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Cazeta BBR, de Queiroz RS, Nacimento TS, Ferreira BR, Saquetto MB, Martinez BP, Carvalho VO, Gomes-Neto M. Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials. Clin Rehabil 2024; 38:898-909. [PMID: 38556253 DOI: 10.1177/02692155241241665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. DESIGN Systematic review and meta-analysis of RCTs. DATA SOURCES We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. REVIEW METHODS Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. RESULTS Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03-0.3, I2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0-5.6, I2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD -1.4 (95% CI: -2.7 to -0.1, I2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. CONCLUSION Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.
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Affiliation(s)
- Bianca Bigogno Reis Cazeta
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Rodrigo Santos de Queiroz
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Tais Silva Nacimento
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | | | - Micheli Bernardone Saquetto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Bruno Prata Martinez
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
| | | | - Mansueto Gomes-Neto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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Nilsson L, Holst M, Villumsen M, Andreasen J. Maintenance of own health after acute hospitalization - older people's experiences and perspectives on physical activity and nutrition. Physiother Theory Pract 2024; 40:100-109. [PMID: 36189947 DOI: 10.1080/09593985.2022.2122912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 08/05/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Studies indicate that prefrail and frail older people would like to exercise, but support from healthcare professionals is required. Knowledge regarding health maintenance in prefrail or frail older people in terms of physical training and nutrition after hospitalization is scarce. OBJECTIVE To explore the perspectives and experiences of prefrail and frail older people concerning physical training and nutrition one and four weeks after an acute medical hospitalization. METHODS Repeated individual semi-structured interviews with ten prefrail and frail older people were conducted. An inductive-deductive thematic analysis was performed. RESULTS Previous experiences with healthcare affected the views of the participants on training, nutrition, and health. Although the participants' knowledge about physical training was limited, they were positive about participating in training and obtaining knowledge about their condition. However, their positive intentions were not successfully achieved within four weeks. Despite positive intentions, appointments at the hospital, musculoskeletal pain, and other limitations hindered the intended training. Furthermore, changing nutritional habits seemed difficult. CONCLUSION The participants were positive toward participating in training and interested in knowledge addressing their condition. Nutritional habits were considered as a personal matter and difficult to change, as they had year long habits about when and how they ate. These findings indicate that a lack of dialogue about training and nutrition may contribute to lower health literacy in frail older people and may therefore affect the maintenance of health after an acute hospitalization. This suggests that physiotherapists should ensure that follow-up is discussed and planned in detail with patients before discharge.
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Affiliation(s)
- Laurine Nilsson
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette Holst
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Morten Villumsen
- Department of Health and Prevention, Centre for Orthopaedic Rehabilitation, Aarhus C, Denmark
- Pain and Motor System Plasticity Research Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
- Aalborg Center of Health and Rehabilitation, Aalborg Muncipality, Aalborg, Denmark
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Pritchard MW, Lewis SR, Robinson A, Gibson SV, Chuter A, Copeland RJ, Lawson E, Smith AF. Effectiveness of the perioperative encounter in promoting regular exercise and physical activity: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101806. [PMID: 36816345 PMCID: PMC9929685 DOI: 10.1016/j.eclinm.2022.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Low levels of physical activity (PA) are associated with poorer health outcomes. The perioperative encounter (extending from initial contact in primary care to beyond discharge from hospital) is potentially a good time to intervene, but data regarding the effectiveness of interventions are scarce. To address this, we systematically reviewed existing literature to evaluate the effectiveness of interventions applied perioperatively to facilitate PA in the medium to long-term (at least six months after the intervention). METHODS In this systematic review and meta-analysis, we searched Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, CINAHL, Embase, PsycInfo, and SPORTDiscus from database inception to October 22nd 2020, with an updated search done on August 4th 2022. We searched clinical trials registers, and conducted forward- and backward-citation searches. We included randomised controlled trials and quasi-randomised trials comparing PA interventions with usual care, or another PA intervention, in adults who were scheduled for, or had recently undergone, surgery. We included trials which reported our primary outcomes: amount of PA or whether participants were engaged in PA at least six months after the intervention. A random effects meta-analysis was used to pool data across studies as risk ratios (RR), or standardised mean differences (SMDs), which we interpreted using Cohen. We used the Cochrane risk of bias tool and used GRADE to assess the certainty of the evidence. This study is registered with PROSPERO, CRD42019139008. FINDINGS We found 57 trials including 8548 adults and compared 71 interventions facilitating PA. Most interventions were started postoperatively and included multiple components. Compared with usual care, interventions may slightly increase the number of minutes of PA per day or week (SMD 0.17, 95% CI 0.09-0.26; 14 studies, 2172 participants; I2 = 0%), and people's engagement in PA at the study's end (RR 1.19, 95% CI 0.96-1.47; 9 studies, 882 participants; I2 = 25%); this was moderate-certainty evidence. Some studies compared two different types of interventions but it was often not feasible to combine data in analysis. The effect estimates generally indicated little difference between intervention designs and we judged all the evidence for these comparisons to be very low certainty. Thirty-six studies (63%) had low risk of selection bias for sequence generation, 27 studies (47%) had low risk of bias for allocation concealment, and 56 studies (98%) had a high risk of performance bias. For detection bias for PA outcomes, we judged 30 studies (53%) that used subjective measurement tools to have a high risk of detection bias. INTERPRETATION Interventions delivered in the perioperative setting, aimed at enhancing PA in the medium to long-term, may have overall benefit. However, because of imprecision in some of the findings, we could not rule out the possibility of no change in PA. FUNDING National Institute for Health Research Health Services and Delivery Research programme (NIHR127879).
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Affiliation(s)
- Michael W. Pritchard
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | - Sharon R. Lewis
- Bone and Joint Health, School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Amy Robinson
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | | | | | - Robert J. Copeland
- The Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Euan Lawson
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Andrew F. Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
- Corresponding author. Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK.
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Ullrich P, Werner C, Schönstein A, Bongartz M, Eckert T, Beurskens R, Abel B, Bauer JM, Lamb SE, Hauer K. Effects of a Home-Based Physical Training and Activity Promotion Program in Community-Dwelling Older Persons with Cognitive Impairment after Discharge from Rehabilitation: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2022; 77:2435-2444. [PMID: 35022728 DOI: 10.1093/gerona/glac005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. The aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical activity (PA), and psychosocial status. METHODS Patients with mild to moderate CI (Mini-Mental State Examination [MMSE]: 17-26 points) discharged home after rehabilitation were included in this randomized, double-blind, placebo-controlled trial with a 12-week intervention and 12-week follow-up period. The intervention group performed a CI-specific, autonomous, home-based strength, balance, and walking training supported by tailored motivational strategies to foster training adherence and promote PA. The control group participated in an unspecific motor placebo activity. Primary outcomes were physical capacity (Short Physical Performance Battery [SPPB]) and PA (sensor-based activity time). RESULTS Among 118 randomized participants (82.3 ± 6.0 years) with CI (MMSE: 23.3 ± 2.4) and high levels of multimorbidity, those participants undergoing home-based training demonstrated superior outcomes to the control group in SPPB (mean difference between groups 1.9 points; 95% CI: 1.0-2.8; p < .001), with persistent benefits over the follow-up (1.3 points; 95% CI: 0.4-2.2; p < .001). There were no differences in PA across any time points. Among secondary outcomes, fear of falling and activity avoidance behavior were reduced in the intervention group at all time points, life-space mobility improved short-term. CONCLUSIONS The results demonstrate clinically important benefits of an individually tailored autonomous physical training and activity promotion program on physical capacity and secondary outcomes in different domains in a vulnerable, multimorbid population. CLINICAL TRIAL REGISTRATION ISRCTN82378327.
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Affiliation(s)
- Phoebe Ullrich
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Christian Werner
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Anton Schönstein
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Martin Bongartz
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Tobias Eckert
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Rainer Beurskens
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany.,FHM Bielefeld, University of Applied Sciences, Bielefeld, Germany
| | - Bastian Abel
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Jürgen M Bauer
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
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Melchiorri G, Triossi T, Viero V, Marroni S, D’Arcangelo G, Tancredi V. A Study about a New Standardized Method of Home-Based Exercise in Elderly People Aged 65 and Older to Improve Motor Abilities and Well-Being: Feasibility, Functional Abilities and Strength Improvements. Geriatrics (Basel) 2022; 7:geriatrics7060134. [PMID: 36547270 PMCID: PMC9777551 DOI: 10.3390/geriatrics7060134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To verify the effects in terms of feasibility, strength and functional abilities of a standardized exercise training method that is partially supported (home training), with the aim of improving motor abilities and well-being. METHODS A total of 67 participants underwent two sessions per week for 12 weeks for the program, based on 8 sequences with specific body part targets, with each sequence made up of 9 exercises. OUTCOME MEASURES Recording of training session data, Chair Test, Hand Grip Test, Timed Up-and-Go Test, Stork Balance Test, Sit-and-Reach Test, VAS, Perceived Physical Exertion. RESULTS In total, 97% of the sample were "adherent" (more than 70% of the prescribed treatments performed). The rate of adverse events was infrequent (only 8). Chair Test +31%, Hand Grip Test +6%, Timed Up-and-Go Test -17%, Stork Balance Test +65%, Sit-and-Reach Test +55%, VAS -34%, Perceived Physical Exertion -69%. CONCLUSIONS Home training has good feasibility (adherence, tolerability, safety) and cost-effectiveness ratio and improves both strength and functional abilities, which, in turns, helps to improve motor abilities and well-being.
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Affiliation(s)
- Giovanni Melchiorri
- School of Sport and Exercise Sciences, Department of Systems Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Don Gnocchi Foundation IRCCS, Piazzale Rodolfo Morandi 6, 20121 Milan, Italy
| | - Tamara Triossi
- School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Valerio Viero
- School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-338-4723601
| | - Silvia Marroni
- School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giovanna D’Arcangelo
- Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Virginia Tancredi
- Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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Lin I, Glinsky J, Dean C, Graham P, Scrivener K. Effectiveness of home-based exercise for improving physical activity, quality of life and function in older adults after hospitalisation: A systematic review and meta-analysis. Clin Rehabil 2022; 36:1170-1185. [PMID: 35522200 DOI: 10.1177/02692155221095936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if home-based exercise programmes for older adults after hospitalisation are effective at improving physical activity, quality of life, activities of daily living (ADL) and mobility compared to no intervention, standard care or centre-based exercise. METHODS Databases were searched from inception to March 2022. Randomised controlled trials which included home-based exercise in older adults recently discharged from hospital were included. The primary outcome was physical activity. Secondary outcomes were quality of life, ADL performance, mobility, adverse events and hospital readmissions. Two reviewers independently selected relevant studies and extracted data. Quantitative synthesis with meta-analyses using a random-effects model and qualitative synthesis were performed. RESULTS Ten trials (PEDro score 6-8) were included. Three trials reported on physical activity but meta-analysis was not possible due to heterogeneity. Home-based exercise was more effective than no intervention at improving ADL performance (SMD 0.60, 95% CI 0.03 to 1.17); and standard care at improving quality of life (SMD 0.30, 95% CI 0.11 to 0.49) and mobility (SMD 0.23, 95% CI 0.00 to 0.45). Few and minor adverse events were associated with home-based exercise. CONCLUSION Based on individual trials, home-based exercise has the potential to improve physical activity compared to no intervention or standard care. Meta-analyses indicate that home-based exercise is more effective than no intervention at improving activities of daily living performance, and standard care at improving mobility and quality of life. It is unclear if home-based exercise is more effective than centre-based exercise at improving these outcomes.
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Affiliation(s)
- Ingrid Lin
- Department of Health Sciences, 7788Macquarie University, Sydney, Australia
| | - Joanne Glinsky
- Department of Health Sciences, 7788Macquarie University, Sydney, Australia
| | - Catherine Dean
- Department of Health Sciences, 7788Macquarie University, Sydney, Australia
| | - Petra Graham
- Department of Mathematics and Statistics, 7788Macquarie University, Sydney, Australia
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Kaizu Y, Tajika K, Miyata K. Measurement of physical activity and prevention of physical inactivity/sedentary behaviors in patients with septic knee arthritis before and after hospital discharge: A case report. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1943. [PMID: 35148439 DOI: 10.1002/pri.1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/03/2021] [Accepted: 01/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with septic knee arthritis tend to have prolonged pain, which may lead to a decrease in physical activity (PA). Pain catastrophizing, which is associated with chronic pain, is known to be a limiting factor for PA. An objective measurement of PA in patients with septic knee arthritis has not been reported. Here we describe the accelerometry-based measurement of the PA of a patient with septic knee arthritis before and after discharge, and we report the ability of follow-up outpatient physical therapy to increase PA. METHODS A 70-year-old Japanese woman admitted to the hospital with a diagnosis of left septic knee arthritis presented with prolonged pain and pain catastrophizing in the left knee. We investigated her pre- and post-discharge PA by using an accelerometer. We also investigated her physical function, pain, and pain catastrophizing as a possible influence on PA. Follow-up outpatient physical therapy (consisting of PA feedback, counseling, and reassurance) was performed to improve the patient's physical function and increase her PA. RESULTS The patient's PA indicated general inactivity from pre-discharge to 1 month post-discharge, especially immediately post-discharge (sedentary behavior [SB]: 540-571.3 min/daytime, light-intensity PA: 145.8-177.8 min/daytime). The follow-up outpatient physical therapy was effective in increasing her physical function and PA (a 31-min decrease in SB, a 32-min increase in light-intensity PA) but was not effective in reducing her pain or pain catastrophizing. DISCUSSION Contrary to the general trend, this patient showed a decrease in PA after hospital discharge compared to PA during hospitalization. Follow-up outpatient physical therapy had the effect of increasing the patient's PA, which was decreased immediately post-discharge.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Centre, Hidaka Hospital, Takasaki, Japan.,Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Kentaro Tajika
- Department of Rehabilitation Centre, Hidaka Hospital, Takasaki, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
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Chastin S, Gardiner PA, Harvey JA, Leask CF, Jerez-Roig J, Rosenberg D, Ashe MC, Helbostad JL, Skelton DA. Interventions for reducing sedentary behaviour in community-dwelling older adults. Cochrane Database Syst Rev 2021; 6:CD012784. [PMID: 34169503 PMCID: PMC8225503 DOI: 10.1002/14651858.cd012784.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Older adults are the most sedentary segment of society, often spending in excess of 8.5 hours a day sitting. Large amounts of time spent sedentary, defined as time spend sitting or in a reclining posture without spending energy, has been linked to an increased risk of chronic diseases, frailty, loss of function, disablement, social isolation, and premature death. OBJECTIVES To evaluate the effectiveness of interventions aimed at reducing sedentary behaviour amongst older adults living independently in the community compared to control conditions involving either no intervention or interventions that do not target sedentary behaviour. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, EPPI-Centre databases (Trials Register of Promoting Health Interventions (TRoPHI) and the Obesity and Sedentary behaviour Database), WHO ICTRP, and ClinicalTrials.gov up to 18 January 2021. We also screened the reference lists of included articles and contacted authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs. We included interventions purposefully designed to reduce sedentary time in older adults (aged 60 or over) living independently in the community. We included studies if some of the participants had multiple comorbidities, but excluded interventions that recruited clinical populations specifically (e.g. stroke survivors). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and full-text articles to determine study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required. Any disagreements in study screening or data extraction were settled by a third review author. MAIN RESULTS We included seven studies in the review, six RCTs and one cluster-RCT, with a total of 397 participants. The majority of participants were female (n = 284), white, and highly educated. All trials were conducted in high-income countries. All studies evaluated individually based behaviour change interventions using a combination of behaviour change techniques such as goal setting, education, and behaviour monitoring or feedback. Four of the seven studies also measured secondary outcomes. The main sources of bias were related to selection bias (N = 2), performance bias (N = 6), blinding of outcome assessment (N = 2), and incomplete outcome data (N = 2) and selective reporting (N=1). The overall risk of bias was judged as unclear. Primary outcomes The evidence suggests that interventions to change sedentary behaviour in community-dwelling older adults may reduce sedentary time (mean difference (MD) -44.91 min/day, 95% confidence interval (CI) -93.13 to 3.32; 397 participants; 7 studies; I2 = 73%; low-certainty evidence). We could not pool evidence on the effect of interventions on breaks in sedentary behaviour or time spent in specific domains such as TV time, as data from only one study were available for these outcomes. Secondary outcomes We are uncertain whether interventions to reduce sedentary behaviour have any impact on the physical or mental health outcomes of community-dwelling older adults. We were able to pool change data for the following outcomes. • Physical function (MD 0.14 Short Physical Performance Battery (SPPB) score, 95% CI -0.38 to 0.66; higher score is favourable; 98 participants; 2 studies; I2 = 26%; low-certainty evidence). • Waist circumference (MD 1.14 cm, 95% CI -1.64 to 3.93; 100 participants; 2 studies; I2 = 0%; low-certainty evidence). • Fitness (MD -5.16 m in the 6-minute walk test, 95% CI -36.49 to 26.17; higher score is favourable; 80 participants; 2 studies; I2 = 29%; low-certainty evidence). • Blood pressure: systolic (MD -3.91 mmHg, 95% CI -10.95 to 3.13; 138 participants; 3 studies; I2 = 73%; very low-certainty evidence) and diastolic (MD -0.06 mmHg, 95% CI -5.72 to 5.60; 138 participants; 3 studies; I2 = 97%; very low-certainty evidence). • Glucose blood levels (MD 2.20 mg/dL, 95% CI -6.46 to 10.86; 100 participants; 2 studies; I2 = 0%; low-certainty evidence). No data were available on cognitive function, cost-effectiveness or adverse effects. AUTHORS' CONCLUSIONS It is not clear whether interventions to reduce sedentary behaviour are effective at reducing sedentary time in community-dwelling older adults. We are uncertain if these interventions have any impact on the physical or mental health of community-dwelling older adults. There were few studies, and the certainty of the evidence is very low to low, mainly due to inconsistency in findings and imprecision. Future studies should consider interventions aimed at modifying the environment, policy, and social and cultural norms. Future studies should also use device-based measures of sedentary time, recruit larger samples, and gather information about quality of life, cost-effectiveness, and adverse event data.
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Affiliation(s)
- Sebastien Chastin
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
| | - Paul A Gardiner
- School of Health & Wellbeing, University of Southern Queensland, Ipswich, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Juliet A Harvey
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Calum F Leask
- Aberdeen City Health & Social Care Partnership, Aberdeen, UK
| | - Javier Jerez-Roig
- Department of Social Sciences and Community Health, Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia, Vic, Spain
| | - Dori Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Jorunn L Helbostad
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dawn A Skelton
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
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Katri Maria T, Laura AM, Erja P, Timo R, Sirkka K, Marja-Liisa K, Sarianna S, Riku N. Effects of a home-based rehabilitation program in community-dwelling older people after discharge from hospital: A subgroup analysis of a randomized controlled trial. Clin Rehabil 2021; 35:1257-1265. [PMID: 33749349 PMCID: PMC8369904 DOI: 10.1177/02692155211001672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To examine whether pre-admission community mobility explains the effects of a rehabilitation program on physical performance and activity in older adults recently discharged from hospital. Design: A secondary analysis of a randomized controlled trial. Setting: Home and community. Participants: Community-dwelling adults aged ⩾60 years recovering from a lower limb or back injury, surgery or other disorder who were randomized to a rehabilitation (n = 59) or standard care control (n = 58) group. They were further classified into subgroups that were not planned a priori: (1) mild, (2) moderate, or (3) severe pre-admission restrictions in community mobility. Interventions: The 6-month intervention consisted of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program, physical activity counselling, and standard care. Measurements: Physical performance was measured with the Short Physical Performance Battery and physical activity with accelerometers and self-reports. Data were analysed by generalized estimating equation models with the interactions of intervention, time, and subgroup. Results: Rehabilitation improved physical performance more in the intervention (n = 30) than in the control group (n = 28) among participants with moderate mobility restriction: score of the Short Physical Performance Battery was 4.4 ± 2.3 and 4.2 ± 2.2 at baseline, and 7.3 ± 2.6 and 5.8 ± 2.9 at 6 months in the intervention and control group, respectively (mean difference 1.6 points, 95% Confidence Interval 0.2 to 3.1). Rehabilitation did not increase accelerometer-based physical activity in the aforementioned subgroup and did not benefit those with either mild or severe mobility restrictions. Conclusions: Pre-admission mobility may determine the response to the largely counselling-based rehabilitation program.
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Affiliation(s)
- Turunen Katri Maria
- Gerontology Research Center, and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Aaltonen-Määttä Laura
- Gerontology Research Center, and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Klinik Healthcare Solutions Oy, Helsinki, Finland
| | - Portegijs Erja
- Gerontology Research Center, and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Rantalainen Timo
- Gerontology Research Center, and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Keikkala Sirkka
- Health Centre Hospital, Health Centre of Jyväskylä Cooperation Area, City of Jyväskylä, Finland
| | - Kinnunen Marja-Liisa
- Health Centre Hospital, Health Centre of Jyväskylä Cooperation Area, City of Jyväskylä, Finland.,Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Central Hospital of Central Finland, Jyväskylä, Finland
| | - Sipilä Sarianna
- Gerontology Research Center, and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Nikander Riku
- Gerontology Research Center, and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Central Hospital of Central Finland, Jyväskylä, Finland.,GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland
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11
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Todo E, Higuchi Y, Ueda T, Murakami T, Kozuki W. A 3-month multicomponent home-based rehabilitation program for older people with restricted life-space mobility: a pilot study. J Phys Ther Sci 2021; 33:158-163. [PMID: 33642692 PMCID: PMC7897524 DOI: 10.1589/jpts.33.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to verify the effects of a 3-month multicomponent home-based rehabilitation program developed on the basis of the reevaluation of older people with restricted life-space mobility. [Participants and Methods] The participants were residents in Japan aged ≥65 years who had Life-Space Assessment scores ≤52.3. Multicomponent home-based rehabilitation was conducted by physical and occupational therapists. Each visit included 40-60 min of combined exercise, practicing activities of daily living, improving the home environment, and caregiver support. The programs were developed in accordance with a flow diagram. The primary outcome was life-space mobility evaluated using the Life-Space Assessment score. [Results] Overall, 30 participants completed the intervention. The mean age of the participants was 82.4 ± 7.5 years. Three months after the intervention initiation, the Life-Space Assessment scores significantly improved from 12.0 to 30.5. The proportion of participants at maximal life-space level 5 (unlimited mobility) doubled from 16.7% at baseline to 33.3%. The functional independent measure score, fall efficacy scale score, and lower limb strength associated with standing up also significantly improved. We found no significant changes in the geriatric depression scale 5 and self-rated good health scores. [Conclusion] Multicomponent home-based rehabilitation can improve life-space mobility in older people with restricted life-space mobility.
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Affiliation(s)
- Emiko Todo
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino-shi, Osaka 583-8555, Japan.,Home-visit Nursing Station, Tatsumi Clinic & Hospital, Japan
| | - Yumi Higuchi
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino-shi, Osaka 583-8555, Japan
| | - Tetsuya Ueda
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino-shi, Osaka 583-8555, Japan
| | - Tatsunori Murakami
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino-shi, Osaka 583-8555, Japan
| | - Wataru Kozuki
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino-shi, Osaka 583-8555, Japan
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12
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Ullrich P, Werner C, Bongartz M, Eckert T, Abel B, Schönstein A, Kiss R, Hauer K. Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2020; 76:1988-1996. [PMID: 33021670 DOI: 10.1093/gerona/glaa254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. METHODS Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17-26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. RESULTS One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89-13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00-0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. CONCLUSIONS The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.
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Affiliation(s)
- Phoebe Ullrich
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany
| | - Christian Werner
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany.,Center of Geriatric Medicine, Heidelberg University, Germany
| | - Martin Bongartz
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany
| | - Tobias Eckert
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany
| | - Bastian Abel
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany
| | | | - Rainer Kiss
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany.,FHM Bielefeld, University of Applied Sciences, Germany
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany.,Center of Geriatric Medicine, Heidelberg University, Germany
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