Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials

Stefan Bachmann, Christoph Finger, Anke Huss, Matthias Egger, Andreas E Stuck, Kerri M Clough-Gorr, Stefan Bachmann, Christoph Finger, Anke Huss, Matthias Egger, Andreas E Stuck, Kerri M Clough-Gorr

Abstract

Objective: To assess the effects of inpatient rehabilitation specifically designed for geriatric patients compared with usual care on functional status, admissions to nursing homes, and mortality.

Design: Systematic review and meta-analysis.

Data sources: Medline, Embase, Cochrane database, and reference lists from published literature. Review methods Only randomised controlled trials were included. Trials had to report on inpatient rehabilitation and report at least one of functional improvement, admission to nursing homes, or mortality. Trials of consultation or outpatient services, trials including patients aged <55, trials of non-multidisciplinary rehabilitation, and trials without a control group receiving usual care were excluded. Data were double extracted. Odds ratios and relative risks with 95% confidence intervals were calculated.

Results: 17 trials with 4780 people comparing the effects of general or orthopaedic geriatric rehabilitation programmes with usual care were included. Meta-analyses of effects indicated an overall benefit in outcomes at discharge (odds ratio 1.75 (95% confidence interval 1.31 to 2.35) for function, relative risk 0.64 (0.51 to 0.81) for nursing home admission, relative risk 0.72 (0.55 to 0.95) for mortality) and at end of follow-up (1.36 (1.07 to 1.71), 0.84 (0.72 to 0.99), 0.87 (0.77 to 0.97), respectively). Limited data were available on impact on health care or cost. Compared with those in control groups, weighted mean length of hospital stay after randomisation was longer in patients allocated to general geriatric rehabilitation (24.5 v 15.1 days) and shorter in patients allocated to orthopaedic rehabilitation (24.6 v 28.9 days).

Conclusion: Inpatient rehabilitation specifically designed for geriatric patients has the potential to improve outcomes related to function, admission to nursing homes, and mortality. Insufficient data are available for defining characteristics and cost effectiveness of successful programmes.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) SB received financial support from the Robert Bosch Foundation (see above) for the submitted work, and no other support was received for the submitted work; (2) they have no relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) they have no non-financial interests that may be relevant to the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787656/bin/bacs689687.f1_default.jpg
Fig 1 Flow of papers through study
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787656/bin/bacs689687.f2_default.jpg
Fig 2 Effect of inpatient rehabilitation specifically designed for geriatric patients on functional improvement at hospital discharge and at follow-up
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787656/bin/bacs689687.f3_default.jpg
Fig 3 Effect of inpatient rehabilitation specifically designed for geriatric patients on admissions to nursing homes at hospital discharge and at follow-up
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787656/bin/bacs689687.f4_default.jpg
Fig 4 Effect of inpatient rehabilitation specifically designed for geriatric patients on mortality at hospital discharge and at follow-up

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