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Pemulihan fizikal untuk golongan warga tua dalam penjagaan jangka panjang

Información

DOI:
https://doi.org/10.1002/14651858.CD004294.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 28 febrero 2013see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Accidentes cerebrovasculares

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Tom Crocker

    Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK

  • Anne Forster

    Correspondencia a: Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK

    [email protected]

    Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Bradford, UK

  • John Young

    Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK

    Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Bradford, UK

  • Lesley Brown

    Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK

  • Seline Ozer

    Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK

  • Jane Smith

    Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK

  • John Green

    Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK

  • Jo Hardy

    Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK

  • Eileen Burns

    Department of Elderly Care, Leeds Teaching Hospitals NHS Trust, Leeds, UK

  • Elizabeth Glidewell

    Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK

  • Darren C Greenwood

    Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK

Contributions of authors

Anne Forster conceived and designed the review and wrote the funding application, with the assistance of John Young, Jane Smith, and John Green. Jo Hardy and Anne Forster took a lead role in writing the protocol, with advice from John Young, Jane Smith, and John Green. Anne Forster co‐ordinated the review, with assistance from Jo Hardy and Tom Crocker. Jo Hardy and Anne Forster developed the search strategy and organised the retrieval of papers. Anne Forster, Jo Hardy, and Tom Crocker screened search results. Jo Hardy, Tom Crocker, Lesley Brown, and Seline Ozer wrote to authors of papers for additional information. All co‐authors assisted in the identification of papers for inclusion into the review, appraised quality of papers, assisted in the design of the data extraction protocol, and extracted data from papers. For this updated review, Tom Crocker developed the database and managed the data. Lesley Brown, Tom Crocker, and Seline Ozer combined the independent data extractions. Darren Greenwood led and conducted the meta‐analyses, which were reproduced in Review Manager by Tom Crocker. Tom Crocker assimilated the information and led the writing of this update, with support from Anne Forster.

Sources of support

Internal sources

  • NHS R&D Levy Funding, UK.

External sources

  • Physiotherapy Research Foundation, UK.

Declarations of interest

John Young was a co‐applicant for a research grant from BUPA to investigate delirium prevention in care homes. Anne Forster, John Young, and Ruth Lambley were developing a research project to investigate exercise programmes in care homes. This work started after the results of the original Cochrane review had been submitted.

Anne Forster and John Young have conducted a NIHR (National Institute for Health Research) development programme to investigate activity in care homes (barriers, enablers, and its measurement). They are applying for a NIHR programme grant to develop and test the feasibility of an intervention to increase activity in care homes.

Darren Greenwood has received grant funding for statistical analysis from Bradford Teaching Hospitals NHS Foundation Trust, and he has received funding from the Department of Health for a systematic review of diet and stroke.

Acknowledgements

The review authors would like to thank the Physiotherapy Research Foundation for providing the funding for this review. Particular thanks must go to Ruth Lambley who, as an author on the original review, screened search results, managed and assimilated data, and assisted with the co‐ordination of the review and its writing. Thanks to authors of the papers involved in these studies for their prompt responses to queries. Thanks to Brenda Thomas and Hazel Fraser from the Cochrane Stroke Group, Michelle Fiander from EPOC, and Rob de Bie from the Rehabilitation and Related Therapies Field. Thanks to Deirdre Andre, Pat Spoor, and Rosemary Campbell‐Blair, University of Leeds, for assistance with developing the search strategy and undertaking searches. Thanks to Gillian Procter and Sarah Smith for assistance with screening search results, Will Green for assistance with data extraction, Ian Sleigh for assistance with database development, and Chung Fu for retrieving articles for the review.

Version history

Published

Title

Stage

Authors

Version

2013 Feb 28

Physical rehabilitation for older people in long‐term care

Review

Tom Crocker, Anne Forster, John Young, Lesley Brown, Seline Ozer, Jane Smith, John Green, Jo Hardy, Eileen Burns, Elizabeth Glidewell, Darren C Greenwood

https://doi.org/10.1002/14651858.CD004294.pub3

2009 Jan 21

Rehabilitation for older people in long‐term care

Review

Anne Forster, Ruth Lambley, Jo Hardy, John Young, Jane Smith, John Green, Eileen Burns

https://doi.org/10.1002/14651858.CD004294.pub2

2003 Jul 21

Rehabilitation for older people in long term care

Protocol

Anne Forster, Jo Bailey, Jane Smith, John Young, John Green, Eileen Burns

https://doi.org/10.1002/14651858.CD004294

Differences between protocol and review

Title

The title has been amended to clarify that the review focuses on the physical aspects of rehabilitation.

Study criteria

The original intention was to limit inclusion to studies that undertook follow up at a minimum of one month. However, because of a lack of such studies, this criterion was not applied.

Outcome measures

We clarified our meaning of function in activities of daily living to include specific measures of performance in physical ADL function, e.g. mobility.

We specified economic outcomes and additional adverse outcomes.

The original intention was to assess outcomes at the scheduled end of each trial (after follow up). However, as many studies lacked follow up, we assessed outcomes at the end of the intervention for consistency. In the narrative synthesis, we also reported follow‐up data.

We had planned, in the face of varied assessment tools, to dichotomise outcomes into deteriorated versus maintained or improved prior to meta‐analysis. For the same purpose, we specified a global poor outcome (death or deterioration). However, we have not included such varied measures in meta‐analysis because we lack the individual level data required to do this.

Search methods for identification of studies

We originally planned to search SIGLE (System for Information on Grey Literature in Europe), but we did not do so because it is no longer accessible. Furthermore, we planned to handsearch relevant journals, but because of their inclusion in electronic databases and the extensive results returned through electronic searches, we considered this unnecessary. In addition to the planned searches, we searched Google Scholar.

Data collection and analysis

We replaced the assessment of methodological quality described in the protocol and undertaken in the original review with The Cochrane Collaboration’s new 'Risk of bias' assessment tool (Higgins 2011). We reassessed all studies in the original review in line with these criteria. We performed data collection on a standardised electronic database, rather than a paper form. We clarified our approach to analysing data from cluster trials. We originally intended to combine results in a fixed‐effect meta‐analysis where sufficient homogeneity existed. However, because of the extensive heterogeneity in interventions (contents, intensity, and duration), we used a random‐effects meta‐analysis as our primary approach, but we still report the results of fixed‐effect models as sensitivity analyses. We did not perform all the subgroup analyses originally proposed in the protocol because there are too few pathology‐specific interventions for any one pathology, and studies often include both nursing and residential care homes. However, both of these groupings were partly intended to split participants by functional ability. Therefore, we instead grouped studies by baseline function in the measure being analysed. In addition to the subgroups suggested in the protocol, we added gender, duration of intervention, and risk of bias. We specified all of these subgroups before analysis commenced and presented and reported all of them for each measure.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.