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 >= 65 years) after discharge from hospital following 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: Fifteen studies (1,255 patients) were included in the systematic review and twelve were included in the meta-analysis (seven assessing mobility using the 6-minute walk distance (6MWD) test and seven assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% CI -1.34 to 48.32; I2 = 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (RR 0.93; 95% CI 0.73 to 1.19; I2 = 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in three studies, and seven 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% confidence intervals indicate that the evidence is not robust. PROSPERO REGISTRATION NUMBER: CRD42017058592.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher