Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials.
Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials.
复制标题
DOI：
10.1136/bmj.c1718
复制
发表时间：
2010-04-20
期刊：
影响因子：
--
通讯作者：
Clough-Gorr KM
中科院分区：
文献类型：
--
作者：
Bachmann S;Finger C;Huss A;Egger M;Stuck AE;Clough-Gorr KM
目的 评估专为老年患者设计的住院康复与常规护理相比对功能状态、入住疗养院和死亡率的影响。设计系统回顾和荟萃分析。数据来源 Medline、Embase、Cochrane 数据库以及已发表文献的参考文献列表。审查方法 仅纳入随机对照试验。试验必须报告住院患者的康复情况，并至少报告功能改善、入住疗养院或死亡率中的一项。咨询或门诊服务的试验、包括年龄<55岁的患者的试验、非多学科康复试验以及没有对照组接受常规护理的试验被排除在外。数据被双重提取。计算优势比和 95% 置信区间的相对风险。结果 纳入了 17 项试验，涉及 4780 人，比较一般或骨科老年康复计划与常规护理的效果。效果荟萃分析表明，出院时和随访结束时（功能比值比 1.75（95% 置信区间 1.31 至 2.35）、入住疗养院相对风险 0.64（0.51 至 0.81）、死亡率相对风险 0.72（0.55 至 0.95））和随访结束时（1.36（1.07 至 1.71）， 0.84（0.72至0.99）， 0.87（分别为 0.77 至 0.97））。关于对医疗保健或成本的影响的可用数据有限。与对照组相比，分配到普通老年康复组的患者随机分组后的加权平均住院时间较长（24.5 天 vs 15.1 天），分配到骨科康复组的患者则较短（24.6 天 vs 28.9 天）。结论 专为老年患者设计的住院康复有可能改善与功能、入住疗养院和死亡率相关的结果。没有足够的数据来定义成功项目的特征和成本效益。
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.