Zdravstvena njega u dnevnim bolnicama za starije ljude naspram drugih oblika skrbi
Referencias
References to studies included in this review
References to studies excluded from this review
References to studies awaiting assessment
Additional references
References to other published versions of this review
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Methods | Randomised controlled trial Method of randomisation: computer generated Concealment of allocation: sealed envelopes Outcome assessor blinding: blinded research sociologist | |
| Participants | Country: UK Patients referred to day hospital 163 patients eligible (28 needed day hospital treatment, 21 refused consent, 9 operational problems at day centre) Age: mean (SD) 80.4 (7.6) years | |
| Interventions | Day hospital: care by multidisciplinary rehabilitation team, principally nursing assessment, occupational therapy and physiotherapy. Median number of treatments (interquartile range) 11.5 (5–20.5). Day centre: rehabilitation provided by a physiotherapist and two support workers. Median number of treatments (interquartile range) 10 (5–14). | |
| Outcomes | 12 month follow up | |
| Notes | Total of 105 patients of whom 23 had a stroke diagnosis, 14 osteoarthritis, 13 fracture, 9 Parkinsonism | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer generated |
| Allocation concealment (selection bias) | Low risk | Quote: "Immediately after consent, subjects were randomly allocated to day hospital or day centre by a sequence of labelled tickets in sealed, opaque envelopes securely kept and opened by a senior ward clerk unattached to the trial team....computer generated blocks of 20." |
| Blinding of participants and personnel (performance bias) | High risk | Reported as single blind which appears to have been the assessor, not participants or personnel |
| Blinding of outcome assessment (detection bias) | Low risk | Outcome assessments were undertaken by a blinded research sociologist Quote: "The interviewer correctly identified 38/55 as day hospital and 20/38 as day centre, yielding kappa = 0.22 indicating poor agreement/successful blinding." |
| Incomplete outcome data (attrition bias) | Low risk | Similar losses per group (˜30%), moderately high but similar reasons reported for both groups |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | High risk | 18% of participants randomised to day centre attendance transferred to the day hospital leading to possibility of contamination (the experiment and control groups becoming mixed) |
| Methods | Randomised controlled trial Method of randomisation: computer generated Concealment of allocation: sealed envelopes Outcome assessor blinding: blinded research occupational therapist | |
| Participants | Country: Australia Hospitalised patients referred for ambulatory rehabilitation Inclusion criteria; medically stable; ready for hospital discharge; rehabilitation which required at least 12 therapy sessions Exclusion criteria: lived out of the health region; if referring clinician felt they were unsuitable to receive one of the programmes 301 patients assessed for study inclusion (34 patients did not meet the eligibility criteria, 38 patients declined to participate or were not approached on the request of the physician) Participants randomised = 229 Modified Bartel Index mean (SD): 92.4 (6.5) Mini‐Mental State Examination mean (SD): 26.9 (3.1) Male: 48% Age: mean (SD) 71.7 (14.1) years | |
| Interventions | Day hospital: Interdisciplinary programme providing 4–6 weeks of high intensity rehabilitation in either individual or group sessions with the option of extending the programme. Each visit lasted 3 hours. Participants had access to physiotherapy, occupational therapy, social work, psychology, dietetics and nursing and rehabilitation medicine. Home based rehabilitation: One to one rehabilitation programme delivered by an interdisciplinary team to participants in their homes. This included physiotherapy, occupational therapy, speech therapy, social work, dietetics, nursing and rehabilitation medicine. Three to five session per week usually delivered for between 4 and 6 weeks. | |
| Outcomes | Primary outcome: Assessment of Motor and Process Skills, bioelectrical impedance | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer generated |
| Allocation concealment (selection bias) | Low risk | Quote: "statistician external to the study generated the randomisation sequence using the random number generator in Microsoft Excel and created sequentially numbered, opaque, sealed envelopes containing group allocation for participants" |
| Blinding of participants and personnel (performance bias) | High risk | The same doctor provided medical services to both groups. Furthermore, participants could not have been blinded to the intervention |
| Blinding of outcome assessment (detection bias) | Low risk | Assesments were undertaken by a research occupational therapist blinded to the group allocation |
| Incomplete outcome data (attrition bias) | Low risk | Missing outcome data balanced across groups and with similar reasons reported |
| Selective reporting (reporting bias) | High risk | Some outcome measures reported in study protocol (Australian New Zealand Clinical Trials Registry) not reported in current publications |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: not reported Concealment of allocation: not reported Outcome assessor blinding: unclear for some outcomes | |
| Participants | Country: USA Patients referred for inpatient rehabilitation Age: not reported | |
| Interventions | Day hospital attendance 5 days a week with emphasis on rehabilitation with greater patient and carer involvement. Complete range of medical and therapeutic services available. | |
| Outcomes | 3 month follow up | |
| Notes | 96 patients were recruited, of whom 55 had a stroke diagnosis and 26 were amputees | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | No information reported |
| Allocation concealment (selection bias) | Unclear risk | No information reported |
| Blinding of participants and personnel (performance bias) | High risk | No information reported but would have been obvious to participants |
| Blinding of outcome assessment (detection bias) | Unclear risk | It was reported that medical status was assessed by a physician who did not know the patient. However, it was unclear if this was the case for other outcomes |
| Incomplete outcome data (attrition bias) | Unclear risk | Not all outcomes were reported in the publication (Cummings 1985). However, some additional information was provided by the authors on request |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Unclear risk | This was an ‘artificial' day hospital designed specifically for the purpose of the study and may have been affected by some environmental factors and under‐utilisation of the hospital |
| Methods | Randomised controlled trial, stratified by conventional service Method of randomisation: not reported Concealment of allocation: not reported Outcome assessor blinding: not undertaken | |
| Participants | Country: Canada Patients referred from the community to 2 geriatricians or about to be discharged from hospital Age: mean (SD) 78.9 (7.2) years | |
| Interventions | Day hospital: Attendance 2 days a week. Treatment included multidisciplinary team assessment, programme of rehabilitation provided by physiotherapists and occupational therapists. Usual care: Management in inpatient geriatric assessment unit for comprehensive assessment and treatment, management in the outpatient geriatric clinic, with limited diagnostic and rehabilitative opportunities, or early discharge from a medical‐surgical inpatient unit and appropriate community follow‐up services. The same professionals provided treatment to both groups | |
| Outcomes | 12 month follow up | |
| Notes | 113 patients were recruited, of whom 26 had a stroke diagnosis, 32 a diagnosis of depression and 19 a diagnosis of degenerative joint disease | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | No information reported |
| Allocation concealment (selection bias) | Unclear risk | No information reported |
| Blinding of participants and personnel (performance bias) | High risk | Quote: “We were unable to blind the patients, caregivers and study personnel administering the questionnaires and instruments for measuring functional status to the study groups” |
| Blinding of outcome assessment (detection bias) | High risk | Quote: “We were unable to blind the patients, caregivers and study personnel administering the questionnaires and instruments for measuring functional status to the study groups” |
| Incomplete outcome data (attrition bias) | Low risk | Missing outcome data fairly balanced in numbers across groups |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: random number table Concealment of allocation: sealed envelopes Outcome assessor blinding: blinded assessment at 6 months and 1 year | |
| Participants | Country: UK Patients discharged home from hospital after acute stroke Age: mean 70 years | |
| Interventions | Domiciliary rehabilitation intervention: 2 half time physiotherapists, 1 occupational therapist and treatment for up to 6 months (75% received treatment). Day hospital intervention: multidisciplinary rehabilitation provided (54% received treatment). | |
| Outcomes | 12 month follow up | |
| Notes | All stroke patients (155) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "consecutive sealed envelopes which contained cards marked either “DRS” or “HRS" which had been prepared before the start of the study by reference to a table of random numbers." |
| Allocation concealment (selection bias) | Low risk | Quote: "consecutive sealed envelopes which contained cards marked either “DRS” or “HRS which had been prepared before the start of the study by reference to a table of random numbers." |
| Blinding of participants and personnel (performance bias) | High risk | No information reported. However, participants would have been aware of allocation |
| Blinding of outcome assessment (detection bias) | Unclear risk | Blinded assessment at 6 months and 1 year, however unclear if baseline data were collected by a blinded assessor |
| Incomplete outcome data (attrition bias) | Low risk | Some imbalance in missing outcome data but losses relatively low in both groups |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: computerised random Concealment of allocation: assignment from central site Outcome assessor blinding: not reported | |
| Participants | Country: USA To be eligible, Veterans Aaffairs service patients had one of the following: at risk of nursing home placement, 'Service connected disability', hospital inpatient, in home care programme, in a Veterans Affaris domiciliary service Age: mean 71.1 years | |
| Interventions | Medical Day Hospital: therapeutically orientated programme providing health maintenance and rehabilitation services. Staff included nurses, rehabilitation therapists, recreation therapists and social worker. Mean attendance over 6 months: 28 days. | |
| Outcomes | 12 month follow up | |
| Notes | No accurate information on patient diagnosis given | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computerised random number generator |
| Allocation concealment (selection bias) | Low risk | Assignment from central site |
| Blinding of participants and personnel (performance bias) | High risk | No reported blinding of participants or personnel. However, it would have been obvious to participants |
| Blinding of outcome assessment (detection bias) | Unclear risk | No reported blinded outcome assessment |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: random number table Concealment of allocation: sealed envelopes Outcome assessor blinding: unclear | |
| Participants | Country: Hong Kong Patients admitted to a rehabilitation ward one week after acute stroke Age: mean (SD) 73.6 (5.7) years | |
| Interventions | Medical day hospital: care under the geriatrician with early discharge, as able, with continued care in the day hospital. Duration of intervention not reported for day hospital or inpatient rehabilitation. Conventional inpatient rehabilitation: delivered by a neurology team with medical clinic follow up. | |
| Outcomes | 6 month follow up | |
| Notes | Stroke patients only | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Random number table (information obtained from follow up correspondence) |
| Allocation concealment (selection bias) | Low risk | Quote (from letter): "The codes were sealed in envelopes and placed at an office in Shatin Hospital. When the patient is deemed suitable to be discharged, an envelope would be withdrawn and patient assigned into the specific group (Day Hospital or Conventional Management)." |
| Blinding of participants and personnel (performance bias) | High risk | No report of blinding but would have been obvious to participants |
| Blinding of outcome assessment (detection bias) | Unclear risk | Follow up assessment was carried out by a research nurse. However, not reported if assessment was blinded |
| Incomplete outcome data (attrition bias) | Unclear risk | Losses relatively similar across the groups. However, reasons for participants defaulting not reported |
| Selective reporting (reporting bias) | Unclear risk | Reported that "patient well‐being...use of community services and financial support were all comparable between the two treatment groups at each follow‐up (data not shown)." No numerical data reported |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: Internet based randomisation service Concealment of allocation: Internet based randomisation service Outcome assessor blinding: not undertaken | |
| Participants | Country: UK Inclusion criteria: the study population was comprised of men and women aged 70 and over identified as being at high risk of falling by a postal screening questionnaire, registered with the participating general practices in Nottinghamshire and Derbyshire. 6113 assessed for study inclusion (844 potential participants did not meet the eligibility criteria, 4925 declined to participate) Participants randomised = 364 Male: 40% Age: mean (SD) 78.8 (5.7) years | |
| Interventions | Medical day hospital: screening questionnaire, information leaflet, leaflet on falls prevention and invitation to attend the day hospital for assessment and any subsequent intervention. Control intervention: screening questionnaire, information leaflet, leaflet on falls prevention and usual care from primary care service until outcome data collected, then offer of day hospital intervention. Duration of intervention not reported for day hospital or control intervention | |
| Outcomes | Primary outcome: Rate of falls over the 12 month follow‐up period Secondary Outcomes Proportion of people with single or recurrent falls and fall‐related injuries: fracture, serious sprain requiring immobilisation in plaster, joint dislocations, head injury requiring hospitalisation, and lacerations requiring suturing Disability: Nottingham Extended Activities of Daily Living Scale; Barthel index of daily living; Quality of life: Falls Institutionalisation and use of health services: residency and diary information Cost analysis Deaths checked from PCT records and measured as proportions | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | An Internet based randomisation service provided by the hosts institution's clinical trials unit |
| Allocation concealment (selection bias) | Low risk | An Internet based randomisation service provided by the hosts institution's clinical trials unit |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention It would not be possible to blind participants |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "it was not possible to blind participants or researchers to allocation." However, the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding. GP recording of death or institutionalisation are unlikely to be biased by the participation in either arm of the study |
| Incomplete outcome data (attrition bias) | Low risk | Misisng data balanced across groups with similar reasons |
| Selective reporting (reporting bias) | Low risk | Study protocol available and additional information provided on request |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: external web based randomisation service Concealment of allocation: external web based randomisation service Outcome assessor blinding: unclear | |
| Participants | Country: UK Participants were older people referred for rehabilitation for various conditions including stroke, orthopaedic rehabilitation, movement disorder, mobility assessment and falls assessment. Inclusion criteria: referred for multidisciplinary rehabilitation, a permanent address in the catchment area, able to give informed consent (with the help of a career or advocate if necessary). Exclusion criteria: local exclusion criteria meant that patients were excluded from randomisation if they had a specific clinical need that could only be addressed at one centre (sites provided specific services). Participants randomised = 89 Baseline function: mean (SD) Nottingham Extended Activities of Daily Living 29.9 (15.2) Males: 55% Age: mean (SD) 75 (11) years | |
| Interventions | Medical day hospital (4 sites): Some variation in the services provided between the four day hospitals. However, all sites were multidisciplinary and patients could access a hospital doctor, nursing care, physiotherapy and occupation therapy services. Some sites provided access to a social worker. Number of rehabilitation episodes: mean 17.7, median 18. Rehabilitation at home: Some variation in the services offered by the 4 participating home rehabilitations teams. However, all provided physiotherapy services and the majority provided occupational therapy. Some services provided access to a doctor and a social worker. Number of rehabilitation episodes: mean 9.4; median 8.5. Reported in the study protocol that the length of the interventions would be determined by the local clinical team with the expectation that 95% of participants would be discharged within 16 weeks. | |
| Outcomes | 12 month follow up Patient outcomes: Hospital anxiety and depression scale Euro‐qol 5D Nottingham Extended Activities of Daily Living Socio‐economic data, survival Therapy outcome measures Views of treatment by qualitative interview Carer outcomes: General health questionnaire Socio‐economic data Views of treatment | |
| Notes | http://www.controlled‐trials.com/ISRCTN71801032 https://portal.nihr.ac.uk/Profiles/NRR.aspx?Publication_ID=N0071140216 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | External web based randomisation service |
| Allocation concealment (selection bias) | Low risk | External web based randomisation service and investigators were not involved in the allocation to groups |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "the nature of the treatments was such that it was not possible for the patients or their health‐care professionals to be blinded to the treatment allocation, or to guarantee that the local researchers remained unaware of allocation for the duration of follow‐up" |
| Blinding of outcome assessment (detection bias) | Unclear risk | Quote: "the nature of the treatments was such that it was not possible for the patients or their health‐care professionals to be blinded to the treatment allocation, or to guarantee that the local researchers remained unaware of allocation for the duration of follow‐up" |
| Incomplete outcome data (attrition bias) | High risk | Whilst the reasons for losses were relatively similar across both groups, losses were > 35% by final follow up |
| Selective reporting (reporting bias) | Low risk | Protocol available (Current Controlled Trials ISRCTN71801032) |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: randomised according to date of birth Concealment of allocation: date of birth, therefore could have been foreseen Outcome assessor blinding: not reported | |
| Participants | Country: Finland Patients receiving home care in a rural community in Finland Age: mean (range) 77 (43‐91) years | |
| Interventions | Day hospital: new 10‐place day hospital provided medical and nursing assessment and care. Intensive physiotherapy and occupational therapy provided according to individual need. Patients attended 2‐3 days a week from 8.30am‐ 4.30pm. On average 20 days treatment over 2 months. Usual care: included mixture of home health care and referral to a hospital or outpatient care. | |
| Outcomes | 12 month follow up | |
| Notes | Total of 174 patients of whom 40 had a stroke diagnosis, 54 a diagnosis of coronary heart disease, 53 arthrosis, 33 'moderate' or 'severe' dementia | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Quote: "were randomised into two groups according to their date of birth." |
| Allocation concealment (selection bias) | High risk | Allocation based on date of birth, therefore could have been foreseen |
| Blinding of participants and personnel (performance bias) | High risk | No report of blinding and would have been obvious to participants which group they were in |
| Blinding of outcome assessment (detection bias) | Unclear risk | No reported blinded outcome assessment |
| Incomplete outcome data (attrition bias) | Unclear risk | Similar numbers of losses but reasons for losses not reported so cannot determine risk |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Unclear risk | Nearly one quarter of the day hospital group refused the care |
| Methods | Randomised controlled trial Method of randomisation: computer generated Concealment of allocation: unclear Outcome assessor blinding: blinded research nurse | |
| Participants | Country: UK Inclusion criteria: patients with newly diagnosed stroke admitted to a Poole Hospital NHS Trust hospital, or community referrals. Age: mean (range) 78.95 (60‐95) years | |
| Interventions | Day hospital: 5 day hospitals with coordinated care from multidisciplinary teams, both individual and group therapies. Median number of visits to the day hospital 17. Domiciliary care: domiciliary stroke team comprising 1 full time physiotherapist and a half time physiotherapist and consultant geriatrician, who met with each other fortnightly to review patients. Out patient speech and language therapy provided. Median number of domicilliary visits 17. In both interventions, therapy was provided until maximum potential for recovery was reached. Patients were then placed on review, and if no further therapy required, discharged. | |
| Outcomes | 6 month follow‐up Barthel index Rivermead Mobility Index | |
| Notes | All stroke patients, previous stroke in the day hospital group 23 (32%) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer generated randomisation |
| Allocation concealment (selection bias) | Unclear risk | Allocation concealment was attempted. Quote: "...by calling a centralised office where closed lists ... were kept" , the sample was stratified by sex (2 groups), disability (3 groups), age and day hospital catchment area. Minimum 2x3x2x5 = 60 groups. There were 5 day hospitals so potentially 60 groups. The approach to stratification is not described but is likely to be a permuted‐block design, with small block size and therefore allocation could have been predicted for some of the patients |
| Blinding of participants and personnel (performance bias) | High risk | Not reported but would have been obvious to participants |
| Blinding of outcome assessment (detection bias) | Low risk | Assesments were carried out by a research nurse blind to allocation |
| Incomplete outcome data (attrition bias) | Low risk | Similar losses in each group with similar reasons |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Low risk | There was contamination: 5 switched from domiciliary to day hospital and two the other way. One other ‘incorrect placement’ (unexplained). Appears these were analysed in original groups (correctly (ITT) but therefore contaminating the result). However, because the contamination involved so few participants we judged it unlikely to have significantly altered the estimate of effect. |
| Methods | Randomised controlled trial Method of randomisation: random number table Concealment of allocation: unclear Outcome assessor blinding: research occupational therapist | |
| Participants | Country: New Zealand Patients over 55 years Age: mean (range) 72 (55‐92) years | |
| Interventions | Day hospital: intensive physiotherapy, occupational therapy, speech therapy and medical and nursing assessment and supervision. Patients attended 2‐3 days per week, Monday to Friday from 8.30 a.m. ‐ 2.00 p.m. for 6 ‐ 8 weeks. Usual care: inpatient, outpatient follow‐up with or without outpatient physiotherapy, by referral for domiciliary services, by referral to the sole care of their GP, or by referral to a day centre as decided before randomisation | |
| Outcomes | 5 months follow up | |
| Notes | No information on number of patients screened for inclusion | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients with and without strokes were randomised separately into day hospital and control groups with standard tables of random numbers." |
| Allocation concealment (selection bias) | Unclear risk | Allocation concealment not reported. Therefore, insufficient information to determine risk |
| Blinding of participants and personnel (performance bias) | High risk | No report of blinding. However, it would have been obvious to participants which group they were in |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "In an attempt to preserve blindness of assessment she [research occupational therapist] was not concerned in the rehabilitation of these patients and worked in another occupational therapy department." |
| Incomplete outcome data (attrition bias) | Unclear risk | Some lost to follow up (5% from experimental group, 14% from control). Some differences in reasons for losses |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial (pilot study) Method of randomisation: not reported Concealment of allocation: sealed envelopes Outcome assessor blinding: not reported | |
| Participants | Country: UK Consecutive patients attending 2 day hospitals were eligible for trial if: Age: 98% over 65 years | |
| Interventions | Day hospitals (2 sites): medical and nursing support and physiotherapy, occupational therapy, speech therapy, chiropody, dietary, pharmaceutical and opthalmic services. Regular team meetings, attempt to equalise amount of therapy given to both groups, the duration of the interventions were not reported. | |
| Outcomes | 2 month follow up | |
| Notes | Total of 59 patients of whom 16 had a stroke diagnosis, 12 fractured neck or femur, 5 osteo‐arthritis | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method of sequence generation not reported |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes opened after participants had been included |
| Blinding of participants and personnel (performance bias) | High risk | No report of blinded outcome assessment. However, it would have been obvious to participants |
| Blinding of outcome assessment (detection bias) | Unclear risk | No report of blinded outcome assessment |
| Incomplete outcome data (attrition bias) | Unclear risk | The outcomes were not reported in the original report (Vetter 1989), although some additional information was provided on request |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: no information reported Concealment of allocation: no information reported Outcome assessor blinding: no information reported | |
| Participants | Country: UK New service established and advertised Age: 50% ≥ 75 years | |
| Interventions | Day hospital: a programme of services including nursing, physiotherapy, patient activities provided under health leadership with physical rehabilitation as the treatment goal. Four different sites available. Patients attended for an average of 51 days per year. | |
| Outcomes | 12 month follow up | |
| Notes | Little information on patient diagnosis (only circulatory disorders (225, 41%) and injuries (55, 10%)) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | No information reported |
| Allocation concealment (selection bias) | Unclear risk | No information reported |
| Blinding of participants and personnel (performance bias) | High risk | No information reported. However, it would have been obvious to participants |
| Blinding of outcome assessment (detection bias) | Unclear risk | No information reported |
| Incomplete outcome data (attrition bias) | High risk | Missing data and numbers/reasons for drop outs per group not reported |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Low risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: random number table Concealment of allocation: not reported Outcome assessor blinding: not reported | |
| Participants | Country: UK Patients (N = 331) from a consecutive series of 500 former geriatric unit inpatients (169 had died, left area, or were not traced) | |
| Interventions | Day hospital: patients received a medical assessment, occupational therapy and group exercises Control: usual care with limited resources available. | |
| Outcomes | 12 month follow up | |
| Notes | No information on patient diagnosis | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Random number table |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | No report of blinding and the nature of the intervention would make it unlikely that blinding had been undertaken |
| Blinding of outcome assessment (detection bias) | Unclear risk | No report of blinded assessment |
| Incomplete outcome data (attrition bias) | High risk | 26% of the original 500 participants lost at the outset, numbers relatively balanced across groups but reasons not reported. Some exclusions due to contamination of controls |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | High risk | No other obvious sources of bias |
| Methods | Randomised controlled trial Method of randomisation: unclear Concealment of allocation: unclear Outcome assessor blinding: researcher | |
| Participants | Country: UK Inclusion criteria: Patients discharged home from hospital after new stroke event Age: Median (range) day hospital 72 years (60‐88), domiciliary group 70 years (60‐89) | |
| Interventions | Day hospital attendance: focus on physical rehabilitation, staffed by a multidisciplinary team of nurses, physiotherapists and occupational therapists. 2 days a week for 8 weeks 9.30am ‐ 3.45pm. | |
| Outcomes | 6 months follow up | |
| Notes | Stroke patients only (124) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "randomisation to one of the two treatment groups was by an independent worker." However, the specific method of randomisation was not reported |
| Allocation concealment (selection bias) | Low risk | Quote: that "randomisation to one of the two treatment groups was by an independent worker" |
| Blinding of participants and personnel (performance bias) | High risk | No report of blinding of participants or personnel. However, it would have been obvious to participants which group they were in. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "by a research worker who was not involved with the randomisation or with the patient’s treatment" |
| Incomplete outcome data (attrition bias) | Low risk | Similar numbers lost from each group for similar reasons ˜20% |
| Selective reporting (reporting bias) | Unclear risk | We were unable to obtain the pre‐study protocol so cannot determine risk of reporting bias |
| Other bias | Low risk | Some contamination from participants changing intervention group. However, this was only 4% |
ADL: activities of daily living
GP: general practitioner
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| Psychiatric patients. | |
| General medical ward versus care at home. | |
| Psychiatric patients. | |
| Patients were randomised to treatment at home or to outpatient/day hospital attendance, patients attending day hospital not reported separately. | |
| Evaluation of adult day care rather than day hospital. | |
| Median age of patients was 53 years. | |
| Not a randomised controlled trial. This is a qualitative study. | |
| Not a randomised controlled trial. This is a longitudinal study. | |
| Patients with heart failure, mean age 56 years. | |
| Not a randomised controlled trial. Patients were free to choose which service they attended. | |
| Psychiatric patients. | |
| The day hospital was part of a more complex intervention. | |
| Not an evaluation of a medical day hospital; patients attended a chronic care clinic for half‐day visits every 3‐4 months. | |
| The intervention took place in a hospital gym and did not meet the criteria for a medical day hospital. | |
| Not a randomised controlled trial. | |
| Retrospective review of patients; not a randomised controlled trial. | |
| The intervention was specific to patients with Chronic Obstructive Pulmonary Disease (COPD). Studies of single, specific conditions were excluded (see methods‐types of interventions). Appears to be an out‐patient intervention rather than day hospital. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| The intervention facility was a clinic specific to treating patients with both diabetes and hypertension, with a specific tailored intervention. Studies of single, specific conditions were excluded (see methods‐types of interventions). | |
| Hospital‐based rehabilitative care versus outpatient services. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Observational study. | |
| Not a randomised controlled trial. | |
| The study took part in a day hospital but this was not the intervention. | |
| Not a randomised controlled trial. | |
| The outpatient programme was specific to patients with coronary heart disease. | |
| Psychiatric patients. | |
| Not a randomised controlled trial. | |
| Psychiatric patients. | |
| Psychiatric patients. | |
| Evaluated the effect of a chronic illness self‐managment programme delivered in a senior centre. All participants attended the senior centre. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Prospective study; not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| The intervention was only for 2.5 hours a week, therefore it does not meet our criteria for a near full day, or full day. The intervention appeared to be more social care rather than rehabilitation (group sessions rather than individualised). | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Psychiatric patients aged 18‐65. | |
| Evaluation of different treatment approaches; all patient attended the day hospital. | |
| Patients were in receipt of day services and were randomised to attend a water exercise program once or twice a week or to a social activity control group. The intervention was a swimming intervention, as part of a day service, and not a day hospital. | |
| Quote: "As randomization was chosen by only 2.5% of participants, the study had to be analyzed as an observational study." | |
| Not day hospital intervention, group meeting for 90 minutes once a month. | |
| Not a randomised controlled trial. | |
| The day hospital arm of the study included data from two other interventions, including home services, and it was not possible to extract the data specific to the day hospital. | |
| Participants only attended day hospital for up to two hours a day. | |
| Not a randomised controlled trial. | |
| Evaluation of treatment for patients with Parkinsons disease. Intervention provided by a specialist multidisciplinary team to patients with Parkinson's disease in a day hospital setting. Studies of single, specific conditions were excluded (see methods‐types of interventions). | |
| Not a randomised or quasi‐randomised study. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. |
Characteristics of studies awaiting assessment [ordered by study ID]
| Methods | |
| Participants | Stroke patients |
| Interventions | Physiotherapy versus standard care |
| Outcomes | Timed 10 metre walk, questionnaire to establish if there is an improvement in function |
| Notes | http://www.controlled‐trials.com/ISRCTN53696600/53696600 |
| Methods | Randomised controlled trial |
| Participants | |
| Interventions | |
| Outcomes | |
| Notes |
| Methods | |
| Participants | |
| Interventions | Multidisciplinary and multifaceted outpatient management of patients with osteoarthritis |
| Outcomes | |
| Notes | Protocol for a randomised controlled trial |
| Methods | Randomised controlled trial |
| Participants | Older people attending the geriatric day hospital |
| Interventions | Core‐Strength training program in comparison to a Stretch & Strength program. |
| Outcomes | Berg balance scale, Functional walking capacity 6 minute walk test, Gait speed, Bridge Test, Activities‐Specific Balance Confidence Scale, International Consultation on Urinary Incontinence Questionnaire |
| Notes | ClinicalTrials.gov identifier: NCT00785746 |
| Methods | |
| Participants | Older patients with dementia |
| Interventions | |
| Outcomes | |
| Notes |
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size | ||||||||||||||||||||||||||||||||||||||||
| 1 Death by the end of follow up Show forest plot | 16 | 3533 | Odds Ratio (M‐H, Random, 95% CI) | 1.05 [0.85, 1.28] | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.1  Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 1 Death by the end of follow up. | ||||||||||||||||||||||||||||||||||||||||||||
| 1.1 Day Hospital vs Comprehensive elderly care | 5 | 1287 | Odds Ratio (M‐H, Random, 95% CI) | 1.26 [0.87, 1.82] | ||||||||||||||||||||||||||||||||||||||||
| 1.2 Day hospital vs Domiciliary care | 7 | 901 | Odds Ratio (M‐H, Random, 95% CI) | 0.97 [0.61, 1.55] | ||||||||||||||||||||||||||||||||||||||||
| 1.3 Day hospital vs No comprehensive elderly care | 4 | 1345 | Odds Ratio (M‐H, Random, 95% CI) | 0.88 [0.63, 1.22] | ||||||||||||||||||||||||||||||||||||||||
| 2 Death or institutional care by the end of follow up Show forest plot | 13 | 3030 | Odds Ratio (M‐H, Random, 95% CI) | 0.85 [0.63, 1.14] | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.2  Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 2 Death or institutional care by the end of follow up. | ||||||||||||||||||||||||||||||||||||||||||||
| 2.1 Day hospital vs Comprehensive elderly care | 4 | 1181 | Odds Ratio (M‐H, Random, 95% CI) | 1.00 [0.69, 1.44] | ||||||||||||||||||||||||||||||||||||||||
| 2.2 Day hospital vs Domiciliary care | 5 | 672 | Odds Ratio (M‐H, Random, 95% CI) | 1.05 [0.57, 1.92] | ||||||||||||||||||||||||||||||||||||||||
| 2.3 Day hospital vs No comprehensive elderly care | 4 | 1177 | Odds Ratio (M‐H, Random, 95% CI) | 0.63 [0.40, 1.00] | ||||||||||||||||||||||||||||||||||||||||
| 3 Death or deterioration in activities of daily living (ADL) Show forest plot | 7 | 1268 | Odds Ratio (M‐H, Random, 95% CI) | 1.07 [0.76, 1.49] | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.3  Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 3 Death or deterioration in activities of daily living (ADL). | ||||||||||||||||||||||||||||||||||||||||||||
| 3.1 Day hospital vs Comprehensive elderly care | 1 | 174 | Odds Ratio (M‐H, Random, 95% CI) | 1.18 [0.63, 2.18] | ||||||||||||||||||||||||||||||||||||||||
| 3.2 Day hospital vs Domiciliary care | 4 | 443 | Odds Ratio (M‐H, Random, 95% CI) | 1.41 [0.82, 2.42] | ||||||||||||||||||||||||||||||||||||||||
| 3.3 Day hospital vs No comprehensive elderly care | 2 | 651 | Odds Ratio (M‐H, Random, 95% CI) | 0.76 [0.56, 1.05] | ||||||||||||||||||||||||||||||||||||||||
| 4 Death or poor outcome (institutional care, disability or deterioration) Show forest plot | 13 | 2831 | Odds Ratio (M‐H, Random, 95% CI) | 0.92 [0.74, 1.15] | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.4  Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 4 Death or poor outcome (institutional care, disability or deterioration). | ||||||||||||||||||||||||||||||||||||||||||||
| 4.1 Day hospital vs Comprehensive elderly care | 5 | 1268 | Odds Ratio (M‐H, Random, 95% CI) | 1.05 [0.79, 1.40] | ||||||||||||||||||||||||||||||||||||||||
| 4.2 Day hospital vs Domiciliary care | 5 | 581 | Odds Ratio (M‐H, Random, 95% CI) | 1.08 [0.67, 1.74] | ||||||||||||||||||||||||||||||||||||||||
| 4.3 Day hospital vs No comprehensive elderly care | 3 | 982 | Odds Ratio (M‐H, Random, 95% CI) | 0.72 [0.53, 0.99] | ||||||||||||||||||||||||||||||||||||||||
| 5 Deterioration in activities of daily living (ADL) in survivors Show forest plot | 7 | 905 | Odds Ratio (M‐H, Random, 95% CI) | 1.11 [0.68, 1.80] | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.5  Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 5 Deterioration in activities of daily living (ADL) in survivors. | ||||||||||||||||||||||||||||||||||||||||||||
| 5.1 Day hospital vs Comprehensive elderly care | 1 | 149 | Odds Ratio (M‐H, Random, 95% CI) | 1.21 [0.58, 2.52] | ||||||||||||||||||||||||||||||||||||||||
| 5.2 Day hospital vs Domiciliary care | 4 | 349 | Odds Ratio (M‐H, Random, 95% CI) | 1.59 [0.87, 2.90] | ||||||||||||||||||||||||||||||||||||||||
| 5.3 Day hospital vs No comprehensive elderly care | 2 | 407 | Odds Ratio (M‐H, Random, 95% CI) | 0.61 [0.38, 0.97] | ||||||||||||||||||||||||||||||||||||||||
| 6 Activities of daily living (ADL) scores Show forest plot | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| Analysis 1.6
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 6 Activities of daily living (ADL) scores. | ||||||||||||||||||||||||||||||||||||||||||||
| 6.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 6.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 6.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 7 Subjective health status Show forest plot | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| Analysis 1.7
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 7 Subjective health status. | ||||||||||||||||||||||||||||||||||||||||||||
| 7.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 7.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 7.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 8 Patient satisfaction Show forest plot | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| Analysis 1.8
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 8 Patient satisfaction. | ||||||||||||||||||||||||||||||||||||||||||||
| 8.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 8.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 8.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 9 Carer Distress Show forest plot | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| Analysis 1.9
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 9 Carer Distress. | ||||||||||||||||||||||||||||||||||||||||||||
| 9.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 9.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 9.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size | ||||||||||||||||||||||||||||||||||||||||
| 1 Requiring institutional care at the end of follow up Show forest plot | 13 | 3003 | Odds Ratio (M‐H, Random, 95% CI) | 0.84 [0.58, 1.21] | ||||||||||||||||||||||||||||||||||||||||
| Analysis 2.1  Comparison 2 Day Hospital vs Alternative Care ‐ resource outcomes, Outcome 1 Requiring institutional care at the end of follow up. | ||||||||||||||||||||||||||||||||||||||||||||
| 1.1 Day hospital vs Comprehensive elderly care | 4 | 1181 | Odds Ratio (M‐H, Random, 95% CI) | 0.91 [0.70, 1.19] | ||||||||||||||||||||||||||||||||||||||||
| 1.2 Day hospital vs Domiciliary care | 5 | 672 | Odds Ratio (M‐H, Random, 95% CI) | 1.49 [0.53, 4.25] | ||||||||||||||||||||||||||||||||||||||||
| 1.3 Day hospital vs No comprehensive elderly care | 4 | 1150 | Odds Ratio (M‐H, Random, 95% CI) | 0.58 [0.28, 1.20] | ||||||||||||||||||||||||||||||||||||||||
| 2 Hospital bed use during follow up Show forest plot | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.2
Comparison 2 Day Hospital vs Alternative Care ‐ resource outcomes, Outcome 2 Hospital bed use during follow up. | ||||||||||||||||||||||||||||||||||||||||||||
| 2.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 2.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 2.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 3 Resource use Show forest plot | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.3
Comparison 2 Day Hospital vs Alternative Care ‐ resource outcomes, Outcome 3 Resource use. | ||||||||||||||||||||||||||||||||||||||||||||
| 3.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 3.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
| 3.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 1 Death by the end of follow up.
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 2 Death or institutional care by the end of follow up.
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 3 Death or deterioration in activities of daily living (ADL).
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 4 Death or poor outcome (institutional care, disability or deterioration).
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 5 Deterioration in activities of daily living (ADL) in survivors.
| Study | |
| Day hospital vs Comprehensive elderly care | |
| Cummings 1985 | No significant difference in the Kenny ADL score ‐ |
| Eagle 1991 | No significant difference in the Geriatric Quality of Life Questionnaire ADL score ‐ |
| Hedrick 1993 | No significant in the physical dimension of the Sickness Impact Profile (NB high score indicates increased disability) ‐ |
| Pitkala 1991 | No data in this form |
| Tucker 1984 | No significant difference in the mean change in Northwick Park ADL score from baseline (NB high score indicates increased disability) |
| Day hospital vs Domiciliary care | |
| Burch 1999 | No significant difference in Barthel index ‐ |
| Gladman 1993 | No significant difference in median Barthel index ‐ |
| Parker 2009 | No significant difference in mean (SD) Nottingham Extended Activities of Daily Living Scale Day hospital: 31.6 (15.4) Control: 28.1 (17.5) |
| Roderick 2001 | Significant improvement in Barthel score in both groups. |
| Vetter 1989 | No significant difference in mean Barthel index ‐ |
| Young 1992 | Significantly (P=0.01) lower Barthel ADL score ‐ |
| Day hospital vs No comprehensive elderly care | |
| Hui 1995 | No significant difference in mean Barthel index ‐ |
| Masud 2006 | No significant difference in median (IQR) Barthel index scores No significant difference in median (IQR) Nottingham Extended Activities of Daily Living (NEADL) scores Day hospital: 53 (43‐62) |
| Weissert 1980 | No comparable data |
| Woodford 1962 | No comparable data |
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 6 Activities of daily living (ADL) scores.
| Study | |
| Day hospital vs Comprehensive elderly care | |
| Cummings 1985 | No significant difference in the modified Dupay assessment ‐ |
| Eagle 1991 | No significant difference in the General Health Questionnaire ‐ |
| Hedrick 1993 | No significant difference in the Sickness Impact Profile ‐ |
| Pitkala 1991 | No comparable data |
| Tucker 1984 | There was a statistically significant improvement in mood measured by the Zung index in the Day hospital group compared to the Comprehensive elderly care group at final follow up (P = 0.01) |
| Day hospital vs Domiciliary care | |
| Burch 1999 | No significant difference in the change in the Philidelphia Geriatric Morale scale during follow up ‐ |
| Gladman 1993 | No significant difference in the number of patients with distress (Nottingham Health Profile >30) ‐ |
| Parker 2009 | There was no significant difference in the EuroQol index (difference in means 0.147, P = 0.141) or the EuroQol VAS (difference in means 0. 6.315, P = 0.187) |
| Roderick 2001 | No between groups significant difference for SF‐36 physical or mental health scales. |
| Vetter 1989 | No significant difference in the Sickness Impact Profile |
| Young 1992 | No significant difference in the number of patients with distress (Nottingham Health Profile >30) ‐ |
| Day hospital vs No comprehensive elderly care | |
| Hui 1995 | No significant difference in the Geriatric Depression Scale |
| Weissert 1980 | No comparable data |
| Woodford 1962 | No comparable data |
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 7 Subjective health status.
| Study | |
| Day hospital vs Comprehensive elderly care | |
| Cummings 1985 | No available data |
| Eagle 1991 | No available data |
| Hedrick 1993 | No comparable data |
| Pitkala 1991 | No comparable data |
| Tucker 1984 | No available data |
| Day hospital vs Domiciliary care | |
| Burch 1999 | No available data |
| Gladman 1993 | No available data |
| Roderick 2001 | No available data |
| Vetter 1989 | No available data |
| Young 1992 | No available data |
| Day hospital vs No comprehensive elderly care | |
| Hui 1995 | No significant difference in the level of satisfaction |
| Weissert 1980 | No available data |
| Woodford 1962 | No available data |
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 8 Patient satisfaction.
| Study | |
| Day hospital vs Comprehensive elderly care | |
| Cummings 1985 | No comparable data |
| Eagle 1991 | No available data |
| Hedrick 1993 | No comparable data |
| Pitkala 1991 | No comparable data |
| Tucker 1984 | No data available |
| Day hospital vs Domiciliary care | |
| Burch 1999 | There was a significant difference in the mean change between baseline and 3 months in the Caregiver Strain Index in both groups There was no significant difference between between groups |
| Crotty 2008 | No significant difference at 3 months in the Carer Strain Index |
| Gladman 1993 | No significant difference at 6 months in the median Life Satisfaction Index ‐ |
| Roderick 2001 | No available data |
| Vetter 1989 | No data available |
| Young 1992 | Proportion of carers showing distress (General Health Questionnaire 28 score > 5) ‐ Differences were not significant |
| Day hospital vs No comprehensive elderly care | |
| Hui 1995 | No available data |
| Weissert 1980 | No available data |
| Woodford 1962 | No available data |
Comparison 1 Day Hospital vs Alternative Care ‐ patient outcomes, Outcome 9 Carer Distress.
Comparison 2 Day Hospital vs Alternative Care ‐ resource outcomes, Outcome 1 Requiring institutional care at the end of follow up.
| Study | |
| Day hospital vs Comprehensive elderly care | |
| Cummings 1985 | Day hospital: 206 bed days for 48 patients (4.3 days per patient) |
| Eagle 1991 | Day hospital: 1388 bed days for 55 patients (25.2 days per patient) |
| Hedrick 1993 | Day hospital: 8020 bed days for 411 patients (19.5 days per patient) |
| Pitkala 1991 | Day hospital: 3538 bed days for 88 patients (40.2 days per patient) |
| Tucker 1984 | Day hospital: 472 bed days for 62 patients (7.6 days per patient) |
| Day hospital vs Domiciliary care | |
| Burch 1999 | Day hospital: 923 bed days for 50 patients (18.5 per patient) |
| Gladman 1993 | Day hospital: 436 bed days for 76 patients (5.7 days per patient) |
| Roderick 2001 | Day hospital: 296 bed days for 74 patients ( 4 days per patient) |
| Vetter 1989 | No bed days used in either group |
| Young 1992 | Day hospital: 311 bed days for 61 patients (5.1 days per patient) |
| Day hospital vs No comprehensive elderly care | |
| Hui 1995 | Day hospital: 81 bed days for 59 patients (1.4 days per patient) |
| Masud 2006 | Day hospital: 552 bed days for 172 patients (3.2 days per patient) |
| Weissert 1980 | Day hospital: 3443 bed days for 313 patients (11.0 days per patient) |
| Woodford 1962 | Day hospital: 2534 bed days for 168 patients (15.1 days per patient) |
Comparison 2 Day Hospital vs Alternative Care ‐ resource outcomes, Outcome 2 Hospital bed use during follow up.
| Study | |
| Day hospital vs Comprehensive elderly care | |
| Cummings 1985 | Average treatment cost per patient to 3 months post discharge ‐ |
| Eagle 1991 | No cost data |
| Hedrick 1993 | Mean total costs over 12 months ‐ |
| Pitkala 1991 | No costing data |
| Tucker 1984 | Average cost for 5 months care ‐ |
| Day hospital vs Domiciliary care | |
| Burch 1999 | Total annual cost per attendance ‐ |
| Gladman 1993 | Mean total health service cost per patient ‐ |
| Parker 2009 | (entries) Mean total cost at 213 days: Day hospital (21) £10,102; Home based rehab (25) £14,330 (note SDs not reported) (entries) Mean total cost at 395 days: Day hospital (13) £23,812; Home based rehab (23) £26,105 (note SDs not reported) (entries) Median total cost at 213 days: Day hospital (21) £5958; Home based rehab (25) £7679 (note IQRs not reported) (entries) Median total cost at 395 days: Day hospital (13) £9842; Home based rehab (23) £18,432 (note IQRs not reported) |
| Roderick 2001 | Median costs per patient: Rehabilitation costs: Day hospital:£1090 (IQR 513‐1475), |
| Vetter 1989 | No cost data |
| Young 1992 | Mean total costs for 8 weeks treatment ‐ |
| Day hospital vs No comprehensive elderly care | |
| Hui 1995 | Mean cost of treatment to the health service over 6 months ‐ |
| Masud 2006 | The mean falls programme cost was £349 per person. With additional health‐care costs, this resulted in a mean incremental cost of £578 for the intervention Health service resource use and costs. Total cost per participant mean (SD): Day hospital £2,238 (4957) Control £1,659 (5100) |
| Weissert 1980 | Average cost for 1 year ‐ |
| Woodford 1962 | No formal costing |
Comparison 2 Day Hospital vs Alternative Care ‐ resource outcomes, Outcome 3 Resource use.
| Day hospitals compared to alternative or no care for rehabilitation | ||||||
| Patient or population: patients with rehabilitation needs | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Alternative or no care | Day hospitals | |||||
| Death by the end of follow up | Study population | OR 1.05 | 3533 | ⊕⊕⊝⊝ | ||
| 127 per 1000 | 132 per 1000 | |||||
| Moderate | ||||||
| 66 per 1000 | 69 per 1000 | |||||
| Death or institutional care by the end of follow up | Study population | OR 0.85 | 3030 | ⊕⊕⊝⊝ | ||
| 303 per 1000 | 270 per 1000 | |||||
| Moderate | ||||||
| 221 per 1000 | 194 per 1000 | |||||
| Death or deterioration in activities of daily living (ADL) | Study population | OR 1.07 | 1268 | ⊕⊕⊝⊝ | ||
| 407 per 1000 | 423 per 1000 | |||||
| Moderate | ||||||
| 430 per 1000 | 447 per 1000 | |||||
| Death or poor outcome (institutional care, disability or deterioration) | Study population | OR 0.92 | 2831 | ⊕⊕⊝⊝ | ||
| 365 per 1000 | 346 per 1000 | |||||
| Moderate | ||||||
| 241 per 1000 | 226 per 1000 | |||||
| Deterioration in ADL in survivors | Study population | OR 1.11 | 905 | ⊕⊕⊝⊝ | ||
| 251 per 1000 | 271 per 1000 | |||||
| Moderate | ||||||
| 233 per 1000 | 252 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Limitations for at least one risk of bias criterion, or some limitations for multiple criteria, sufficient to lower confidence in the estimate of effect | ||||||
| Day hospitals compared to no comprehensive care for rehabilitation needs | ||||||
| Patient or population: patients with rehabilitation needs | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| No comprehensive care | Day hospitals | |||||
| Death by the end of follow up | Study population | OR 0.88 | 1345 | ⊕⊕⊝⊝ | ||
| 128 per 1000 | 114 per 1000 | |||||
| Moderate | ||||||
| 131 per 1000 | 117 per 1000 | |||||
| Death or institutional care by the end of follow up | Study population | OR 0.63 | 1177 | ⊕⊕⊝⊝ | ||
| 248 per 1000 | 172 per 1000 | |||||
| Moderate | ||||||
| 307 per 1000 | 218 per 1000 | |||||
| Death or deterioration in ADL | Study population | OR 0.76 | 651 | ⊕⊕⊝⊝ | ||
| 436 per 1000 | 370 per 1000 | |||||
| Moderate | ||||||
| 446 per 1000 | 380 per 1000 | |||||
| Death or poor outcome (institutional care, disability or deterioration) | Study population | OR 0.72 | 982 | ⊕⊕⊝⊝ | ||
| 347 per 1000 | 277 per 1000 | |||||
| Moderate | ||||||
| 400 per 1000 | 324 per 1000 | |||||
| Deterioration in ADL in survivors | Study population | OR 0.61 | 407 | ⊕⊕⊝⊝ | ||
| 277 per 1000 | 189 per 1000 | |||||
| Moderate | ||||||
| 227 per 1000 | 152 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Limitations for at least one risk of bias criterion or some limitations for multiple criteria, sufficient to lower confidence in the estimate of effect | ||||||
| Day hospitals compared to domiciliary care for rehabilitation | ||||||
| Patient or population: patients with rehabilitation needs | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Domiciliary care | Day hospitals | |||||
| Death by the end of follow up | Study population | OR 0.97 | 901 | ⊕⊕⊝⊝ | ||
| 101 per 1000 | 98 per 1000 | |||||
| Moderate | ||||||
| 64 per 1000 | 62 per 1000 | |||||
| Death or institutional care by the end of follow up | Study population | OR 1.05 | 672 | ⊕⊕⊝⊝ | ||
| 187 per 1000 | 194 per 1000 | |||||
| Moderate | ||||||
| 69 per 1000 | 72 per 1000 | |||||
| Death or deterioration in ADL | Study population | OR 1.41 | 443 | ⊕⊕⊝⊝ | ||
| 392 per 1000 | 476 per 1000 | |||||
| Moderate | ||||||
| 334 per 1000 | 414 per 1000 | |||||
| Death or poor outcome (institutional care, disability or deterioration) | Study population | OR 1.08 | 581 | ⊕⊕⊝⊝ | ||
| 297 per 1000 | 313 per 1000 | |||||
| Moderate | ||||||
| 364 per 1000 | 382 per 1000 | |||||
| Deterioration in ADL in survivors | Study population | OR 1.59 | 349 | ⊕⊕⊝⊝ | ||
| 225 per 1000 | 315 per 1000 | |||||
| Moderate | ||||||
| 188 per 1000 | 269 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Limitations for at least one risk of bias criterion or some limitations for multiple criteria, sufficient to lower confidence in the estimate of effect | ||||||
| Day hospitals compared to comprehensive care for older people requiring rehabilitation | ||||||
| Patient or population: older people requiring rehabilitation | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Comprehensive care | Day hospitals | |||||
| Death by the end of follow up | Study population | OR 1.26 | 1287 | ⊕⊕⊝⊝ | ||
| 144 per 1000 | 175 per 1000 | |||||
| Moderate | ||||||
| 69 per 1000 | 85 per 1000 | |||||
| Death or institutional care by the end of follow up | Study population | OR 1 | 1181 | ⊕⊕⊝⊝ | ||
| 426 per 1000 | 426 per 1000 | |||||
| Moderate | ||||||
| 231 per 1000 | 231 per 1000 | |||||
| Death or deterioration in ADL | Study population | OR 1.18 | 174 | ⊕⊕⊝⊝ | ||
| 349 per 1000 | 387 per 1000 | |||||
| Moderate | ||||||
| 349 per 1000 | 387 per 1000 | |||||
| Death or poor outcome (institutional care, disability or deterioration) | Study population | OR 1.05 | 1268 | ⊕⊕⊝⊝ | ||
| 410 per 1000 | 422 per 1000 | |||||
| Moderate | ||||||
| 221 per 1000 | 230 per 1000 | |||||
| Deterioration in ADL in survivors | Study population | OR 1.21 | 149 | ⊕⊕⊝⊝ | ||
| 243 per 1000 | 280 per 1000 | |||||
| Moderate | ||||||
| 243 per 1000 | 280 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Limitations for at least one risk of bias criterion or some limitations for multiple criteria, sufficient to lower confidence in the estimate of effect | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Death by the end of follow up Show forest plot | 16 | 3533 | Odds Ratio (M‐H, Random, 95% CI) | 1.05 [0.85, 1.28] |
| 1.1 Day Hospital vs Comprehensive elderly care | 5 | 1287 | Odds Ratio (M‐H, Random, 95% CI) | 1.26 [0.87, 1.82] |
| 1.2 Day hospital vs Domiciliary care | 7 | 901 | Odds Ratio (M‐H, Random, 95% CI) | 0.97 [0.61, 1.55] |
| 1.3 Day hospital vs No comprehensive elderly care | 4 | 1345 | Odds Ratio (M‐H, Random, 95% CI) | 0.88 [0.63, 1.22] |
| 2 Death or institutional care by the end of follow up Show forest plot | 13 | 3030 | Odds Ratio (M‐H, Random, 95% CI) | 0.85 [0.63, 1.14] |
| 2.1 Day hospital vs Comprehensive elderly care | 4 | 1181 | Odds Ratio (M‐H, Random, 95% CI) | 1.00 [0.69, 1.44] |
| 2.2 Day hospital vs Domiciliary care | 5 | 672 | Odds Ratio (M‐H, Random, 95% CI) | 1.05 [0.57, 1.92] |
| 2.3 Day hospital vs No comprehensive elderly care | 4 | 1177 | Odds Ratio (M‐H, Random, 95% CI) | 0.63 [0.40, 1.00] |
| 3 Death or deterioration in activities of daily living (ADL) Show forest plot | 7 | 1268 | Odds Ratio (M‐H, Random, 95% CI) | 1.07 [0.76, 1.49] |
| 3.1 Day hospital vs Comprehensive elderly care | 1 | 174 | Odds Ratio (M‐H, Random, 95% CI) | 1.18 [0.63, 2.18] |
| 3.2 Day hospital vs Domiciliary care | 4 | 443 | Odds Ratio (M‐H, Random, 95% CI) | 1.41 [0.82, 2.42] |
| 3.3 Day hospital vs No comprehensive elderly care | 2 | 651 | Odds Ratio (M‐H, Random, 95% CI) | 0.76 [0.56, 1.05] |
| 4 Death or poor outcome (institutional care, disability or deterioration) Show forest plot | 13 | 2831 | Odds Ratio (M‐H, Random, 95% CI) | 0.92 [0.74, 1.15] |
| 4.1 Day hospital vs Comprehensive elderly care | 5 | 1268 | Odds Ratio (M‐H, Random, 95% CI) | 1.05 [0.79, 1.40] |
| 4.2 Day hospital vs Domiciliary care | 5 | 581 | Odds Ratio (M‐H, Random, 95% CI) | 1.08 [0.67, 1.74] |
| 4.3 Day hospital vs No comprehensive elderly care | 3 | 982 | Odds Ratio (M‐H, Random, 95% CI) | 0.72 [0.53, 0.99] |
| 5 Deterioration in activities of daily living (ADL) in survivors Show forest plot | 7 | 905 | Odds Ratio (M‐H, Random, 95% CI) | 1.11 [0.68, 1.80] |
| 5.1 Day hospital vs Comprehensive elderly care | 1 | 149 | Odds Ratio (M‐H, Random, 95% CI) | 1.21 [0.58, 2.52] |
| 5.2 Day hospital vs Domiciliary care | 4 | 349 | Odds Ratio (M‐H, Random, 95% CI) | 1.59 [0.87, 2.90] |
| 5.3 Day hospital vs No comprehensive elderly care | 2 | 407 | Odds Ratio (M‐H, Random, 95% CI) | 0.61 [0.38, 0.97] |
| 6 Activities of daily living (ADL) scores Show forest plot | Other data | No numeric data | ||
| 6.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||
| 6.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||
| 6.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||
| 7 Subjective health status Show forest plot | Other data | No numeric data | ||
| 7.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||
| 7.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||
| 7.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||
| 8 Patient satisfaction Show forest plot | Other data | No numeric data | ||
| 8.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||
| 8.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||
| 8.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||
| 9 Carer Distress Show forest plot | Other data | No numeric data | ||
| 9.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||
| 9.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||
| 9.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Requiring institutional care at the end of follow up Show forest plot | 13 | 3003 | Odds Ratio (M‐H, Random, 95% CI) | 0.84 [0.58, 1.21] |
| 1.1 Day hospital vs Comprehensive elderly care | 4 | 1181 | Odds Ratio (M‐H, Random, 95% CI) | 0.91 [0.70, 1.19] |
| 1.2 Day hospital vs Domiciliary care | 5 | 672 | Odds Ratio (M‐H, Random, 95% CI) | 1.49 [0.53, 4.25] |
| 1.3 Day hospital vs No comprehensive elderly care | 4 | 1150 | Odds Ratio (M‐H, Random, 95% CI) | 0.58 [0.28, 1.20] |
| 2 Hospital bed use during follow up Show forest plot | Other data | No numeric data | ||
| 2.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||
| 2.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||
| 2.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||
| 3 Resource use Show forest plot | Other data | No numeric data | ||
| 3.1 Day hospital vs Comprehensive elderly care | Other data | No numeric data | ||
| 3.2 Day hospital vs Domiciliary care | Other data | No numeric data | ||
| 3.3 Day hospital vs No comprehensive elderly care | Other data | No numeric data | ||
