Abstract
BackgroundSelecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients. The aim of this review was to describe primary outcome measures that have been used in randomized controlled trials (RCTs) on early rehabilitation in acutely hospitalized older patients, to analyze their matching, and to evaluate the effects of matching on the main findings of these RCTs.MethodsA systematic literature search was conducted in PubMed, Cochrane CENTRAL, CINAHL, and PEDro databases. Additional studies were identified through reference and citation tracking. Inclusion criteria were: RCT, patients aged ≥65 years, admission to an acute hospital medical ward (but not to an intensive medical care unit), physical exercise intervention (also as part of multidisciplinary programs), and primary outcome measure during hospitalization. Two independent reviewers extracted the data, assessed the methodological quality, and analyzed the matching of primary outcome measures to the intervention, study sample, and setting. Main study findings were related to the results of the matching procedure.ResultsTwenty-eight articles reporting on 24 studies were included. A total of 33 different primary outcome measures were identified, which were grouped into six categories: functional status, mobility status, hospital outcomes, adverse clinical events, psychological status, and cognitive functioning. Outcome measures differed considerably within each category and showed a large heterogeneity in their matching to the intervention, study sample, and setting. Outcome measures that specifically matched the intervention contents were more likely to document intervention-induced benefits. Mobility instruments seemed to be the most sensitive outcome measures to reveal such benefits.ConclusionsThis review highlights that the selection of outcome measures has to be highly specific to the intervention contents as this is a key factor to reveal benefits attributable to early rehabilitation in acutely hospitalized older patients. Inappropriate selection of outcome measures may represent a major cause of inconsistent findings reported on the effectiveness of early rehabilitation in this setting.Trial registrationPROSPERO CRD42017063978.
Highlights
Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients
The inclusion criteria were as follows: (1) randomized, controlled intervention trial (RCT), (2) in older people aged 65 years or older, (3) admitted to an acute hospital medical ward but (4) not to an intensive medical care unit, (5) with a physical exercise intervention or a multidisciplinary program with physical exercise as a training component, both performed in an acute hospital medical ward, and (6) at least one primary outcome measure during acute care hospitalization
The aim of this review was to analyze the matching of outcome measures used in previous randomized controlled trials (RCTs) on early rehabilitation in acutely hospitalized older patients to the specific study characteristics and to evaluate the effects of matching on the main findings reported in these RCTs
Summary
Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients. The prevalence of functional decline during hospital stay is high, varying from 30 to80% depending on the assessment methodology, medical status, and age cohorts included [2, 3]. The consequences of this decline during are manifold, ranging from re-hospitalization, nursing home placement [4], and subsequent mortality [5] to an increased number of falls, poor quality of life, and increased use of healthrelated resources [6]. Hospital admission represents a vulnerable period in the treatment process in which an early onset of rehabilitation and physical training is of utmost importance, providing the basis for post-recovery and subsequent therapeutic and rehabilitative care
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