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Cochrane Database of Systematic Reviews

Reabilitação física para idosos institucionalizados

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.

Keywords

MeSH

Medical Subject Headings Check Words

Aged; Aged, 80 and over; Female; Humans; Male;

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.

Review update flow diagram
Figuras y tablas -
Figure 1

Review update flow diagram

'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies

Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.1 Barthel Index.
Figuras y tablas -
Figure 3

Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.1 Barthel Index.

Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.4 TUG test
Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.4 TUG test

Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.5 Walking speed
Figuras y tablas -
Figure 5

Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.5 Walking speed

Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.6 Death
Figuras y tablas -
Figure 6

Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.6 Death

'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study
Figuras y tablas -
Figure 7

'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study

Comparison 1 Rehabilitation versus control, Outcome 1 Barthel Index.
Figuras y tablas -
Analysis 1.1

Comparison 1 Rehabilitation versus control, Outcome 1 Barthel Index.

Comparison 1 Rehabilitation versus control, Outcome 2 Functional Independence Measure (FIM).
Figuras y tablas -
Analysis 1.2

Comparison 1 Rehabilitation versus control, Outcome 2 Functional Independence Measure (FIM).

Comparison 1 Rehabilitation versus control, Outcome 3 Rivermead Mobility Index (RMI).
Figuras y tablas -
Analysis 1.3

Comparison 1 Rehabilitation versus control, Outcome 3 Rivermead Mobility Index (RMI).

Comparison 1 Rehabilitation versus control, Outcome 4 Timed Up and Go (TUG) Test.
Figuras y tablas -
Analysis 1.4

Comparison 1 Rehabilitation versus control, Outcome 4 Timed Up and Go (TUG) Test.

Comparison 1 Rehabilitation versus control, Outcome 5 Walking speed.
Figuras y tablas -
Analysis 1.5

Comparison 1 Rehabilitation versus control, Outcome 5 Walking speed.

Comparison 1 Rehabilitation versus control, Outcome 6 Death.
Figuras y tablas -
Analysis 1.6

Comparison 1 Rehabilitation versus control, Outcome 6 Death.

Comparison 1 Rehabilitation versus control, Outcome 7 Barthel Index (by risk of bias).
Figuras y tablas -
Analysis 1.7

Comparison 1 Rehabilitation versus control, Outcome 7 Barthel Index (by risk of bias).

Comparison 1 Rehabilitation versus control, Outcome 8 Barthel Index (by duration of intervention).
Figuras y tablas -
Analysis 1.8

Comparison 1 Rehabilitation versus control, Outcome 8 Barthel Index (by duration of intervention).

Comparison 1 Rehabilitation versus control, Outcome 9 Barthel Index (by mode of delivery).
Figuras y tablas -
Analysis 1.9

Comparison 1 Rehabilitation versus control, Outcome 9 Barthel Index (by mode of delivery).

Comparison 1 Rehabilitation versus control, Outcome 10 Barthel Index (by baseline Barthel Index score).
Figuras y tablas -
Analysis 1.10

Comparison 1 Rehabilitation versus control, Outcome 10 Barthel Index (by baseline Barthel Index score).

Comparison 1 Rehabilitation versus control, Outcome 11 Barthel Index (by age).
Figuras y tablas -
Analysis 1.11

Comparison 1 Rehabilitation versus control, Outcome 11 Barthel Index (by age).

Comparison 1 Rehabilitation versus control, Outcome 12 Barthel Index (by gender).
Figuras y tablas -
Analysis 1.12

Comparison 1 Rehabilitation versus control, Outcome 12 Barthel Index (by gender).

Comparison 1 Rehabilitation versus control, Outcome 13 Functional Independence Measure (by risk of bias).
Figuras y tablas -
Analysis 1.13

Comparison 1 Rehabilitation versus control, Outcome 13 Functional Independence Measure (by risk of bias).

Comparison 1 Rehabilitation versus control, Outcome 14 Functional Independence Measure (by duration of intervention).
Figuras y tablas -
Analysis 1.14

Comparison 1 Rehabilitation versus control, Outcome 14 Functional Independence Measure (by duration of intervention).

Comparison 1 Rehabilitation versus control, Outcome 15 Functional Independence Measure (by mode of delivery).
Figuras y tablas -
Analysis 1.15

Comparison 1 Rehabilitation versus control, Outcome 15 Functional Independence Measure (by mode of delivery).

Comparison 1 Rehabilitation versus control, Outcome 16 Functional Independence Measure (by baseline FIM score).
Figuras y tablas -
Analysis 1.16

Comparison 1 Rehabilitation versus control, Outcome 16 Functional Independence Measure (by baseline FIM score).

Comparison 1 Rehabilitation versus control, Outcome 17 Functional Independence Measure (by age).
Figuras y tablas -
Analysis 1.17

Comparison 1 Rehabilitation versus control, Outcome 17 Functional Independence Measure (by age).

Comparison 1 Rehabilitation versus control, Outcome 18 Functional Independence Measure (by gender).
Figuras y tablas -
Analysis 1.18

Comparison 1 Rehabilitation versus control, Outcome 18 Functional Independence Measure (by gender).

Comparison 1 Rehabilitation versus control, Outcome 19 Rivermead Mobility Index (by risk of bias).
Figuras y tablas -
Analysis 1.19

Comparison 1 Rehabilitation versus control, Outcome 19 Rivermead Mobility Index (by risk of bias).

Comparison 1 Rehabilitation versus control, Outcome 20 Rivermead Mobility Index (by duration of intervention).
Figuras y tablas -
Analysis 1.20

Comparison 1 Rehabilitation versus control, Outcome 20 Rivermead Mobility Index (by duration of intervention).

Comparison 1 Rehabilitation versus control, Outcome 21 Rivermead Mobility Index (by mode of delivery).
Figuras y tablas -
Analysis 1.21

Comparison 1 Rehabilitation versus control, Outcome 21 Rivermead Mobility Index (by mode of delivery).

Comparison 1 Rehabilitation versus control, Outcome 22 Rivermead Mobility Index (by baseline RMI score).
Figuras y tablas -
Analysis 1.22

Comparison 1 Rehabilitation versus control, Outcome 22 Rivermead Mobility Index (by baseline RMI score).

Comparison 1 Rehabilitation versus control, Outcome 23 Rivermead Mobility Index (by age).
Figuras y tablas -
Analysis 1.23

Comparison 1 Rehabilitation versus control, Outcome 23 Rivermead Mobility Index (by age).

Comparison 1 Rehabilitation versus control, Outcome 24 Rivermead Mobility Index (by gender).
Figuras y tablas -
Analysis 1.24

Comparison 1 Rehabilitation versus control, Outcome 24 Rivermead Mobility Index (by gender).

Comparison 1 Rehabilitation versus control, Outcome 25 TUG Test (by risk of bias).
Figuras y tablas -
Analysis 1.25

Comparison 1 Rehabilitation versus control, Outcome 25 TUG Test (by risk of bias).

Comparison 1 Rehabilitation versus control, Outcome 26 TUG Test (by duration of intervention).
Figuras y tablas -
Analysis 1.26

Comparison 1 Rehabilitation versus control, Outcome 26 TUG Test (by duration of intervention).

Comparison 1 Rehabilitation versus control, Outcome 27 TUG Test (by mode of delivery).
Figuras y tablas -
Analysis 1.27

Comparison 1 Rehabilitation versus control, Outcome 27 TUG Test (by mode of delivery).

Comparison 1 Rehabilitation versus control, Outcome 28 TUG Test (by baseline TUG score).
Figuras y tablas -
Analysis 1.28

Comparison 1 Rehabilitation versus control, Outcome 28 TUG Test (by baseline TUG score).

Comparison 1 Rehabilitation versus control, Outcome 29 TUG Test (by age).
Figuras y tablas -
Analysis 1.29

Comparison 1 Rehabilitation versus control, Outcome 29 TUG Test (by age).

Comparison 1 Rehabilitation versus control, Outcome 30 TUG Test (by gender).
Figuras y tablas -
Analysis 1.30

Comparison 1 Rehabilitation versus control, Outcome 30 TUG Test (by gender).

Comparison 1 Rehabilitation versus control, Outcome 31 Walking speed (by risk of bias).
Figuras y tablas -
Analysis 1.31

Comparison 1 Rehabilitation versus control, Outcome 31 Walking speed (by risk of bias).

Comparison 1 Rehabilitation versus control, Outcome 32 Walking speed (by duration of intervention).
Figuras y tablas -
Analysis 1.32

Comparison 1 Rehabilitation versus control, Outcome 32 Walking speed (by duration of intervention).

Comparison 1 Rehabilitation versus control, Outcome 33 Walking speed (by mode of delivery).
Figuras y tablas -
Analysis 1.33

Comparison 1 Rehabilitation versus control, Outcome 33 Walking speed (by mode of delivery).

Comparison 1 Rehabilitation versus control, Outcome 34 Walking speed (by baseline walking speed).
Figuras y tablas -
Analysis 1.34

Comparison 1 Rehabilitation versus control, Outcome 34 Walking speed (by baseline walking speed).

Comparison 1 Rehabilitation versus control, Outcome 35 Walking speed (by age).
Figuras y tablas -
Analysis 1.35

Comparison 1 Rehabilitation versus control, Outcome 35 Walking speed (by age).

Comparison 1 Rehabilitation versus control, Outcome 36 Walking speed (by gender).
Figuras y tablas -
Analysis 1.36

Comparison 1 Rehabilitation versus control, Outcome 36 Walking speed (by gender).

Comparison 1 Rehabilitation versus control, Outcome 37 Walking speed (by distance walked).
Figuras y tablas -
Analysis 1.37

Comparison 1 Rehabilitation versus control, Outcome 37 Walking speed (by distance walked).

Comparison 1 Rehabilitation versus control, Outcome 38 Death (by risk of bias).
Figuras y tablas -
Analysis 1.38

Comparison 1 Rehabilitation versus control, Outcome 38 Death (by risk of bias).

Comparison 1 Rehabilitation versus control, Outcome 39 Death (by duration of intervention).
Figuras y tablas -
Analysis 1.39

Comparison 1 Rehabilitation versus control, Outcome 39 Death (by duration of intervention).

Comparison 1 Rehabilitation versus control, Outcome 40 Death (by mode of delivery).
Figuras y tablas -
Analysis 1.40

Comparison 1 Rehabilitation versus control, Outcome 40 Death (by mode of delivery).

Comparison 1 Rehabilitation versus control, Outcome 41 Death (by age).
Figuras y tablas -
Analysis 1.41

Comparison 1 Rehabilitation versus control, Outcome 41 Death (by age).

Comparison 1 Rehabilitation versus control, Outcome 42 Death (by gender).
Figuras y tablas -
Analysis 1.42

Comparison 1 Rehabilitation versus control, Outcome 42 Death (by gender).

Comparison 1 Rehabilitation versus control, Outcome 43 Sensitivity analysis: Barthel Index (fixed‐effect).
Figuras y tablas -
Analysis 1.43

Comparison 1 Rehabilitation versus control, Outcome 43 Sensitivity analysis: Barthel Index (fixed‐effect).

Comparison 1 Rehabilitation versus control, Outcome 44 Sensitivity analysis: Barthel Index (cluster trials).
Figuras y tablas -
Analysis 1.44

Comparison 1 Rehabilitation versus control, Outcome 44 Sensitivity analysis: Barthel Index (cluster trials).

Comparison 1 Rehabilitation versus control, Outcome 45 Sensitivity analysis: Functional Independence Measure (fixed‐effect).
Figuras y tablas -
Analysis 1.45

Comparison 1 Rehabilitation versus control, Outcome 45 Sensitivity analysis: Functional Independence Measure (fixed‐effect).

Comparison 1 Rehabilitation versus control, Outcome 46 Sensitivity analysis: Rivermead Mobility Index (fixed‐effect).
Figuras y tablas -
Analysis 1.46

Comparison 1 Rehabilitation versus control, Outcome 46 Sensitivity analysis: Rivermead Mobility Index (fixed‐effect).

Comparison 1 Rehabilitation versus control, Outcome 47 Sensitivity analysis: TUG Test (fixed‐effect).
Figuras y tablas -
Analysis 1.47

Comparison 1 Rehabilitation versus control, Outcome 47 Sensitivity analysis: TUG Test (fixed‐effect).

Comparison 1 Rehabilitation versus control, Outcome 48 Sensitivity anlaysis: TUG Test (cluster trials).
Figuras y tablas -
Analysis 1.48

Comparison 1 Rehabilitation versus control, Outcome 48 Sensitivity anlaysis: TUG Test (cluster trials).

Comparison 1 Rehabilitation versus control, Outcome 49 Sensitivity analysis: TUG Test (re‐including Christofoletti 2008).
Figuras y tablas -
Analysis 1.49

Comparison 1 Rehabilitation versus control, Outcome 49 Sensitivity analysis: TUG Test (re‐including Christofoletti 2008).

Comparison 1 Rehabilitation versus control, Outcome 50 Sensitivity analysis: Walking speed (fixed‐effect).
Figuras y tablas -
Analysis 1.50

Comparison 1 Rehabilitation versus control, Outcome 50 Sensitivity analysis: Walking speed (fixed‐effect).

Comparison 1 Rehabilitation versus control, Outcome 51 Sensitivity analysis: Walking speed (cluster trials).
Figuras y tablas -
Analysis 1.51

Comparison 1 Rehabilitation versus control, Outcome 51 Sensitivity analysis: Walking speed (cluster trials).

Comparison 1 Rehabilitation versus control, Outcome 52 Sensitivity analysis: Death (random‐effects: odds ratio).
Figuras y tablas -
Analysis 1.52

Comparison 1 Rehabilitation versus control, Outcome 52 Sensitivity analysis: Death (random‐effects: odds ratio).

Comparison 1 Rehabilitation versus control, Outcome 53 Sensitivity analysis: Death (random‐effects: risk difference).
Figuras y tablas -
Analysis 1.53

Comparison 1 Rehabilitation versus control, Outcome 53 Sensitivity analysis: Death (random‐effects: risk difference).

Comparison 1 Rehabilitation versus control, Outcome 54 Sensitivity analysis: Death (fixed‐effect).
Figuras y tablas -
Analysis 1.54

Comparison 1 Rehabilitation versus control, Outcome 54 Sensitivity analysis: Death (fixed‐effect).

Comparison 1 Rehabilitation versus control, Outcome 55 Sensitivity analysis: Death (fixed‐effect: Peto odds ratio).
Figuras y tablas -
Analysis 1.55

Comparison 1 Rehabilitation versus control, Outcome 55 Sensitivity analysis: Death (fixed‐effect: Peto odds ratio).

Comparison 1 Rehabilitation versus control, Outcome 56 Sensitivity analysis: Death (cluster trials).
Figuras y tablas -
Analysis 1.56

Comparison 1 Rehabilitation versus control, Outcome 56 Sensitivity analysis: Death (cluster trials).

Comparison 1 Rehabilitation versus control, Outcome 57 Sensitivity analysis: Death (including Brittle 2009).
Figuras y tablas -
Analysis 1.57

Comparison 1 Rehabilitation versus control, Outcome 57 Sensitivity analysis: Death (including Brittle 2009).

Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 1 TUG Test.
Figuras y tablas -
Analysis 2.1

Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 1 TUG Test.

Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 2 Death.
Figuras y tablas -
Analysis 2.2

Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 2 Death.

Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 3 Sensitivity analysis: TUG Test (fixed‐effect).
Figuras y tablas -
Analysis 2.3

Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 3 Sensitivity analysis: TUG Test (fixed‐effect).

Comparison 1. Rehabilitation versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Barthel Index Show forest plot

7

857

Mean Difference (Random, 95% CI)

6.38 [1.63, 11.12]

2 Functional Independence Measure (FIM) Show forest plot

4

303

Mean Difference (Random, 95% CI)

4.98 [‐1.55, 11.51]

3 Rivermead Mobility Index (RMI) Show forest plot

3

323

Mean Difference (Random, 95% CI)

0.69 [0.04, 1.33]

4 Timed Up and Go (TUG) Test Show forest plot

7

885

Mean Difference (Random, 95% CI)

‐4.59 [‐9.19, 0.01]

5 Walking speed Show forest plot

9

590

Mean Difference (Random, 95% CI)

0.03 [‐0.01, 0.07]

6 Death Show forest plot

25

3721

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.80, 1.13]

7 Barthel Index (by risk of bias) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

7.1 lower risk of bias

2

275

Mean Difference (Random, 95% CI)

3.38 [‐2.10, 8.86]

7.2 higher risk of bias

5

582

Mean Difference (Random, 95% CI)

8.25 [1.15, 15.34]

8 Barthel Index (by duration of intervention) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

8.1 shorter (< 3 months intervention)

2

46

Mean Difference (Random, 95% CI)

17.55 [6.97, 28.13]

8.2 longer (3+ months intervention)

5

811

Mean Difference (Random, 95% CI)

3.08 [‐0.03, 6.19]

9 Barthel Index (by mode of delivery) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

9.1 group

4

256

Mean Difference (Random, 95% CI)

10.99 [1.51, 20.48]

9.2 individual

2

275

Mean Difference (Random, 95% CI)

3.38 [‐2.10, 8.86]

9.3 not reported

1

326

Mean Difference (Random, 95% CI)

2.19 [‐4.35, 8.73]

10 Barthel Index (by baseline Barthel Index score) Show forest plot

6

Mean Difference (Random, 95% CI)

Subtotals only

10.1 better (baseline Barthel Index score > median)

3

511

Mean Difference (Random, 95% CI)

7.94 [‐1.77, 17.64]

10.2 worse (baseline Barthel Index score < median)

3

305

Mean Difference (Random, 95% CI)

3.97 [‐0.83, 8.78]

11 Barthel Index (by age) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

11.1 younger (mean age < 85 years)

4

552

Mean Difference (Random, 95% CI)

8.02 [‐0.25, 16.30]

11.2 older (mean age 85+ years)

3

305

Mean Difference (Random, 95% CI)

3.97 [‐0.83, 8.78]

12 Barthel Index (by gender) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

12.1 < 80% female

4

402

Mean Difference (Random, 95% CI)

7.93 [0.18, 15.69]

12.2 80%+ female

3

455

Mean Difference (Random, 95% CI)

4.29 [‐1.25, 9.83]

13 Functional Independence Measure (by risk of bias) Show forest plot

4

Mean Difference (Random, 95% CI)

Subtotals only

13.1 lower risk of bias

0

0

Mean Difference (Random, 95% CI)

0.0 [0.0, 0.0]

13.2 higher risk of bias

4

303

Mean Difference (Random, 95% CI)

4.98 [‐1.55, 11.51]

14 Functional Independence Measure (by duration of intervention) Show forest plot

4

Mean Difference (Random, 95% CI)

Subtotals only

14.1 shorter (< 3 months intervention)

1

30

Mean Difference (Random, 95% CI)

2.0 [‐10.26, 14.26]

14.2 longer (3+ months intervention)

3

273

Mean Difference (Random, 95% CI)

5.85 [‐2.22, 13.93]

15 Functional Independence Measure (by mode of delivery) Show forest plot

4

Mean Difference (Random, 95% CI)

Subtotals only

15.1 group

3

240

Mean Difference (Random, 95% CI)

3.90 [‐3.08, 10.88]

15.2 individual

1

63

Mean Difference (Random, 95% CI)

11.76 [‐2.66, 26.18]

16 Functional Independence Measure (by baseline FIM score) Show forest plot

3

Mean Difference (Random, 95% CI)

Subtotals only

16.1 better (baseline FIM score > median)

2

95

Mean Difference (Random, 95% CI)

7.77 [1.39, 14.14]

16.2 worse (baseline FIM score < median)

1

145

Mean Difference (Random, 95% CI)

0.3 [‐1.73, 2.33]

17 Functional Independence Measure (by age) Show forest plot

4

Mean Difference (Random, 95% CI)

Subtotals only

17.1 younger (mean age < 85 years)

2

128

Mean Difference (Random, 95% CI)

9.91 [4.41, 15.42]

17.2 older (mean age 85+ years)

2

175

Mean Difference (Random, 95% CI)

0.35 [‐1.65, 2.34]

18 Functional Independence Measure (by gender) Show forest plot

4

Mean Difference (Random, 95% CI)

Subtotals only

18.1 < 80% female

2

93

Mean Difference (Random, 95% CI)

6.11 [‐3.33, 15.55]

18.2 80%+ female

2

210

Mean Difference (Random, 95% CI)

4.51 [‐4.56, 13.58]

19 Rivermead Mobility Index (by risk of bias) Show forest plot

3

Mean Difference (Random, 95% CI)

Subtotals only

19.1 lower risk of bias

3

323

Mean Difference (Random, 95% CI)

0.69 [0.04, 1.33]

19.2 higher risk of bias

0

0

Mean Difference (Random, 95% CI)

0.0 [0.0, 0.0]

20 Rivermead Mobility Index (by duration of intervention) Show forest plot

3

Mean Difference (Random, 95% CI)

Subtotals only

20.1 shorter (< 3 months intervention)

1

49

Mean Difference (Random, 95% CI)

0.6 [‐1.48, 2.68]

20.2 longer (3+ months intervention)

2

274

Mean Difference (Random, 95% CI)

0.69 [0.02, 1.37]

21 Rivermead Mobility Index (by mode of delivery) Show forest plot

3

Mean Difference (Random, 95% CI)

Subtotals only

21.1 group

1

49

Mean Difference (Random, 95% CI)

0.6 [‐1.48, 2.68]

21.2 individual

2

274

Mean Difference (Random, 95% CI)

0.69 [0.02, 1.37]

22 Rivermead Mobility Index (by baseline RMI score) Show forest plot

3

Mean Difference (Random, 95% CI)

Subtotals only

22.1 better (baseline RMI score > median)

2

235

Mean Difference (Random, 95% CI)

0.70 [0.01, 1.39]

22.2 worse (baseline RMI score < median)

1

88

Mean Difference (Random, 95% CI)

0.6 [‐1.17, 2.37]

23 Rivermead Mobility Index (by age) Show forest plot

3

Mean Difference (Random, 95% CI)

Subtotals only

23.1 younger (mean age < 85 years)

1

49

Mean Difference (Random, 95% CI)

0.6 [‐1.48, 2.68]

23.2 older (mean age 85+ years)

2

274

Mean Difference (Random, 95% CI)

0.69 [0.02, 1.37]

24 Rivermead Mobility Index (by gender) Show forest plot

3

Mean Difference (Random, 95% CI)

Subtotals only

24.1 < 80% female

2

235

Mean Difference (Random, 95% CI)

0.70 [0.01, 1.39]

24.2 80%+ female

1

88

Mean Difference (Random, 95% CI)

0.6 [‐1.17, 2.37]

25 TUG Test (by risk of bias) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

25.1 lower risk of bias

1

556

Mean Difference (Random, 95% CI)

0.6 [‐5.36, 6.56]

25.2 higher risk of bias

6

329

Mean Difference (Random, 95% CI)

‐5.92 [‐11.29, ‐0.54]

26 TUG Test (by duration of intervention) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

26.1 shorter (< 6 months intervention)

4

185

Mean Difference (Random, 95% CI)

‐7.34 [‐13.93, ‐0.75]

26.2 longer (6+ months intervention)

3

700

Mean Difference (Random, 95% CI)

0.13 [‐4.28, 4.53]

27 TUG Test (by mode of delivery) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

27.1 group

4

154

Mean Difference (Random, 95% CI)

‐4.98 [‐10.74, 0.77]

27.2 individual

3

731

Mean Difference (Random, 95% CI)

‐4.56 [‐14.02, 4.90]

28 TUG Test (by baseline TUG score) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

28.1 better (baseline TUG score < median)

4

185

Mean Difference (Random, 95% CI)

‐7.34 [‐13.93, ‐0.75]

28.2 worse (baseline TUG score > median)

3

700

Mean Difference (Random, 95% CI)

0.13 [‐4.28, 4.53]

29 TUG Test (by age) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

29.1 younger (mean age < 85 years)

5

741

Mean Difference (Random, 95% CI)

‐5.39 [‐10.77, ‐0.00]

29.2 older (mean age 85+ years)

2

144

Mean Difference (Random, 95% CI)

‐5.40 [‐25.75, 14.96]

30 TUG Test (by gender) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

30.1 < 80% female

3

594

Mean Difference (Random, 95% CI)

0.17 [‐3.90, 4.24]

30.2 80%+ female

4

291

Mean Difference (Random, 95% CI)

‐7.55 [‐14.28, ‐0.82]

31 Walking speed (by risk of bias) Show forest plot

9

Mean Difference (Random, 95% CI)

Subtotals only

31.1 lower risk of bias

1

75

Mean Difference (Random, 95% CI)

‐0.10 [‐0.21, 0.01]

31.2 higher risk of bias

8

515

Mean Difference (Random, 95% CI)

0.04 [0.01, 0.07]

32 Walking speed (by duration of intervention) Show forest plot

9

Mean Difference (Random, 95% CI)

Subtotals only

32.1 shorter (< 3 months intervention)

3

59

Mean Difference (Random, 95% CI)

0.24 [‐0.74, 1.22]

32.2 longer (3+ months intervention)

6

531

Mean Difference (Random, 95% CI)

0.02 [‐0.03, 0.08]

33 Walking speed (by mode of delivery) Show forest plot

9

Mean Difference (Random, 95% CI)

Subtotals only

33.1 group

7

475

Mean Difference (Random, 95% CI)

0.03 [‐0.02, 0.07]

33.2 individual

1

48

Mean Difference (Random, 95% CI)

0.26 [‐0.32, 0.83]

33.3 not reported

1

67

Mean Difference (Random, 95% CI)

‐0.03 [‐0.19, 0.13]

34 Walking speed (by baseline walking speed) Show forest plot

9

Mean Difference (Random, 95% CI)

Subtotals only

34.1 better (baseline walking speed > median)

5

198

Mean Difference (Random, 95% CI)

‐0.00 [‐0.15, 0.14]

34.2 worse (baseline walking speed < median)

4

392

Mean Difference (Random, 95% CI)

0.04 [0.01, 0.07]

35 Walking speed (by age) Show forest plot

9

Mean Difference (Random, 95% CI)

Subtotals only

35.1 younger (mean age < 85 years)

9

590

Mean Difference (Random, 95% CI)

0.03 [‐0.01, 0.07]

35.2 older (mean age 85+ years)

0

0

Mean Difference (Random, 95% CI)

0.0 [0.0, 0.0]

36 Walking speed (by gender) Show forest plot

9

Mean Difference (Random, 95% CI)

Subtotals only

36.1 < 80% female

5

437

Mean Difference (Random, 95% CI)

0.01 [‐0.04, 0.07]

36.2 80%+ female

4

153

Mean Difference (Random, 95% CI)

0.13 [‐0.02, 0.28]

37 Walking speed (by distance walked) Show forest plot

9

Mean Difference (Random, 95% CI)

Subtotals only

37.1 less far (< 6 metres)

2

185

Mean Difference (Random, 95% CI)

0.04 [0.01, 0.07]

37.2 further (6+ metres)

7

405

Mean Difference (Random, 95% CI)

0.01 [‐0.06, 0.09]

38 Death (by risk of bias) Show forest plot

25

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

38.1 lower risk of bias

6

1366

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.76, 1.46]

38.2 higher risk of bias

19

2355

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.71, 1.10]

39 Death (by duration of intervention) Show forest plot

25

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

39.1 shorter intervention (< 3 months)

10

663

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.18, 2.29]

39.2 longer intervention (3+ months)

15

3058

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.80, 1.14]

40 Death (by mode of delivery) Show forest plot

25

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

40.1 group

12

1007

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.46, 1.49]

40.2 individual

9

2172

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.70, 1.19]

40.3 group and individual

1

24

Risk Ratio (M‐H, Random, 95% CI)

5.0 [0.27, 94.34]

40.4 not reported

3

518

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.73, 1.36]

41 Death (by age) Show forest plot

25

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

41.1 younger (mean age < 85 years)

16

3001

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.81, 1.17]

41.2 older (mean age 85+ years)

9

720

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.49, 1.27]

42 Death (by gender) Show forest plot

25

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

42.1 < 80% female

12

2366

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.77, 1.25]

42.2 80%+ female

12

1340

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.71, 1.18]

42.3 not reported

1

15

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.16, 4.68]

43 Sensitivity analysis: Barthel Index (fixed‐effect) Show forest plot

7

857

Mean Difference (Fixed, 95% CI)

4.54 [1.59, 7.49]

44 Sensitivity analysis: Barthel Index (cluster trials) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

44.1 cluster (adjusted)

5

811

Mean Difference (Random, 95% CI)

3.08 [‐0.03, 6.19]

44.2 individual

2

46

Mean Difference (Random, 95% CI)

17.55 [6.97, 28.13]

45 Sensitivity analysis: Functional Independence Measure (fixed‐effect) Show forest plot

4

303

Mean Difference (Fixed, 95% CI)

1.46 [‐0.42, 3.34]

46 Sensitivity analysis: Rivermead Mobility Index (fixed‐effect) Show forest plot

3

323

Mean Difference (Fixed, 95% CI)

0.69 [0.04, 1.33]

47 Sensitivity analysis: TUG Test (fixed‐effect) Show forest plot

7

885

Mean Difference (Fixed, 95% CI)

‐3.66 [‐5.86, ‐1.45]

48 Sensitivity anlaysis: TUG Test (cluster trials) Show forest plot

7

Mean Difference (Random, 95% CI)

Subtotals only

48.1 cluster (adjusted)

2

Mean Difference (Random, 95% CI)

0.51 [‐3.93, 4.95]

48.2 individual

5

Mean Difference (Random, 95% CI)

‐7.85 [‐14.34, ‐1.37]

49 Sensitivity analysis: TUG Test (re‐including Christofoletti 2008) Show forest plot

8

914

Mean Difference (Random, 95% CI)

‐8.41 [‐15.53, ‐1.29]

50 Sensitivity analysis: Walking speed (fixed‐effect) Show forest plot

9

590

Mean Difference (Fixed, 95% CI)

0.03 [0.00, 0.06]

51 Sensitivity analysis: Walking speed (cluster trials) Show forest plot

9

Mean Difference (Random, 95% CI)

Subtotals only

51.1 cluster (unadjusted)

1

Mean Difference (Random, 95% CI)

0.04 [0.01, 0.07]

51.2 individual

8

Mean Difference (Random, 95% CI)

0.01 [‐0.05, 0.08]

52 Sensitivity analysis: Death (random‐effects: odds ratio) Show forest plot

25

3721

Odds Ratio (M‐H, Random, 95% CI)

0.93 [0.75, 1.15]

53 Sensitivity analysis: Death (random‐effects: risk difference) Show forest plot

25

3721

Risk Difference (M‐H, Random, 95% CI)

‐0.01 [‐0.02, 0.01]

54 Sensitivity analysis: Death (fixed‐effect) Show forest plot

25

3721

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.80, 1.13]

55 Sensitivity analysis: Death (fixed‐effect: Peto odds ratio) Show forest plot

25

3721

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.93 [0.75, 1.14]

56 Sensitivity analysis: Death (cluster trials) Show forest plot

25

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

56.1 cluster (unadjusted)

13

2644

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.79, 1.15]

56.2 individual

12

1077

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.60, 1.44]

57 Sensitivity analysis: Death (including Brittle 2009) Show forest plot

26

3777

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.79, 1.11]

Figuras y tablas -
Comparison 1. Rehabilitation versus control
Comparison 2. Rehabilitation (experimental) versus rehabilitation (control)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 TUG Test Show forest plot

2

57

Mean Difference (Random, 95% CI)

‐7.95 [‐19.22, 3.31]

2 Death Show forest plot

4

118

Risk Ratio (M‐H, Random, 95% CI)

2.67 [0.12, 60.93]

3 Sensitivity analysis: TUG Test (fixed‐effect) Show forest plot

2

57

Mean Difference (Fixed, 95% CI)

‐7.19 [‐10.92, ‐3.46]

Figuras y tablas -
Comparison 2. Rehabilitation (experimental) versus rehabilitation (control)