Sinacore DR, Ehsani AA, Binder EF, Holloszy JO, Kohrt WM. Low-intensity exercise as a modifier of physical frailty in older adults. Arch Phys Med Rehabil 200;81:960-5.
Lee JH, Kim SJ, Lam J, Kim S, Nakagawa S, Yoo JW. The effects of shared situational awareness on functional and hospital outcomes of hospitalized older adults with heart failure. J Multidiscip Healthc 2014;7:259.
Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review.
Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up.
Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis.
Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program.
Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial.
The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.
Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.
Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Does it pay to penalize hospitals for excess readmissions? Intended and unintended consequences of Medicare’s Hospital Readmissions Reductions Program.
American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
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