Interventions for reducing hospital-associated deconditioning: a systematic review and meta-analysis

Toby Smith, Ashwini Sreekanta, Sarah Walkeden, Bridget Penhale, Sarah Hanson

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Abstract

Purpose: To determine the effectiveness of hospital-based interventions designed to reduce Hospital-Associated Deconditioning (HAD) for people in inpatient hospital settings. Materials & Methods: Systematic literature search of published and unpublished databases was conducted from (inception to 01 June 2020). Randomised and non-randomised controlled trials investigating the effectiveness of enhanced inpatient programmes aimed to reduce HAD in adults admitted to a hospital ward were included. Evidence was appraised using the Cochrane Risk of Bias tool and outcomes evaluated against the GRADE criteria. Where appropriate, data were pooled in meta-analyses and presented as risk difference (RD) or standardised mean difference with 95% confidence intervals (CI). Results: Seven studies recruiting 12,597 participants (7864 enhanced programmes; 4349 usual care) were included. There was low-quality evidence for reduced risk of decline in physical performance for those in the enhanced programmes compared to usual care (RD: -0.04; 95% CI: -0.08 to -0.01; N=2085). There was low- or very-low quality evidence reporting no benefit of enhanced programmes for mobility on discharge, length of hospital stay, hospital readmission, and mortality within the first three-months post-admission (p>0.05). There was low-quality evidence that nursing home placement and mortality at 12-months was superior through enhanced inpatient programmes compared to usual care. Conclusion: Enhanced inpatient programmes targeted at HAD may offer benefit over usual care for some outcomes. There remain uncertainty in relation to how applicable the findings are to non-North American countries, which elements of an enhanced programme are most important to reduce HAD, and longer-term sequelae.
Original languageEnglish
Article number104176
JournalArchives of Gerontology and Geriatrics
Volume90
Early online date6 Jul 2020
DOIs
Publication statusPublished - Sep 2020

Keywords

  • Inpatient
  • deconditioning
  • physical inactivity
  • bed rest
  • frailty
  • ward intervention

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