Care home versus hospital and own home environments for rehabilitation of older people

Ward, Derek; Severs, Martin; Dean, Tara; Brooks, N

doi:10.1002/14651858.cd003164

Cited by 26 publications

(20 citation statements)

References 24 publications

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“…Home based programmes have been shown to be superior to centre-based ones in terms of adherence to exercise [53] and are attractive to many people with COPD who are unable to attend centre-based activities due to work/life commitments or due to limitations to performing exercise such as additional musculoskeletal impairments or profound breathlessness. Therefore, it is of clinical significance that participants have derived important benefits from this home based programme.…”

Section: Clinical Implications Limitations and Further Researchmentioning

confidence: 99%

Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests

Nikoletou

Man

Mustfa

et al. 2015

Disability and Rehabilitation

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Purpose: To evaluate the effectiveness of a home-based Inspiratory Muscle Training (IMT) programme using multiple inspiratory muscle tests. group and trained with a threshold loading device at intensity >30% maximum inspiratory pressure (PImax) or < 15%PImax respectively for 7 weeks. Thirty nine patients (23M) completed the study. The following measures were assessed pre-and post-IMT: PImax, sniff inspiratory nasal pressure (SNIP), diaphragm contractility (Pdi,tw), incremental shuttle walk test (ISWT), respiratory muscle endurance (RME), chronic respiratory disease questionnaire (CRDQ), the hospital anxiety and depression scale (HADS) and the SF-36. Between group changes were assessed using one-way analysis of variance (ANOVA). Method Results

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Section: Clinical Implications Limitations and Further Researchmentioning

confidence: 99%

Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests

Nikoletou

Man

Mustfa

et al. 2015

Disability and Rehabilitation

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“…Two systematic reviews 9,26 compared rehabilitation environments irrespective of diagnosis. Ward et al 26 were unable to determine the benefits or risks of the 3 different care environments they studied. Evans et al 9 more narrowly focused on inpatient specialized rehabilitation compared with conventional medical care and found that specialized rehabilitation resulted in an increased likelihood of home discharge and, in the short-term, greater functional improvement and better rates of survival.…”

Section: Summary Of Findings On Efficacymentioning

confidence: 99%

“…12,14,20,26 The variability may have been exacerbated by the quality of studies or by the inclusion of studies from countries with different policies for access, payment, and service delivery. Additionally challenging the systematic review process, particularly in the reviews by Beaupre 20 and Ward, 26 was the diversity of the study designs selected for inclusion, which ranged from RCTs to interrupted time series. The expanded selection criteria and the heterogeneity confounding the systematic reviews may have been unavoidable in order to collect the data that were available to address the primary research question.…”

Section: Summary Of Findings On Efficacymentioning

confidence: 99%

“…28,29 The instruments used to measure the outcome, 16,20,26 define the patient population, 16,26 clarify the setting or environments, and characterize the interventions, varied. 12,14,20,26 The variability may have been exacerbated by the quality of studies or by the inclusion of studies from countries with different policies for access, payment, and service delivery. Additionally challenging the systematic review process, particularly in the reviews by Beaupre 20 and Ward, 26 was the diversity of the study designs selected for inclusion, which ranged from RCTs to interrupted time series.…”

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confidence: 99%

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Effectiveness of Multidisciplinary Rehabilitation Services in Postacute Care: State-of-the-Science. A Review

Bettger

Stineman

2007

Archives of Physical Medicine and Rehabilitation

138

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Objectives-To summarize the efficacy of postacute rehabilitation and to outline future research strategies for increasing knowledge of its effectiveness.Data Sources-English-language systematic reviews that examined multidisciplinary therapybased rehabilitation services for adults, published in the last 25 years and available through Cochrane, Medline, or CINAHL databases. We excluded multidisciplinary biopsychosocial rehabilitation programs and mental health services.Study Selection-Using the search term rehabilitation, 167 records were identified in the Cochrane database, 1163 meta-analyses and reviews were identified in Medline, and 226 in CINAHL. The Medline and CINAHL search was further refined with 3 additional search terms: therapy, multidisciplinary, and interdisciplinary. In summary, we used 12 reviews to summarize the efficacy of multidisciplinary, therapy-based postacute rehabilitation; the 12 covered only 5 populations.Data Extraction-Two reviewers extracted information about study populations, sample sizes, study designs, the settings and timing of rehabilitation, interventions, and findings.Data Synthesis-Based on systematic reviews, the evidence for efficacy of postacute rehabilitation services across the continuum was strongest for stroke. There was also strong evidence supporting multidisciplinary inpatient rehabilitation for patients with rheumatoid arthritis, moderate to severe acquired brain injury, including traumatic etiologies, and for older adults. Heterogeneity limited our ability to conclude a benefit or a lack of a benefit for rehabilitation in other postacute settings for the other conditions in which systematic reviews had been completed. The efficacy of multidisciplinary rehabilitation services has not been systematically reviewed for many of the diagnostic conditions treated in rehabilitation. We did not complete a summary of findings from individual studies.Conclusions-Given the limitations and paucity of systematic reviews, information from carefully designed nonrandomized studies could be used to complement randomized controlled No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. The pressure on providers of postacute rehabilitation to deliver clinically effective care will only intensify as cost-containment efforts and requirements for documenting the quality of care increase. Systematically acquired evidence can guide rehabilitation services toward higher quality, effective and cost-efficient care; however, the evidence for certain conditions and rehabilitation settings is better developed than for others. More clearly delineating the evidence of effectiveness will help determine whether certain postacute rehabilitation services produce better outcomes than alternatives. Subsequently, policy-makers, health care administrators, and clinicians might be better informed for making decisions about prov...

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“…[2][3][4] Although trials of rehabilitation in the home environment indicate cost effectiveness for many conditions, there is lack of robust evidence toward comparability of the effect of the hospital versus alternative environments. 2,5,6 The evidence is strongest for stroke 7 followed by elective joint surgery 1,8,9 and several other conditions. 1,[8][9][10][11] Rehabilitation in the home (RITH) schemes generally aim to provide short-term, person-centred care in selected cases.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of 'rehabilitation in the home' service

Bharadwaj

Bruce²

2014

Aust. Health Review

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Objectives. Rehabilitation in the home (RITH) services increasingly provide hospital substitution services. This study examines clinical outcomes in a large metropolitan RITH service in Western Australia.Methods. The 2010 database of Fremantle Hospital RITH service was interrogated to identify the clinical profile of cases, length of stay (LOS) and clinical outcomes. Negative outcomes included death or unexpected hospital readmission. Multiple logistic regression modelling was used to explore associations with negative outcomes. This study was reviewed by the Institutional Review Board which deemed it not to require ethics approval.Results. There were 1348 cases managed by RITH: 70.6% were aged !65 years; elective joint replacement (29.7%), medical conditions (20%), stroke (13%), hip fractures (10%) were major contributors. The majority (93.3%) were discharged after a median of 9 days. Negative outcomes occurred in 90 cases (6.7%), including five deaths (0.4%) and 85 readmissions (6.3%). Independent associations with negative outcomes included older age (odds ratio (OR) (95% CI); 1.02, P = 0.006), orthopaedic conditions (OR 1.91, P = 0.004) and longer inpatient LOS (OR 1.96, P = 0.003). Age above 80 years was independently associated with risk of negative outcome (OR 2.99, P = 0.004).Conclusions. RITH had a low rate of negative outcomes. The database proved useful for monitoring quality of service provision.What is known about the topic? Rehabilitation in the home environment has proven cost effective for multiple conditions, particularly stroke and elective joint surgery, among others, facilitating better quality of life, with reduced rates of delirium and mortality. Overall there are few negative outcomes and death is rare. What does this paper add? Although RITH services are widely utilised as bed substitution services, there is scant literature on clinical outcomes while within the service. This study focuses on frequency of good and poor clinical outcomes in a well-established RITH service in Western Australia, suggesting pattern recognition of an at-risk cohort by identifying potentially useful predictors of poor outcome. What are the implications for practitioners? RITH services are a safe alternative for many, including older people. Health administration databases are useful tools to monitor clinical outcomes. Clinical indicators such as older age, long hospital stay and orthopaedic diagnoses may be useful predictors of poor outcomes in such services.

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Care home versus hospital and own home environments for rehabilitation of older people

Abstract: Care home versus hospital and own home environments for rehabilitation of older people.

Cited by 26 publications

References 24 publications

Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests

Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests

Effectiveness of Multidisciplinary Rehabilitation Services in Postacute Care: State-of-the-Science. A Review

Effectiveness of 'rehabilitation in the home' service

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