Physical Rehabilitation for Older People in Long-Term Care

Summary

A Cochrane review [Abstract] 1 included 67 studies with a total of 6300 subjects. Studies were undertaken in nursing and residential care homes. A total of 76% of participants were women, mean ages ranged from 69 to 90 years. The physical and cognitive status of participants varied widely within and between studies, the majority of participants had at least one significant comorbidity. Forty-eight studies randomised individuals into experimental groups; the remaining 19 used cluster designs, randomising facilities, not individuals. Regarding interventions, 49 included exercises targeted at basic components of physical fitness, such as strength or flexibility, 40 included practice of basic ADLs, such as walking or transfers, and 21 featured other recreation or leisure activities, such as ball games or dancing. Thirty-five studies compared their intervention(s) to a 'usual care' control group, the remaining studies supplemented 'usual care' in some way. Most typically, interventions were 12 weeks in duration. Fifty-one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of 6 points (95% CI 2 to 11, p=0.008; 7 studies, n=857), Functional Independence Measure (0 to 126) scores of 5 points (95% CI -2 to 12, p=0.1; 4 studies, n=303), Rivermead Mobility Index (0 to 15) scores of 0.7 points (95% CI 0.04 to 1.3, p=0.04; 3 studies, n=323), Timed Up and Go test of 5 seconds (95% CI -9 to 0, p=0.05; 7 studies, n=885), and walking speed of 0.03 m/s (95% CI -0.01 to 0.07, p=0.1; 9 studies, n=589). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. Rehabilitation does not increase risk of mortality in this population (RR 0.95, 95% CI 0.80 to 1.13; 25 studies, n=3721).

Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment), indirectness (short follow-up time) and inconsistency (heterogeneity in patients, interventions and outcomes).