PMID- 29902471 OWN - NLM STAT- MEDLINE DCOM- 20191224 LR - 20191224 IS - 1532-821X (Electronic) IS - 0003-9993 (Linking) VI - 100 IP - 3 DP - 2019 Mar TI - Effects of Postacute Multidisciplinary Rehabilitation Including Exercise in Out-of-Hospital Settings in the Aged: Systematic Review and Meta-analysis. PG - 530-550 LID - S0003-9993(18)30357-5 [pii] LID - 10.1016/j.apmr.2018.05.010 [doi] AB - OBJECTIVE: Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect on mobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic. DATA SOURCES: Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018. STUDY SELECTION: OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect of multidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age >/=65y) after discharge from hospital after an acute illness. DATA EXTRACTION: Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospital readmission within 3 months of discharge. DATA SYNTHESIS: A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7 assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]=: -1.34 to 48.32; I(2): 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I(2): 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly. CONCLUSION: OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge. However, the wide 95% CIs indicate that the evidence is not robust. CI - Copyright (c) 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. FAU - Verweij, Lotte AU - Verweij L AD - ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: l.verweij@hva.nl. FAU - van de Korput, Eva AU - van de Korput E AD - Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. FAU - Daams, Joost G AU - Daams JG AD - Research Support, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. FAU - Ter Riet, Gerben AU - Ter Riet G AD - Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. FAU - Peters, Ron J G AU - Peters RJG AD - Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. FAU - Engelbert, Raoul H H AU - Engelbert RHH AD - ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. FAU - Scholte Op Reimer, Wilma J M AU - Scholte Op Reimer WJM AD - ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. FAU - Buurman, Bianca M AU - Buurman BM AD - ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20180611 PL - United States TA - Arch Phys Med Rehabil JT - Archives of physical medicine and rehabilitation JID - 2985158R SB - IM MH - Aged MH - Aged, 80 and over MH - Exercise Therapy/methods/*statistics & numerical data MH - Female MH - Humans MH - Male MH - Outcome Assessment, Health Care/*statistics & numerical data MH - *Patient Care Team MH - Patient Discharge/statistics & numerical data MH - Patient Readmission/statistics & numerical data MH - Rehabilitation/methods/*statistics & numerical data MH - Subacute Care/*methods MH - Treatment Outcome OTO - NOTNLM OT - Aged OT - Continuity of patient care OT - Interdisiplinary research OT - Meta-analysis OT - Rehabilitation EDAT- 2018/06/15 06:00 MHDA- 2019/12/25 06:00 CRDT- 2018/06/15 06:00 PHST- 2018/01/19 00:00 [received] PHST- 2018/05/02 00:00 [revised] PHST- 2018/05/04 00:00 [accepted] PHST- 2018/06/15 06:00 [pubmed] PHST- 2019/12/25 06:00 [medline] PHST- 2018/06/15 06:00 [entrez] AID - S0003-9993(18)30357-5 [pii] AID - 10.1016/j.apmr.2018.05.010 [doi] PST - ppublish SO - Arch Phys Med Rehabil. 2019 Mar;100(3):530-550. doi: 10.1016/j.apmr.2018.05.010. Epub 2018 Jun 11.