Effectiveness of a simplified reablement program to minimize functional decline in hospitalized older patients

Hu, Fang; Huang, Yi; Lin, Huey Shyan; Chen, Ching Huey; Chen, Mei Ju; Chang, Chia Ming

doi:10.1111/ggi.13891

Cited by 8 publications

(8 citation statements)

References 27 publications

(22 reference statements)

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“…After removing duplicates, 1601 records were screened for titles and abstracts and 44 full-text articles were screened for eligibility. In total, 19 studies6 14–16 38–52 involving 3842 participants were included in the review. For the dose-response analyses, 39 data points (ie, effect sizes) were retrieved.…”

Section: Resultsmentioning

confidence: 99%

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Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials

et al. 2023

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ObjectiveTo identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults.DesignSystematic review and Bayesian model-based network meta-analysis.Data sourcesFour databases were searched from inception to 20 June 2022.Eligibility criteria for selecting studiesRandomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models.ResultsNineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days).ConclusionsThis meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population.Trial registration numberPROSPERO CRD42021271999.

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Section: Resultsmentioning

confidence: 99%

“…The median reported age was 78 (range 55–87) years. Participants were admitted to an ICU (758; 21.67%)6 16 51 or general wards 14 15 37–49 51. The median reported body mass index was 27 (range 24.5–33).…”

Section: Resultsmentioning

confidence: 99%

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials

et al. 2023

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“…As we known, due to the sedative effect, mechanical ventilation patients are commonly unconscious and inactive for a long time, making it easy to develop a time-dependent decline in muscle strength. [14,15] Those patients of the intervention group receiving early progressive mobilization from passive movement to active exercise, effectively activated extension-contraction cycle of joints and maintained muscle flexibility by turning over, massage, and passive flexion and extension of limb joints, and other treatments, subsequently increased self-care ability of patients. This result was consistent with the report of Wu H et al [16] Furthermore, the proportion of patients who can independently complete daily actions (eating, taking a shower, wearing clothes, grooming, moving from bed to chair, using the toilet) in the intervention group were significantly higher than those of the control group, indicating that in the case of ensuring safety, early progressive mobilization can help patients to recover functional independence, which was consistent with the report of Schaller SJ et al [17] For safety reasons, early progressive mobilization was generally not recommended for ICU inpatients in the past.…”

Section: Discussionmentioning

confidence: 99%

Effect of early progressive mobilization on intensive care unit-acquired weakness in mechanically ventilated patients: An observational study

Zhou¹,

Zhang²,

Zhou³

et al. 2022

Medicine

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Early progressive mobilization is usually considered as an effective method for intensive care unit-acquired weakness (ICU-AW), but the controversies on this topic remain debatable, especially in initiation time, safety profile, and other implementation details. So, more studies should be performed to solve these disputes. A set of critically ill patients underwent mechanical ventilation in intensive care unit (ICU) of our hospital from March 2018 to September 2020 were included as study object. Patients received early progressive mobilization were included into the intervention group (n = 160), and another patients matched with the intervention group by gender, age, and APACHE II score, and these patients received routine intervention were included into the control group (n = 160). Then, indexes involving muscle strength, Barthel index, functional independence, incidence rates of ICU-AW and other complications were comparatively analyzed between the 2 groups. The Medical Research Council score and Barthel index score in the intervention group were significantly higher than those in the control group (all P < .05). The percentages of patients who were able to complete taking a shower, wearing clothes, eating, grooming, moving from bed to chair and using the toilet by alone in the intervention group were significantly higher than those in the control group (69.38% vs 49.38%, 73.13% vs 51.88%, 81.25% vs 55.63%, 74.38% vs 48.75%, 82.50% vs 65.63%, 78.13% vs 63.13%, respectively, all P < .05). The incidence rate of ICU-AW and overall incidence rate of complications in the intervention group were significantly lower than those in the control group (6.88% vs 28.13% and 23.13% vs 48.13%, both P < .05). Early progressive mobilization can effectively increase muscle strength and daily basic motion ability, improve functional status, and decrease risk of ICU-AW in critically ill patients underwent mechanical ventilation, and it has an attractive application value in clinic.

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“…In the disability process model, functional impairment was defined as difficulty performing activities in any domain of life, including activities of daily living (ADL) and instrumental activities of daily living (IADL; Nikolova et al, 2011 ). Approximately 30–60% of older patients with multimorbidity developed new ADL dependence ( Hu et al, 2020 ). Similarly, patients with multimorbidity are also more likely to show poorer cognitive performance ( Kingston et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Moderated-mediation analysis of multimorbidity and health-related quality of life among the Chinese elderly: The role of functional status and cognitive function

Wei

Zhou³

et al. 2022

Front. Psychol.

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ObjectivesTo investigate the relationship between multimorbidity and health-related quality of life (HRQoL), and explore the effects of functional status and cognitive function on Chinses elderly behind this relationship.MethodsThe Multivariate logistic regression and Tobit regression models were used to determine the influence of multimorbidity on HRQoL. Bootstrap analysis was used to probe the mediating effects of functional status and the moderating role of cognition on multimorbidity and HRQoL.ResultsResults of the 2,887 participants age ≥ 60 years included in the analysis, 51.69% had chronic diseases. Stroke (β = −0.190; 95% confidence interval [CI], −0.232, −0.149; p < 0.001) and the combination of hypertension and stroke (β = −0.210; 95% CI, −0.259, −0.160; p < 0.001) had the greatest influence on HRQoL. Functional status partially mediated the relationship between the number of non-communicable diseases (No. of NCDs) and HRQoL, while cognitive function had a moderating effect not only in the A-path (No. of NCDs to functional status, β = 0.143; t = 7.18; p < 0.001) and but also in the C-path (No. of NCDs to HRQoL, β = 0.007; t = 6.08; p < 0.001).ConclusionFunctional status partially mediated the relationship between multimorbidity and HRQoL in older adults. And cognitive function, if declined, may strengthen this relationship. These findings suggested that improving cognitive function and functional status in those who developed multimorbidity could be a viable prevention or treatment strategy to improve HRQoL in elderly patients.

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Effectiveness of a simplified reablement program to minimize functional decline in hospitalized older patients

Abstract: Aim: To examine the effects of a simplified reablement program on physical function and quality of life in hospitalized older patients.

Cited by 8 publications

References 27 publications

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials

Effect of early progressive mobilization on intensive care unit-acquired weakness in mechanically ventilated patients: An observational study

Moderated-mediation analysis of multimorbidity and health-related quality of life among the Chinese elderly: The role of functional status and cognitive function

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