Table 1 Characteristics of Included Studies
Author | Year | Country | Methods | Population | Intervention | Control | Outcomes Measured |
|---|---|---|---|---|---|---|---|
Closa et al. | 2017 | Spain | Quasi-RCT On discharge from the acute orthopaedic surgery/traumatology unit, patients who met the inclusion criteria were admitted to the HHU if an effective primary caregiver was willing to accept responsibility for the home-based program and the patient agreed to hospitalization at home. Otherwise, patients were admitted to the hospital-based post-acute GRU | Aged > 65 years, attended by an acute orthopaedic surgery/ traumatology unit (at the emergency department or at ward) after a fracture or elective arthroplasty with good orthopaedic prognosis, decline in functional status in relation to baseline characteristics susceptible to rehabilitative treatment and clinical status sufficiently stable to enable active participation in a rehabilitation program. | Hospital-at-home integrated care unit (HHU) (n = 91) - all patients underwent a CGA to develop a care plan focusing on cardiorespiratory function and nutritional status, detection of delirium and cognitive impairment, treatment of pain, and prevention of pressure ulcers. Nursing visits were limited to 7 per week; physiotherapy and occupational therapy sessions were limited to 5 per week. Each therapy visit lasted 35 to 45 min. | Geriatric rehabilitation unit (GRU) (n = 276) - received the same geriatric assessment and nursing care, as well as physiotherapy and occupational therapy following hospital ward guidelines (maximum duration 1 h per session, limited to 5 sessions per week) | BI Heinemann Index Direct cost of care LoS |
Crotty et al. | 2002 | Australia | RCT, participants from three hospitals, computer generated randomisation by a hospital pharmacist who had no other involvement in the study | Aged ≥ 65 years living in the Adelaide Southern Metropolitan Region treated surgically for a hip fracture, medically stable, had adequate physical and mental capacity to participate in a rehabilitation programme, expected to return home after discharge from hospital and had a home environment suitable for rehabilitation | Acceleration discharge and home-based rehabilitation (n = 34) - initial assessment by the study co-ordinator who visited their home environment and organized any modifications, installation of equipment or assistive aids prior to discharge. GPs were contacted and asked to consent to their patient participating in the programme. Participants were discharged from acute care within 48 h of randomization and promptly visited by therapists from the home rehabilitation team including a team co-ordinator, a physiotherapist, an occupational therapist, a speech pathologist, a social worker and a therapy aid, who negotiated realistic, short-term and measurable treatment goals with both the participant and their carer. Therapy frequency was tailored to the needs and rate of progress of individual participants, and structured practice sessions were encouraged between visits. Progress was reviewed at weekly case conferences attended by all staff and a specialist in rehabilitation medicine or a geriatrician. | Conventional care (n = 32) - routine hospital care and rehabilitation in hospital; inpatient services and the development of care pathways and discharge planning | Four months post: TUG MBI Balance Confidence Scale FES BBS London Handicap Scale Falls Hospital re-admissions Patient and carer satisfaction SF-36 (patients and carers) Use of community services e.g. home help, district nursing CSI |
Crotty et al. | 2003 | Australia | As per Crotty et al. (2002) | As per Crotty et al. (2002) | As per Crotty et al. (2002) | As per Crotty et al. (2002) | 12 months post: TUG MBI SF-36 MBI CSI Changes in Residence Mortality |
Karlsson et al. | 2016 | Sweden | RCT, using sequentially numbered lots in opaque, sealed envelopes drawn by a nurse at the ward, not involved in the study. The randomization was stratified into 2 categories according to type of housing (ordinary housing or residential care facilities) and type of fracture (cervical or trochanteric). | Aged ≥ 70 years post-acute hip fracture surgery (cervical or trochanteric fracture) and living in the municipality of Umeå in ordinary housing or in residential care facilities. Pathological or in hospital fractures were excluded. Patients were considered to have no medical obstacles, could manage basic transfers, and had the care they required at home | Conventional geriatric care and rehabilitation with Geriatric Interdisciplinary Home Rehabilitation (GIHR) after discharge (n = 107) - treated according to the multifactorial rehabilitation programme, including CGA with focus on detection, prevention, and treatment of postoperative complications. The GIHR team included a nurse, an occupational therapist, and two physiotherapists who visited the participants regularly. A geriatrician was medically responsible, and a social worker and a dietician could be consulted when necessary. Rehabilitation was individually designed according to the participants’ own goals. During the first days after discharge, all participants received nearly daily home visits from someone in the GIHR team and later according to the participants’ needs. The maximum duration in GIHR was 10 weeks. | Convention care and geriatric ward rehabilitation (n = 98) - interdisciplinary rehabilitation using CGA with regular meetings and individual rehabilitation plan | At 3 and 12 months: Walking ability indoors Walking ability outdoors Use of a gait aid Self-chosen gait speed Maximum gait speed LoS from surgery to hospital discharge LoS from admission to geriatric ward until discharge ready date LoS from admission to geriatric ward until discharge Rehabilitation received after discharge |
Karlsson et al. | 2020 | Sweden | As per Karlsson et al. (2016) | As per Karlsson et al. (2016) | As per Karlsson et al. (2016) | As per Karlsson et al. (2016) | At 3 and 12 months: BI ADL Staircase |
Berggren et al. | 2019 | Sweden | As per Karlsson et al. (2016) | As per Karlsson et al. (2016) | As per Karlsson et al. (2016) | As per Karlsson et al. (2016) | Complications at 3 & 12 months: Infection Cardiovascular event DVT PE Stroke Gastric ulcer Decubital ulcer Fallers Falls Additional fracture Luxation Reoperation Deceased Delirium Days with delirium LoS Re-admissions Days in hospital after discharge |
Parsons et al. | 2019 | New Zealand | RCT, participants were randomized using a computer-generated randomization sequence | Older adults who had suffered an injury that required hospital admission and subsequent rehabilitation as well as meeting the START inclusion criteria: ≥ 65 years of age; in hospital at time of referral and did not require ongoing acute hospital-based treatment (in the judgment of the consultant geriatrician); consented to being treated at home; and agreed with the objectives set by the referring inter-disciplinary team. Following assessment by the referring team, the participant was considered to have potential for partial or complete recovery with suitable home rehabilitation within 6 weeks; was able to stand and transfer with 1person (with or without the help of a resident carer); had a recent injury and was at a borderline level of function with an associated reduction in activities of daily living (ADL) and/or instrumental ADL (IADL); and who without input from the team was considered likely to fail to recuperate full potential of functional recovery or was likely to fail to manage satisfactorily at home despite conventional community support and, therefore, would be at risk of hospital re-admission or institutionalization | Early SDT Intervention (START) (n = 201) - consisted of healthcare assistants (HCAs), registered nurses (RNs) and allied health (physiotherapists and occupational therapists). Consultant geriatricians provide input through weekly case conferences. HCAs provide up to 4 visits a day, 7 days a week. Patients are limited to 6 weeks attendance, though the team on an exception basis may choose to extend this to maximize potential recovery. The rehabilitation program is developed jointly by RNs and allied health professionals and progress is discussed within the team. Interdisciplinary practice is core to the delivery of the model; HCAs, RNs, and allied health meet daily to discuss patient progress and find solutions for problems as they arise. | Usual care (n = 202) - discharge planning from the hospital to their place of residence and subsequent community-based services as required. Community-based services could include allied health, district nursing, and home care. | LoS Re-admissions Time in hospital in the following 12 months Inpatient costs - index admission Inpatient costs - re-admissions Community care costs in the following 12 months interRAI Functional Assessment |