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Exercise for acutely hospitalised older medical patients

  • Review
  • Intervention

Authors


Abstract

Background

A high incidence of functional decline (deterioration in physical or cognitive function) during hospitalisation of older adults is reported. The role of exercise in preventing these deconditioning effects is unclear.

Objectives

To determine the effect of exercise interventions for acutely hospitalised older medical patients on functional status, adverse events and hospital outcomes.

Search methods

We searched MEDLINE (1966-Feb 2006), CINAHL (1982-Feb 2006), EMBASE (1988 to Feb 2006), Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2006), PEDro (1929- Feb 2006), Current Contents (1993- Feb 2006) and Sports Discus (1830-Feb 2006). The Journal of the American Geriatrics Society was hand searched. Additional studies were identified through reference and citation tracking, personal communications with a content expert and contacting authors of eligible trials. There was no language restriction.

Selection criteria

Eligible studies were prospective randomised controlled trials (RCT) or prospective controlled clinical trials (CCT) comparing exercise for acutely hospitalised older medical patients to usual care or no treatment controls.

Data collection and analysis

Two independent reviewers extracted data relating to patient and hospital outcomes and assessed the method quality of included studies. Data were pooled in meta-analysis using the relative risk (RR) and absolute risk reduction (ARR) for dichotomous outcomes and the standardised mean difference (SMD) or the weighted mean difference (WMD) for continuous outcomes.

Main results

Of 3138 potentially relevant articles screened, 7 randomised controlled trials and 2 controlled clinical trials were included. The effect of exercise on functional outcome measures is unclear. No intervention effect was found on adverse events. Pooled analysis of multidisciplinary interventions that included exercise indicated a small significant increase in the proportion of patients discharged to home at hospital discharge (Relative Risk 1.08, 95% CI 1.03 to 1.14 and Numbers Needed to Treat 16, 95% CI 11 to 43) and a small but important reduction in acute hospital length of stay (weighted mean difference, -1.08 days, 95% CI -1.93 to -0.22) and total hospital costs (weighted mean difference, -US$278.65, 95% CI -491.85 to -65.44) compared to usual care. Pooled analysis of exercise intervention trials found no effect on the proportion of patients discharged to home or acute hospital length of stay.

Authors' conclusions

There is 'silver' level evidence (www.cochranemsk.org) that multidisciplinary intervention that includes exercise may increase the proportion of patients discharged to home and reduce length and cost of hospital stay for acutely hospitalised older medical patients.

摘要

背景

運動治療急性內科住院老人

住院老人高比率功能﹝身體或認知功能﹞退化。運動治療急性內科住院老人之效果不明。

目標

研究運動處置對治療急性內科住院老人在功能狀態、副作用、住院結果之效果。

搜尋策略

搜尋包括MEDLINE (1966Feb 2006), CINAHL (1982Fe 006), EMBASE (1988 to Feb 2006), Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2006), PEDro (1929 Feb 2006), Current Contents (1993 Feb 2006) and Sports Discus (1830Feb 2006)。同時手動搜尋Journal of the American Geriatrics Society及參考文獻並詢問專家。

選擇標準

隨機對照試驗或控制對照試驗比較運動處置對一般照顧或安慰劑治療急性內科住院老人之效果。

資料收集與分析

兩位作者進行資料摘錄,並對每篇試驗研究的品質進行評估。二分法類別資料使用相對風險(RR)及絕對風險減少(ARR)來分析,連續性資料使用標準化平均差異(SMD)或加權平均差異(WMD)分析。

主要結論

7個隨機對照試驗研究,及2個對照控制研究包含於分析中。運動對功能結果並不清楚。副作用未發現。與一般照顧相比較,包括運動的多科別處置綜合分析顯示,少量增加出院後回家庭的比率:相對風險1.08, 95% CI 1.03 to 1.14,NN 6, 95% CI 11 to 43,另外減少急性住院天數(WMD, −1.08天 5% CI −1.93 to −0.22) 及住院花費(WMD US$278.65, 95% CI −491.85 to −65.44)。運動處置的綜合分析顯示,出院後回家庭的比率與急性住院天數,並無顯著差異。

作者結論

銀級證據顯示,包括運動的多科別處置,可增加出院後回家庭的比率,減少急性住院天數及住院花費。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

急性內科住院老人,運動處置對功能、傷害、急性住院天數與出院後回家庭或護理之家或其他照護機構的比率,並無顯著差異。一個包括運動的處置計劃,對功能、傷害並無顯著差異,但可增加出院後回家庭的比率,稍微減少急性住院天數及住院花費。無足夠證據確定這些結果。研究包括65歲以上因內科疾病住院老人,運動及特殊計劃在住院後數天開始,許多計劃包括走路,整體而言,無足夠證據確定這些益處與害處的結果。功能及害處(跌倒,進加護病房、或死亡):可能無或少許差異。回家或住院天數:可能少許差異。一個包括運動的特殊處置計劃:患者可能早一天回家,每100人中多6人回家,每100人中81人回家;一般照顧組,每100人中75人回家。健康照護花費:運動處置研究未報告;包括運動的特殊處置計劃每住院人次可減少300元美金花費。

Plain language summary

Exercise for older patients in hospital

This summary of a Cochrane review presents what we know from research about the effects of exercise for older patients who are admitted to hospital. The review shows that:

For older patients who are admitted to hospital, exercise sessions

- may not lead to any difference in function, harms, length of stay in hospital or whether they go home or to a nursing home or other care facility.

For older patients who are admitted to hospital, a special care programme that includes exercise

- may not lead to any difference in function or harms.
- may slightly reduce the length of stay in hospital, may slightly increase the number of patients who go home instead of to a nursing home or another hospital.
- may slightly reduce the cost of care to the health system.

There is not enough evidence to be certain of these results.

Why exercise for older patients when they are in hospital?
It has been argued that older people often leave hospital less able to function or move than before they were admitted. For example, one study shows that many older patients, who were able to walk on their own two weeks before going into hospital, needed help to walk when they left hospital. This may be because they are resting in bed during their hospital stay. Usual care in hospitals does not always include exercise. It is thought that if older patients exercise more during their hospital stay they may not lose as much function. Usual care in hospitals does not always include exercise.

What are the effects of exercise?
The studies included patients who were 65 years or older and were admitted to hospital with a medical illness. While in hospital they received either usual hospital care, usual care plus exercise sessions or a special overall care programme that included exercise. The exercise sessions and special programmes started within a few days of patients being admitted to hospital. Many of the programmes included walking.

Overall, there is not enough evidence to be certain of the benefits and harms of exercise sessions or programmes for older patients in hospital.

Function and harms (falls, move to an intensive care unit (ICU), or death): There may be little or no difference with exercise sessions or with an overall programme of care that includes exercise.

Going home and length of time in hospital: There may be little difference with exercise sessions. With a special care programme that includes exercise, patients may go home 1 day earlier and 6 more patients out of 100 may go home instead of to a nursing home or other care facility
- 81 patients out of 100 may go home after receiving an overall programme of care that includes exercise
- 75 patients out of 100 may go home after receiving usual care

Health care costs: Costs were not reported for studies of exercise sessions. A special care programme that includes exercise may reduce health care costs by approximately $300 per patient hospital stay.

Ancillary