Table 2 Characteristics of the included studies
Study Country | Sample | Intervention | Outcome measures during hospitalization* (category: outcome measure) *primary outcome measure in bold | Time point of measurement (primary outcome) | Main findings |
|---|---|---|---|---|---|
Abizanda 2011 [32] Spain | n = 400 Mean age, 84 yrs. Females: n = 227 (57%); Patients with acute medical illness (stroke, cardiopulmonary pathologies, or other diagnoses) | Intervention: - Additional occupational therapy by special trained therapists (daily 45-min sessions, 5 days/week) - Day 1: physical, functional, cognitive social and emotional assessment; preparation of individual therapeutic plan - Day 2 until discharge: cognitive exercises, ADL training (mobility in bed, sitting and standing, chair to bed transfers, wheelchair to bed/toilet transfers, dressing, bathing, personal hygiene, toilet use) - Day of discharge: a second 30-min session in addition to the regular 45-min daily intervention; instruction for relatives or caregivers; recommendations for ADL at home Control: Conventional treatment with usual physiotherapy | FCT: Barthel Index (improvement of ≥10 pt. from admission to discharge) COG: CAM | Admission Discharge | Between-group differences at discharge: - Improvement in Barthel Index of ≥10 pt. from admission to discharge: n.s. (total sample, stroke/cardiopulmonary patients), ↑ (others) - Absolute improvement in Barthel Index: n.s. (total sample, stroke patients, others), ↑ (cardiopulmonary patients) Feasibility: - Missing data: Barthel Index = 0% (admission), 6% (discharge) |
Blanc-Bisson 2008 [33] France | n = 76 Mean age: 85 yrs. Females: n = 55 (72%); Patients with acute medical illness | Intervention: - Additional early physiotherapy (start: day 1 or 2, 2 times/day for 30 min, 5 days/week), - Focus on leg extension exercises in the upright position - Nutritional supplements Control: - Walking with/without technical assistance or human help (start: day 3 to 6, 3 times/week until discharge) - Nutritional supplements - Physical therapy at home for 1 month | MOB: Handgrip strength (handheld dynamometry) FCT: Katz ADL Index BPN: Body weight, energy intake, protein intake, calf and arm circumferences, triceps skin fold, biochemical measures (serum albumin, C-reactive protein) | Admission Clinical stable condition | Changes from admission to clinical stable situation in total sample (time effect): - Katz ADL Index: ↓ Feasibility: - Missing data: Katz ADL Index = 0% |
Brown 2016 [34] USA | n = 100 Mean age: 74 yrs. Females: n = 3 (3%) Patients with acute medical illness | Intervention: - Additional mobility protocol: Starting with basic transfers with progress to ambulation if tolerated (2 times/day, 15–20 min, 7 days/week) - Patients were encouraged to walk at each session - Physical activity behavioral strategy: goal setting, diary and interview to increase times out of bed Control: Usual care (physical therapy had to be ordered by physicians) | FCT: Modified Katz ADL Index HU: LOS, physical therapy ordered during hospitalization ACE: Falls | Admission Discharge | Between-group differences at discharge: - Modified Katz ADL Index: n.s. Changes during hospitalization in total sample: - Katz ADL Index: n.s. Group × time interaction during hospitalization: - Katz ADL Index: n.s. Feasibility: - Katz ADL Index: mean admission score in both groups was within the best 15% of the rating scale → ceiling effect |
Czyzewski 2013 [35] Poland | n = 34 Mean age: 76 yrs. Females: n = 14 (41%); Patients with major abdominal surgery | Intervention: - Usual care with a modified exercise component based on the Proprioceptive Neuromuscular Facilitation concept (30 min/day) Control: Usual care (30 min/day) | MOB: 10MWT, TUG FCT: Lawton IADL scale MOB: UCLA scale, PPSA BPN: Forced ventilation capacity, first-second forced expiratory volume, maximal expiratory flow (spirometry) HU: LOS | 3 days prior surgery 4 days after surgery | Within-group changes from 3 days prior surgery to 4 days after surgery: - 10MWT, TUG: ↓ in both groups - Lawton IADL scale, UCLA, PPSA: NA Between-group differences 4 days after surgery: - PPSA: ↑ - 10MWT, TUG: NA Feasibility: - Lawton IADL scale: mean admission score of the sample was within the best 15% of the rating scale → ceiling effect - Missing data (3 days prior & 4 days after surgery): 10MWT, TUG = 9%, SAP = 0%, UCLA, IADL: NA |
Eyres 2005 [36] Australia | n = 15 Mean age: 80 yrs. Females: n = 9 (60%); Patients with acute medical illness | Intervention: - Daily additional occupational therapy - Self-care program (ADL), IADL training (e.g., cooking, laundry, café visits), community mobility (e.g., walking outdoors) Control: Usual care | FCT: FIM PSY: Self-Efficacy Gauge, Life Satisfaction Index HU: LOS, use of allied health services, use of community services, discharge destination | Admission Discharge | Within-group comparisons over time: - FIM ↑ (IG, CG) - Self-Efficacy Gauge: n.s. (IG, CG) - Life Satisfaction Index: n.s. (IG, CG) Feasibility: - Missing data: FIM, Self-Efficacy Gauge, Life Satisfaction Index = 0% |
Hagsten 2004 [37] Sweden | n = 100 Mean age: 80 yrs. Females: n = 80 (80%); Patients with hip fracture | Intervention: - Additional occupational therapy (40–60 min, 5 days/week) - Self-care, independence at home (transfers, bathroom visits, morning activities, dressing), use of aids - Home visits - Instruction of a physiotherapist CG: Usual care from nursing staff, instruction of a physiotherapist | FCT: Modified Klein-Bell ADL Scale (75 items of 4 areas: dressing, toilet visits, mobility, bathing/hygiene); mDRI with visual analogize scales for ADL, indoor IADL, and outdoor IADL PSY: Study-specific mDRI items on fear of performing (I)ADL and for pain level during (I)ADL performance | Discharge | Between-group differences at discharge: - Modified Klein-Bell ADL scale: dressing ↑, toilet visits ↑, hygiene ↑, mobility: n.s. mDRI: ADL, indoor/outdoor IADLs, fear, pain: n.s. Feasibility: - Missing data: Klein-Bell ADL scale, mDRI = 0% |
He 2015 [38] China | n = 101 Mean age: 71 yrs. Females: n = 11 (12%) Patient with acute COPD exacerbation | Intervention: - Patient education (physical activity behavior intervention): benefits and importance of daily exercise, pacing and energy-conservation technique to manage ADL - Stretching, endurance & strength training (endurance lower limb: walking with treadmill; upper limb: shoulder flexion and abduction with light weight; strength training: free weights or body weights) - breathing exercise: relaxation, breathing control, pursed-lip breathing, pacing during exercise - 30 min 2 times/day Control: Usual care | MOB: 6MWT DS: mMRC dyspnea grade, ADL-Dyspnea scale, CRQ-SAS, CAT Borg dyspnea scale, Bode index BPN: Resting/exercise oxygen saturation (spirometry, arterial blood gas analysis) | Admission Discharge | Within-group differences from admission to discharge: - 6MWT: ↑ (IG), n.s. (CG) - mMRC dyspnea grade: ↑ (IG), n.s. (CG) - ADL-Dyspnea scale: ↑ (IG), n.s. (CG) - CRQ-SAS: ↑ (IG), n.s. (CG) - CAT: ↑ in both groups Feasibility: NA |
Jeffs 2013 [39] Australia | n = 649 Mean age: 79 yrs. Females: n = 340 (52%) Patients with acute medical illness | Intervention: - Graded physical activity and orientation program twice daily in addition to usual care - Physical activity program: progressive, variable resistance training against gravity, body or light weight (progression whenever a patient could perform 10 repetitions), - Cognitive exercise program: Orientation, (7 questions for improving orientation [day, month, year, date, ward, bed number, name of primary nurse]); - 2 times/day, 5 days/week, 20–30 min until discharge + self-training on weekends Control: Usual care (including: 24 h nursing care, daily medical assessment, allied health referral) | COG: Number of delirious patients, severity/duration of delirium (CAM) HU: Discharge destination, LOS | Admission Every 48 h until discharge | Between-group differences - Number of delirious patients: n.s. Feasibility: - No delirium in 94% of patients → rare event |
Jones 2006 [40] Australia | n = 160 Mean age: 82 yrs. Females: n = 92 (58%) Patients with acute medical illness | Intervention: - Additional exercise program (2 times/day, 30 min) - Strengthening and mobility exercises (e.g., sit-to-stand transfer) specifically designed to be carried out in a hospital setting Control: Usual care with standard physiotherapy | FCT: Barthel Index MOB: TUG HU: Discharge destination, LOS ACE: Falls, mortality, deterioration in medical status | Admission Discharge | Between-group differences at discharge: - Barthel Index: n.s. Multivariable regression analyses: - Barthel Index: low admission Barthel Index & IG assignment = independent predictors of improving Barthel Index Feasibility: - Missing data: Barthel Index = 0% |
Kimmel 2016 [41] Australia | n = 92 Mean age: 81 yrs. Females n = 59 (64%) Patients with hip fracture | Intervention: - Two additional physiotherapy sessions aimed to improve the functional advances achieved during the usual physiotherapy session (3 times/day, 7 days/week) Control: Usual care (physiotherapy: 1 time/day, 7 days/week) | MOB: mILOAS, TUG HU: LOS, Discharge destination, opioid equivalence score ACE: Postoperative complications PSY: Self-developed pain scale | Day 5 | Between-group differences at post-operative Day 5: - mILOAS: n.s. Between-group differences controlled for confounding factors: - mILOAS: ↑ Feasibility: - Missing data: mILOA = 0% |
Nikolaus 1999 [42] Germany | n = 545 Mean age, 81 yrs. Females: n = 400 (73%); Patients with acute medical illness | Intervention 1:Comprehensive geriatric assessment and interdisciplinary intervention in the hospital and at home, physical and occupational therapy (washing, eating, dressing, walking) twice a week up to twice a day for 30 min Intervention 2: Comprehensive geriatric assessment with recommendation in the hospital and usual care at home Control: Assessment of ADL and cognition and usual care in the hospital and at home | FCT: Barthel Index, Lawton IADL scale HU: Discharge destination, LOS | Admission Discharge | Between-group differences at discharge: - Barthel Index, Lawton IADL scale: n.s. Feasibility: - Barthel Index, Lawton IADL scale: mean discharge scores in both groups within the best 15% of the rating scale → ceiling effect - Missing data: Barthel Index, Lawton IADL scale = 0% (discharge) |
Oldmeadow 2006 [43] Australia | n = 60 Mean age: 79 yrs. Females: n = 43 (68%) Patient with hip fracture | Intervention: - First walk at day 1 or 2 (early mobilization) (7 days/week) Control: Usual care (first walk at day 3 or 4) (7 days/week) | MOB: mILOAS items: Transfer from supine to sitting, transfer from sitting to standing (independent vs. assisted), ambulation (walking distance), step negotiation (independent vs. failed/unable) HU: Discharge destination, LOS | Day 7 | Between-group differences at post-surgery day 7: - mILOAS: transfer item: ↑, walking distance: ↑, step negotiation: n.s. Feasibility at day 7: - mILOAS step negotiation item: > 15% (23%) of total sample with worst possible score → floor effect, 21% missing data - mILOAS transfer item = 15% missing data |
Siebens et al., 2000 [44] USA | n = 300 Mean age: 78 yrs. Females: n = 182 (61%); Patients with acute medical illness | Intervention: - Hospital-based exercise program (twice a day) - Flexibility and strengthening exercises - Walking program (60 to 80% max. Heart rate, 5 min to 30 min) Control: Usual care | HU: LOS ACE: Mortality | Discharge | Between-group differences at discharge: - LOS: n.s. Feasibility: - Missing data: LOS = 0% |
Torres-Sanchez 2017 [45] Spain | n = 58 Mean age: 74 yrs. Females: n = 16 (28%); Patients with acute exacerbation of COPD | Intervention: - Additional individually-adapted endurance training on a pedal exerciser - Cycling time, velocity, and resistance were adapted to patient and increased every day Control: Usual care (no supervised or progressive exercise) | MOB: Lower limb strength (handheld dynamometer), balance (OLS), exercise capacity (30CST), physical activity/number of steps (SenseWear Armband) | Admission Discharge | Group × time interaction: - Lower-limb strength: ↑ - Balance: ↑ - Exercise capacity: ↑ Between-group differences at discharge: - Lower-limb strength: ↑ - Balance (OLS): ↑ - Exercise capacity (30STS): n.s. Feasibility: - Missing data: Lower-limb strength, balance (OLS), exercise capacity (30CST) = 0% |
Asplund 2000 [46] Sweden | n = 444 Mean age: 81 yrs. Females: n = 251 (61%) Patients with acute medical illness | Intervention: - Multidisciplinary teamwork (internist, geriatrician, nurses, nurse aids, physiotherapist, occupational therapist, social worker, dietician) - Assessment by physiotherapist and occupational therapist - Early start of rehabilitation - Discharge planning Control: General medical unit care | ACE: Mortality HU: LOS, discharge destination, hospital costs | Admission Discharge | Between-group differences at discharge: - Mortality: n.s. Feasibility: - Missing data: mortality = 3% 97% survivals → mortality = rare event |
Barnes 2012 [47] USA | n = 1632 Mean age: 81 yrs. Females: n = 1094 (67%) Patient with acute medical illness | Intervention: - Prepared environment (e.g., carpeting, handrails, uncluttered hallways) - Patient-centered care (daily assessment by nurse of physical, cognitive and psychosocial function - Protocols to improve of ADL (bathing/dressing, mobility/transferring, toileting, feeding), nutrition, skin care, falls, cognition, mood etc., daily team rounds by physiotherapist, nurse, social worker, nutritionist) - Planning for discharge - Medical care review (daily by medical director) - Protocols to minimize adverse effects (e.g., urinary catheterization) Control: Usual care | HU: LOS, hospital costs, process-of-care measures (physical therapy consults, orders for bed rest, use of physical restraints, documentation of discharge planning, discharge destination) FCT: Katz ADL Index (bathing, dressing, toileting, transferring, eating), Lawton IADL scale (shopping, cooking, performing household chores, using transportation, managing money, managing medication, and using the telephone) MOB: 5-items hierarchical mobility scale ACE: Mortality | Admission Discharge | Between-group differences at discharge: - LOS: ↓ - Hospital costs: ↓ - Feasibility: - Missing data: LOS, hospital costs = NA |
Counsell 2000 [48] USA | n = 1531 Mean age: 80 yrs. Females: n = 926 (61%) Patients with acute medical illness | Intervention: - Prepared environment (e.g., carpeting, handrails, uncluttered hallways) - Patient-centered care (daily assessment by nurse of physical, cognitive and psychosocial function - Protocols to improve of ADL (bathing/dressing, mobility/transferring, toileting, feeding) nutrition, skin care, falls, cognition, mood etc., daily team rounds by physiotherapist, nurse, social worker, nutritionist) - Planning for discharge - Medical care review (daily by medical director) - Protocols to minimize adverse effects Control: Usual care | FCT: Modified Katz ADL Index (bathing, dressing, toileting, transferring, eating), modified Lawton IADL scale (shopping, cooking, performing household chores, using transportation, managing money, managing medication, and using the telephone) MOB: PPME, 5-items hierarchical mobility scale HU: Process-of-care measures (nursing care plans, time from admission to initiation of discharge planning, social work consultation, orders for bed rest, physical therapy consults, use of urinary catheters, and application of physical restraints, inappropriate medications), LOS, hospital costs, discharge destination PSY: Caregiver satisfaction ACE: Mortality | Admission Discharge | Between-group differences at discharge: - Mortality: n.s.; Modified Katz ADL Index: n.s. Feasibility: - Missing data: Katz ADL Index = NA (admission & discharge) |
Huusko 2000 [49] Finland | n = 260 Mean age: 80 yrs. Females: n = 184 (72%) Patients with hip fracture No dementia (MMSE 24–30): n = 99 (41%) Suspected severe dementia (MMSE 0–11): n = 28 (12%) Suspected moderate dementia (MMSE 12–17): n = 36 (15%) Suspected mild dementia (MMSE 18–23): n = 77 (32%) | Intervention: - Multidisciplinary teamwork (geriatrician, general practitioner, nurses, social worker, neuropsychologist, occupational therapist, physiotherapist) - Geriatric team assessment - Physiotherapy (2times/day), ADL training by nurses - Weekly meetings by physiotherapists and nurses - Discharge plan Control: Discharged to local hospitals | HU: LOS | Discharge | Between-group differences at discharge: - LOS: severe dementia (MMSE score: 0–11 pt): n.s.; moderate dementia (MMSE score: 12–17 pt): ↓; mild dementia (MMSE score: 18–23 pt) ↓; normal (MMSE score: 24–30): n.s. Feasibility: - Missing data: LOS = 0% |
Landefeld 1995 [50] USA | n = 651 Mean age: 80 yrs. Females: n = 435 (67%) Patients with acute medical illness | Intervention: - Prepared environment (e.g., carpeting, handrails, uncluttered hallways) - Patient-centered care (daily assessment by nurse of physical, cognitive and psychosocial function - Protocols to improve of ADL (bathing/dressing, mobility/transferring, toileting, feeding) nutrition, skin care, falls, cognition, mood etc., daily team rounds by physiotherapist, nurse, social worker, nutritionist) - Planning for discharge - Medical care review (daily by medical director) - Protocols to minimize adverse effects (e.g., urinary catheterization) Control: Usual care | FCT: Modified Katz ADL Index (bathing, dressing, toileting, transferring, eating), Lawton IADL scale MOB: Walking ability HU: Discharge destination, LOS, hospital costs PSY: GDS, overall health status COG: MMSE | Admission Discharge | Between-group differences at discharge: - Katz ADL Index: ↑ Multivariable regression analyses controlled for confounding baseline patient characteristics: IG assignment = significant independent predictor of an increase in the number of independently performed ADLs Feasibility: - Katz ADL Index: > 15% of participants reaching a score within the best 15% of the instrument’s rating scale → ceiling effect - Missing data: Katz ADL Index: 0% (admission & discharge) |
Naglie 2002 [51] Canada | n = 279 Mean age 84 yrs. Females n = 223 (80%); Patients with hip fracture | Intervention: - Multidisciplinary teamwork (physiotherapist, occupational therapist, nurse, social worker) - Special education of staff - Prevention of complications (e.g., delirium, urinary problems, malnutrition) - Physiotherapy: early full weight bearing, ADL training, (2 times/day for 5 day/week) - Discharge plan, pre-discharge home visits - 2 times/week meeting for monitoring treatment plan Control: Usual care | HU: Discharge destination, LOS | Admission Discharge | Between-group differences at discharge: - Discharge destination: ↑ (in community-dwellers, relative’s/retirement home residents), n.s. (in nursing home residents) Feasibility: - Missing data: Discharge destination: 0% |
Pitkälä 2008 [52] Finland | n = 174 Mean age: 83 yrs. Females: n = 128 (74%) Patients with delirium | Intervention: - Comprehensive geriatric assessment (physical examination, cognition, nutrition, screening of depression, review of medication) - Administering antipsychotics for hyperactive/psychotic symptoms - Cholinesterase inhibitors - Orientation (calendars, clocks) - Physiotherapy - Nutritional supplements - Comprehensive discharge planning (e.g., occupational home visits) Control: Usual care | PSY: 15D HRQOL questionnaire, self-developed subjective health scale | Admission Discharge | Between-group differences at discharge: - HRQOL: ↑ - Self-developed subjective health sale: ↑ Feasibility: - Missing data: 15D questionnaire: 9%; self-developed subjective health sale: NA (admission & discharge) |
Prestmo 2015 [30] Taraldsen 2014 [31] Norway | n = 397 Mean age: 83 yrs. Females: n = 293 (73%) Patients with hip fracture | Intervention: - Multidisciplinary teamwork (geriatricians, nurses, physiotherapists, occupational therapists, with special competence in geriatrics) - Comprehensive geriatric assessment (somatic and mental health, function, social situation) - Interdisciplinary team meetings - Adequate nutrition, - Individual rehabilitation plan based on cognition and motivation - Early mobilization, functioning in ADL, weight-bearing exercise program - Early discharge planning Control: Usual care (standard orthopedic care) | MOB: SPPB, PA (activPAL: time spent in upright, number of upright events), Cumulated Ambulation Score HU: LOS, discharge destination, hospital costs | Day 4 after surgery (activePAL) Day 5 after surgery (SPPB) | Between-group differences at day 4 (activePAL) and 5 (SPPB): - SPPB: ↑ - Time spent in upright: ↑ Feasibility: - Missing data: SPPB = 13% (5 days after surgery) - activPAL: > 15% missing data |
Siebens et al., 2000 [44] USA | n = 300 Mean age: 78 yrs. Females: n = 182 (61%); Patients with acute medical illness | Intervention: - Hospital-based exercise program (twice a day) - Flexibility and strengthening exercises - Walking program (60 to 80% max. Heart rate, 5 min to 30 min) Control: Usual care | HU: LOS ACE: Mortality | Discharge | Between-group differences at discharge: - LOS: n.s. Feasibility: - Missing data: LOS = 0% |
Stenvall 2007a,b, 2012 [27,28,29] Lundström 2007 [26] Sweden | Total sample: n = 199 Mean age: 82 yrs. Females: n = 148 (74%) Patients with hip fracture | Intervention: - Multidisciplinary teamwork (nurses, physiotherapists, occupational therapists, dietician, geriatrician) - Staff education in prevention of postoperative complication - Individual care planning (all team members assessed each patient as soon as possible, planning of process and goals twice a week) - Prevention and treatment of complications (falls, delirium etc.) - Pain treatment (contained assessment of underlying causes) - Saturation (oxygen-enriched air during first two postoperative days) - Nutrition (protein-enriched meals during the first four days) - Mobilization: (ADL training with focus on fall risk factors, high-intensity weight-bearing exercises) Control: Usual care (no corresponding team work) | ACE: Falls, fallers, and time lapse to first fall after admission; AIS, postoperative complications (urinary tract infections, decubitus ulcer, sleeping disturbances, mortality) MOB: COVS walking item FCT: ADL staircase (Katz ADL Index with IADL items) HU: Discharge destination, LOS COG: Number of delirious days (OBS scale), MMSE PSY: GDS BPN: Nutritional problems assessed by care/nursing staff | Discharge | Between-group differences at discharge: - Falls: ↓ - Fallers: ↓ - AIS: minor or moderate injuries:↓, serious injuries: n.s. - COVS walking item: n.s. - ADL staircase: NA (Katz ADL Index: n.s., IADL: NA) - Discharge destination: n.s. - Number of delirious days: ↓ - MMSE: n.s. - GDS: n.s. Feasibility: - Falls: 81% = non-fallers → rare event - AIS: not assessable in 81%; 42% of fallers with an AIS score of 0 pt. → floor effect - GDS: missing data at discharge in 20% - ADL staircase: > 15% of patients reaching a score within the best 15% of the best possible score → ceiling effect |
Subsample: n = 64 (32%) Mean age: 82 yrs. Females: n = 47 (73%) Patients with hip fracture & dementia Mean MMSE score: 8.6 (IG), 6.9 (CG) | ACE: Postoperative complications (pneumonia, urinary tract infection, decubital ulcers, new fracture, falls, fallers, fall incidence rate, mortality) COG: Number of delirious days (OBS scale) BPN: Nutritional problems assessed by care/nursing staff MOB: COVS walking item FCT: ADL staircase (Katz ADL Index with IADL items) | Between-group differences at discharge: - Postoperative complications: total: NA; urinary tract infection: ↓; fallers: ↓; Fall incidence rate: ↓; mortality, pneumonia, decubital ulcers, new fracture: n.s. - Number of delirious days: ↓ - COVS walking item: n.s. - ADL staircase: NA (Katz ADL Index: n.s., IADL: NA) | |||
Vidan 2005 [53] Spain | n = 319 Mean age: 82 yrs. Females: n = 260 (82%) Patients with hip fracture | Intervention: - Multidisciplinary teamwork (geriatrician, rehabilitation specialist, and specific social worker) - Geriatric assessment (medical, psychosocial problems and functional capability) - Interdisciplinary meeting to elaborate a comprehensive therapeutic plan (weekly repeated) - Daily visits by geriatrician - Rehabilitation specialist planned physiotherapy (schedule, intensity and duration) - Social worker assessed the social environment Control: Usual care | HU: LOS ACE: Mortality, postoperative complications COG: CAM | Admission Discharge | Admission to discharge: - LOS: n.s. - Mortality: ↓ - Postoperative complications: ↓ Feasibility: - LOS: 0% (admission to discharge) - Mortality: 97% survivals → rare event - Postoperative complications: 47% of patients without complications (admission to discharge) → rare events |