Study characteristics

Methods

Design: RCT

Baseline time point (T1): first 48 hours of admission

Outcome time point (T2): day of discharge from hospital

Participants

Inclusion criteria: aged ≥ 65 years; admitted for an acute medical illness or exacerbation of a previous chronic condition; either participant or legal representative provided informed consent

Exclusion criteria: none

Exercise arm

• n at baseline: 198

• Age mean: 83.3 (SD 6.5) years

• Women (n (%)): 112 (56.6)

• Barthel Index (0–100) on admission: 27.4 (23.4)

• Confusion on admission – CAM (n (%)): 70 (35.3)

Control arm

• n at baseline: 202

• Age mean: 83.7 (SD 6.1) years

• Women (n (%)): 115 (56.9)

• Barthel Index (0–100) on admission: 31.8 (25.6)

• Confusion on admission – CAM (n (%)): 48 (24)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): OT intervention + usual care.

• TIDieR item 2: (why: describe any rationale, theory, or goal of the elements essential to the intervention): OT intervention could improve functional outcomes on an acute geriatric unit.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): see item 4.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): day 1: OT assessment including instruction of the primary carer in patient mobilisation techniques. Day 2 until discharge: delivery of therapeutic plan (tailored to individual) may include: cognitive stimulation; instructions to family re. prevention of hospital‐associated complications; retraining in ADLs (including mobility practice). Day of discharge: as day 2 to discharge with additional 30‐minute session including: instructions to relatives/carers; assessment of technical aids; recommendations for patient maintenance/increased independence.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): occupational therapist, trained by specialist geriatric therapist and by unit geriatricians.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): individually and face‐to‐face with participant and relative or carer.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): acute geriatric unit.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): approximately 1 hour to formulate therapeutic plan on day 1. From day 2 until discharge, 45 minutes sessions; day of discharge 30 minutes. Mean of 5 sessions per inpatient stay. Included 10 minutes of cognitive therapy; 30 minutes retraining of ADL and approximately 5 minutes family/carer education.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): personalised according to need based on assessment day 1.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): all participants received the treatment to which they were allocated. Mean number of OT sessions: 5.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: during hospitalisation, all participants received medical treatment, nursing care, PT, and social assistance in accordance with the usual practice of the unit. Participants were treated as per usual by a geriatrician who prescribed and adjusted the pharmacological and non‐pharmacological treatment daily from admission to discharge. Physiotherapy was indicated as per usual, when the geriatrician considered appropriate, to participants in both trial arms. No other physical or cognitive therapy was administered to usual care participants.

• TIDieR item 5: geriatrician‐led usual care; PT as appropriate.

• TIDieR item 6: not specified.

• TIDieR item 7: acute geriatric unit.

• TIDieR item 8: not specified.

• TIDieR item 9: as item 4.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: all participants received the treatment to which they were allocated.

Outcomes

Barthel Index (score of 0–100) at T2

Incidence of delirium during hospitalisation

Falls during hospitalisation

Mortality during hospitalisation

Musculoskeletal injuries during hospitalisation

Length of hospital stay

Notes

Participants randomised to intervention group were admitted for stroke more often than the control group (19.7% with intervention vs 7.9% with control; P < 0.01) and presented greater ambulation‐dependence on admission (57.9% with intervention vs 41.8% with control; P < 0.01).

Study characteristics

Methods

Design: RCT

Baseline time point (T1): admission to hospital

Outcome time point (T2): discharge from hospital

Follow‐up time point (T3): 3 months after discharge

Participants

Inclusion criteria: aged > 70 years; acutely admitted to University Hospital of Umeå for medical ailments

Exclusion criteria: required treatment in specialised units, such as the intensive care unit, coronary care unit or acute stroke unit; or required treatment in 1 of the designated subspecialities such as in a renal care unit

Exercise arm

• n at baseline: 190

• Age mean: 80.9 (95% CI 80.1 to 81.9) years

• Women (n (%)): 111 (58)

• Barthel Index (0–20) on admission: 0–14 points: 16%; 15–19 points: 32%; 20 points: 52%

• Confusion on admission – CAM (n (%)): 86 (47)

Control arm

• n at baseline: 223

• Age mean: 81.0 (95% CI 80.3 to 81.8) years

• Women (n (%)): 140 (63)

• Barthel Index (0–20) on admission: 0–14 points: 15%; 15–19 points: 41%; 20 points: 44%

• Confusion on admission – CAM (n (%)): 113 (53)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): AGW.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): 1. When compared with participants admitted to general medical wards, global outcome at 3 months after admission is improved in participants acutely admitted to a dedicated geriatric medical unit. 2. Acute care in a dedicated geriatric unit reduces resource consumption without compromising participant outcome at 3 months.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the geriatric approach followed the principles outlined by the Nordic Working Group on geriatric assessment and rehabilitation. Staffing of the ward was designed to optimise the conditions for treatment, nursing, early rehabilitation and planning of care for older, acutely ill patients. Care covered by both internists and geriatricians. MDT included nursing staff, physiotherapists, OTs and dietician (no social workers). Most participants assessed by physiotherapists and OTs. Early rehabilitation, interdisciplinary teamwork and 'intense' discharge planning.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the staff were recruited from geriatric, medical and surgical departments. There was a 1‐week education period for the staff with emphasis on the principles of interdisciplinary and geriatric working forms and on ethical issues. This was followed by a 3‐week run‐in period of the AGW before the beginning of randomisation.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): AGW consisted of 11 beds and shared facilities with a surgical ward.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): not specified.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): not specified.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): fidelity to the intervention not described other than 4 participants refused to participate after first consenting.

Control arm

• TIDieR item 1: medical ward.

• TIDieR item 2: NA.

• TIDieR item 3: NA.

• TIDieR item 4: wards were covered by internists only (no geriatricians). Physiotherapists, OT and dietitian not routinely available. Only occasional assessment by physiotherapists or OT. Dedicated part‐time social worker.

• TIDieR item 5: as item 4.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: 2 medical wards, 30 beds on each ward.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Barthel Index (categorised scores only) at T2 and T3

Mini‐Mental State Examination at T3

Incidence of delirium during hospitalisation

Length of hospital stay

Adverse events (mortality during hospitalisation)

New institutionalisation at discharge from hospital

Readmission to an acute hospital during first 3 months after discharge

Notes

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within first 24 hours of admission

Outcome time point (T2): when deemed clinically stable

Follow‐up time point (T3): 1 month after T2

Participants

Inclusion criteria: aged > 70 years; confined to bed or walking from bed to chair with human help, but independent for locomotion within 3 months; written consent from participants and surrogates

Exclusion criteria: any neuromuscular diseases affecting lower limbs, chronic respiratory impairment, severe heart failure (New York Heart Association class IV), peripheral vascular disease, palliative care, use of drugs known to impair muscle function. Owing to PT availability, admitted patients in a period that was incompatible to PT intervention the following day after admission were excluded. Thus, no more than 5/20 patients admitted from Sunday to Thursday were included per week

Exercise arm

• n at baseline: 38

• Age mean: 85.5 (SD 6.0) years

• Women (n (%)): 25 (65.8)

Control arm

• n at baseline: 38

• Age mean: 85.4 (SD 7.3) years

• Women (n (%)): 30 (78.9)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): Acute Care for Elders programme (early and intense PT rehabilitation).

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): it was hypothesised the exercise programme may improve ADL performance. The intervention focused on leg extension exercises because knee and hip extensors are essential to perform independent activities, such as walking, stair climbing, and rising from a chair.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): for crural triceps: 10 repetitions of dynamic work against the foot of the bed, extended legs to push the body to the top of the bed. If the participant was too weak, exercise was performed against the hand of the physiotherapist. When the participant was able to stand, exercises of plantar flexors and extensors were performed in the upright position. For all the leg: extended leg, hip flexion at 45° in alternate for each leg, each repetition is maintained 3–5 seconds, 10 repetitions with 10‐second rest period between each. For the pelvis: knee flexed at 30°, moving pelvis to the left and to the right, 10 repetitions.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): physiotherapists delivered the intervention, their experience/specific training was not specified.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): acute care geriatric medicine ward and in PT room.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): additional to usual care until participant deemed 'clinically stable'. Started on day 1 or 2 of hospitalisation. 30‐minute sessions. Twice per day, five days per week.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): some modification for crural triceps exercises based on ability (see item 4).

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): exercise was supervised.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): fidelity not reported.

Control arm

• TIDieR item 1: acute care geriatric medicine unit.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: local policy indicated that participants should be transferred to armchair as soon as possible according to their general health status. From day 3 to 6, participants started to walk with human help with or without technical assistance in the PT room for 3 sessions per week until discharge. PT was continued at home for 1 month.

• TIDieR item 5: physiotherapists delivered the intervention, their experience/specific training was not specified.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: acute care geriatric medicine ward and in PT room.

• TIDieR item 8: from day 3 to 6, participants started to walk in the PT room for 3 sessions per week. After discharge PT was continued at home for 1 month.

• TIDieR item 9: as per item 4. Walking practice was with or without technical assistance.

• TIDieR item 10: not specified.

• TIDieR item 11: in‐hospital walking practice supervised.

• TIDieR item 12: not specified.

Outcomes

Katz ADL score (0–12) at T2 and T3

Adverse events (mortality)

Notes

The intervention group had a higher mean BMI approaching significance (P < 0.06) and a higher mean weight approaching significance (P < 0.07).

Study characteristics

Methods

Design: RCT

Baseline time point (T1): admission to hospital

Outcome time point (T2): discharge from hospital

Follow‐up time point (T3): 4 weeks after discharge

Participants

Inclusion criteria: aged ≥ 65 years; with medical reason for admission; not being imminently terminal (death not expected in the next 30 days)

Exclusion criteria: delirium (CAM score > 0); cognitive impairment (Mini‐Cognitive Assessment score < 3); self‐report of not being ambulatory with or without an assistive device in the 2 weeks before admission; significant language barrier that required a translator; being previously enrolled in the study

Exercise arm

• n at baseline: 50

• Age mean: 74.4 (SD 6.9) years

• Women (n (%)): 2 (4)

Control arm

• n at baseline: 50

• Age mean: 73.4 (SD 7.0) years

• Women (n (%)): 1 (2)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): mobility programme.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): mobility programme designed to address the evidence that older adults who experience low mobility during hospitalisation are at substantially increased risk of serious declines in strength and function, which may lead to long‐term mobility disability.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): a rolling walker was provided if needed. Gait belts were used to ensure safe ambulation. A diary was provided to participants to record their physical activity, see item 9.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): protocol for the mobility programme began with assisted sitting, then standing, progressing to weight shifting, stepping in place and ambulation as tolerated with the assistance of the research assistant. Additionally, a behavioural intervention was used to encourage additional physical activity outside supervised intervention.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): all members of the research team who transferred and walked with participants received in‐depth training in safe patient handling techniques by physical therapists. Proficiency and competency were documented using objective standards.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): participants seen individually, face‐to‐face by the research assistant.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): medical ward.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): exercise was supervised up to twice per day for 15–20 minutes, 7 days per week. Although participants were encouraged to walk at each session, they could refuse any or all sessions. The research assistant attempted to make ≥ 3 visits for each scheduled walk. If a participant was away at a test or busy with another healthcare professional, the research assistant returned at a later time to walk with the participant. In addition to the mobility protocol, a behavioural intervention strategy was integrated to encourage participants to increase time spent out of bed.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): the level of out‐of‐bed activity was dependent on the individual participant and incorporated activities participants were deemed able to do independent of cueing or assistance during each walking session. The participant and research assistant set daily goals regarding the amount of time the participant would try to spend out of bed. The participants physical activity diary was used by the research assistants to reinforce positive behaviour and to set goals for the following day. In addition to goal setting, participants were encouraged to discuss any barriers to mobility they were experiencing. Using an interview guide, the research assistant asked about mobility challenges and prompted participants to develop potential solutions to these challenges.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): to assist in self‐monitoring of out‐of‐bed mobility, the participants were provided with a diary that could be used to document each time they sat up or walked.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): the group completed 122 (51.3%) of the potential 238 walks. Reasons for lack of completion included participant refusal 18.9%, participant unavailable because of tests or procedures 16.4%, staff not available 11.3%, and other 2%. Although 45 walks were refused during the study, 28 refusals (62.2%) came from 4 participants. For the behavioural intervention component, which included goal setting and discussion of mobility barriers, the MP group completed 108 (80%) of the 135 visits.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: participants were provided with a diary that looked identical to those provided to the participants in the mobility programme group. The participants in the control arm were asked to document frequency of visitors, both family and healthcare professionals.

• TIDieR item 4: the participants received visits by the research assistant to control for the daily attention that intervention group received. Physicians were able to order PT services.

• TIDieR item 5: not specified.

• TIDieR item 6: participants seen individually, face‐to‐face by the research assistant.

• TIDieR item 7: medical ward.

• TIDieR item 8: the visits from the research assistant were approximately 15–20 minutes long and occurred up to twice per day 7 days per week.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: the group completed 184/223 (82.5%) visits.

Outcomes

Katz ADL score (7–21) at T2 and T3

Incidence of delirium during hospitalisation

Falls during hospitalisation

Mortality during hospitalisation

Medical deterioration during hospitalisation

Length of hospital stay

Notes

Study characteristics

Methods

Design: RCT

Baseline time point (T1): admission to hospital

Outcome time point (T2): discharge from hospital

Follow‐up time point (T3): 1, 3, 6 and 12 months after discharge

Participants

Inclusion criteria: ≥ aged 70 years, community‐dwelling and admitted to a medicine or family practice service

Exclusion criteria: transferred from a nursing facility or another hospital; required speciality unit admission (e.g. intensive care, coronary care, telemetry or oncology); admitted electively; had a length of stay < 2 days; had been previously enrolled in the study

Exercise arm

• n at baseline: 767

• Age mean: 80 (SD 7) years

• Women (n (%)): 462 (60)

• Diagnosis of dementia (n (%)): 120 (16)

Control arm

• n at baseline: 764

• Age mean: 79 (SD 7) years

• Women (n (%)): 464 (61)

• Diagnosis of dementia (n (%)): 137 (18)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): Acute Care for Elders unit.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): researchers hypothesised that Acute Care for Elders intervention will improve functional outcomes and the process of care in hospitalised older patients.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): full description of intervention provided in Landefeld and colleagues, 1995. The intervention included environmental changes with carpeting, handrails, large clocks and calendars, elevated toilet seats and door levers described.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): physical and psychosocial function were assessed by the admitting nurse and daily interdisciplinary team rounds were conducted by the geriatrician medical director and geriatric clinical nurse specialist. Suggestions by the interdisciplinary team were recorded and communicated to the attending physician. Nursing care plans for fall risk assessment, mobility, self‐care, skin integrity, nutrition, continence, confusion, depression and anxiety, which had been modified for the intervention from those used routinely on usual care units, were implemented when appropriate. Medications of potential risk to older patients were identified by the medical director, who recommended alternative treatments, including non‐pharmacological interventions.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): nursing staff did not move between the intervention and usual care units, attending and resident physicians provided care to both groups. No other information regarding training/expertise provided.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): as item 4.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): 34 bed Acute Care for Elders unit. Including a room for PT and a parlour for dining and visiting with family.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): not specified.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as item 4.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): significant differences favouring Acute Care for Elders unit in: adherence to care plans promoting independent function; time to discharge planning first being mentioned; number of referrals to the social workers, and delay to referral; days of ordered bed rest; number of referrals to PT and delay to consult; number of participants with physical constraints and time the constraints were used for; number of participants with prescriptions of high‐risk medication in first 24 hours. No differences in: number of participants who had an order of bed rest; number of participants with urinary catheters and time urinary catheters used for; number of participants with prescriptions of high‐risk medications in day prior to discharge.

Control arm

• TIDieR item 1: usual care units.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: nursing staff‐to‐participant ratios were similar on the intervention and usual care units.

• TIDieR item 5: same nursing ratios.

• TIDieR item 6: not specified.

• TIDieR item 7: usual care units.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Katz ADL score (0–5) at T1 and T2

Physical Performance and Mobility Examination at T2

Mortality during hospitalisation

Length of hospital stay

Readmissions at 1 month after discharge from hospital

New institutionalisation at discharge from hospital

Notes

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within 72 hours of admission

Outcome time point (T2): 4 weeks after discharge from hospital

Follow‐up time point (T3): 12 and 24 weeks after discharge

Participants

Inclusion criteria: aged ≥ 65 years, admitted with a medical diagnosis, with ≥ 1 risk factor for readmission (i.e. aged ≥ 75, multiple hospital admissions in previous 6 months, multiple comorbidities, living alone, lack of social support, poor self‐rating of health, functional impairment, history of depression, or a combination of these)

Exclusion criteria: requiring home oxygen; dependent on a wheelchair or unable to walk independently for 3 m, living in a nursing home; cognitive deficit; progressive neurological disease

Exercise arm

• n at baseline: 64 (58 reported in Courtney and colleagues Journal of the American Geriatrics Society 2009)

• Age mean: 78.1 (SD 6.3) years

• Women (n (%)): 36 (62.1)

Control arm

• n at baseline: 64

• Age mean: 79.4 (SD 7.3) years

• Women (n (%)): 40 (62.5)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): older hospitalised patients' discharge planning and in‐home follow‐up.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): multifaceted transitional care intervention including hospital and home‐based exercise strategies for at‐risk older adults was hypothesised to reduce readmissions and improve functional outcomes of hospitalisation.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): care plan as described in item 4. Written guidelines were provided on postdischarge management, including diagrams and specific instructions for their exercise programme.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): within 72 hours of admission, a nurse and physiotherapist undertook a comprehensive participant assessment and developed a goal‐directed, individualised care plan in consultation with the participant, healthcare professionals, family and carers. The care plan included, an exercise intervention, a nursing intervention and an intervention after discharge. The exercise intervention included stretching, balance training, walking, strengthening (elbow flexors/extensors, hip flexors/extensors/abductors, knee extensors). The nursing intervention involved a nurse visiting the participant daily whilst in hospital to address concerns, facilitate the exercise programme and oversee discharge planning. While the participant remained in hospital, the nurse developed a transitional care plan covering the areas of functional ability and need for assistance with ADL, postdischarge treatments and follow‐up care, social support, chronic disease management plans and information, medication information, community services, and assistance with the exercise programme. The intervention after discharge consisted of a home visit by the nurse within 48 hours of discharge, to assess availability of support, address transitional concerns, provide advice and support and ensure that the exercise programme could be safely undertaken at home. Extra home visits were provided if required. Weekly follow‐up telephone calls were provided for 4 weeks, followed by monthly calls for a further 5 months.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): no specific training for the nurse specified, other than the nurse and physiotherapist combined their visits when planning, explaining and demonstrating the exercise programme to ensure continuity when the nurse continued to facilitate the exercise programme during extended hospital stays and at home.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): the physiotherapist and nurse explained and demonstrated the exercise programme face‐to‐face. The daily visits whist in hospital by the nurse included 'facilitating the exercise programme'. Written guidance was provided for postdischarge management, and as described in item 4, postdischarge the participants received home visit(s) and regular telephone calls.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): in‐hospital interventions were carried out on the medical wards. Postdischarge the intervention was carried out in the participants home.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): intervention commenced within the first 72 hours of admission, and continued daily during the participant's admission. Follow‐up ended with a telephone call at 5 months postdischarge. The daily exercise programme included walking at a slow pace for 3–5 minutes, increasing to a moderate level for 5–10 minutes, followed by a slower pace, initially 2–3 times per week, increasing to 3–4 times per week. The strengthening component of the exercise programme was 2–3 times per week, increasing to 3–4 times per week, progressing from the lowest resistance to higher resistance depending on ability. Contractions were held for 3–5 seconds, repeated 5 times, and building to 2–3 sets of 10 repetitions.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as in item 4 and 8. Care plan, exercise plan and postdischarge management tailored to individual.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): during the telephone follow‐ups feedback was sought on the levels of adherence to the exercise programme and progress with the exercise plan and goals.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): 31 (53%) participants reported following their programme all the time or nearly every day, another 11 (19%) doing their exercises 3–4 days per week and 16 (28%) doing their exercises ≤ 2 days per week or none of the time.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: routine care as would normally be provided.

• TIDieR item 5: not specified.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: medical ward.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Katz ADL score (0–6) at T1 and T3 only

Lawton Instrumental Activities of Daily Living Scale score (0–7) at T1 and T3 only

Walking Impairment Scale at T1 and T3 only

Quality of life at T1 and T3 only

Mortality

Adverse events (undefined composite score)

Length of hospital stay

Readmissions at 6 months after discharge from hospital

Notes

Poor self‐rating of health was higher in the intervention group compared to the control group (65% with intervention vs 47% with control; P = 0.038).

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within 48 hours of admission

Outcome time point (T2): within 48 hours of discharge from hospital

Follow‐up time point (T3): 1 month after discharge from hospital

Participants

Inclusion criteria: aged ≥ 65 years, diagnosed with a general medical condition, admitted to either of the 2 medical wards, and assessed within 48 hours of admission

Exclusion criteria: admitted to hospital from a nursing home, assessed to need nursing home level of care or palliative care; had a stroke or a condition for which mobilisation was contraindicated (e.g. deep vein thrombosis or fracture); too medically unwell to ambulate or exercise; readmitted having previously participated in the study

Exercise arm

• n at baseline: 110

• Age mean: 80 (SD 8) years

• Women (n (%)): 61 (55.5)

• Barthel Index (0–100) on admission (mean): 66 (SD 26)

Control arm

• n at baseline: 126

• Age mean: 78 (SD 7) years

• Women (n (%)): 68 (54)

• Barthel Index (0–100) on admission (mean): 68 (SD 26)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): usual care + additional exercise programme.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): the primary hypothesis was that exercise intervention for hospitalised acute general medical patients would reduce the requirements for inpatient rehabilitation. The secondary hypothesis was that the intervention would improve hospital outcomes and measures of participant activity limitation at hospital discharge.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the additional exercise programme was designed by a physiotherapist and consisted of exercises for the upper limb, lower limb and trunk. It included 4 exercise levels (level 1: bed exercise programme, level 2: sitting exercise programme, level 3: standing exercise programme and level 4: stairs exercise programme). Gravity, bodyweight and light weights were used for resistance whenever possible. A certified allied health assistant supervised each session.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the project physiotherapist had 4 years of clinical experience.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): individual face‐to‐face sessions supervised by an allied health assistant.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): medical ward.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): starting the day of recruitment, the additional exercise was twice daily, 5 days per week. Session duration 20–30 minutes.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): the project physiotherapist prescribed the programme level and individually tailored the exercises to safely challenge each participant in the experimental group. Participants with reduced exercise tolerance exercised more frequently for shorter periods. Exercise resistance was increased when participants could perform 10 repetitions. Participants were also encouraged to increase exercise repetitions and their walking distances as tolerated.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): referrals for usual PT care were received for 94% of the intervention group. Both groups received a median of 3 sessions (IQR 2–5) of usual PT care (P = 0.50). Participants in the intervention group received a median of 90 minutes (IQR 40 to 131) of usual PT care.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: comparison with usual care.

• TIDieR item 3: not specified.

• TIDieR item 4: usual care included daily medical assessment, 24‐hour nursing assistance and allied health service on referral from medical, nursing or other allied health staff.

• TIDieR item 5: 4 teams delivered general medical care and were not ward specific whereas nursing staff were ward specific.

• TIDieR item 6: face‐to‐face provided to individual participants.

• TIDieR item 7: medical ward.

• TIDieR item 8: daily with 24‐hour nursing assistance.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: referrals for usual PT care were received for 96% of the control group. Participants received a median of 80 minutes (IQR 40–145) of usual PT care.

Outcomes

Barthel Index (score of 0–100) at T2

Functional Ambulatory Category at T2

Falls during hospitalisation

Mortality during hospitalisation

Medical deterioration during hospitalisation

Length of hospital stay

Readmissions within the first 28 days after discharge

New institutionalisation at discharge from hospital

Timed Up and Go at T2

Notes

Participants in intervention group were a mean 2 years older.

Study characteristics

Methods

Design: quasi‐RCT

Baseline time point (T1): admission to hospital

Outcome time point (T2): (quote) "intention was to perform the initial physical tests during the latter part of the hospital stay, before discharge."

Follow‐up time point (T3): 3 months after discharge

Participants

Inclusion criteria: aged ≥ 75 years, in need of in‐hospital treatment, and with ≥ 2 of the following FRail Elderly Support researcH group (FRESH) criteria: general fatigue, tiredness from a short walk, dependence in shopping, frequent falls/anticipation of falls, or ≥ 3 more visits to the emergency ward during the last 12 months

Exclusion criteria: person clearly suited for care in a conventional acute medical care unit due to the severity and type of condition: acute stroke, acute myocardial infarction, sepsis, or other acute life‐threatening conditions; patient declined participation in study; informed consent could not be obtained from the patient (and it was not possible to obtain informed consent from a relative); or the patient was a previously defined MÄVA (acute elderly care CGA units) patient

Exercise arm

• n at baseline: 206

• Age mean: 85.7 (SD 5.3) years

• Women (n (%)): 122 (59)

• Diagnosis of dementia (n (%)): 20 (10)

Control arm

• n at baseline: 202

• Age mean: 85.6 (SD 5.4) years

• Women (n (%)): 108 (53%)

• Diagnosis of dementia (n (%)): 27 (13)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): CGA and care units.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): CGA units are believed to be associated with less functional decline at discharge, lower mortality and higher probability of living at home.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): participants were admitted directly to the CGA ward from the ambulance. Participants received interdisciplinary assessment (CGA), early discharge planning, mobility and ADL assessment early in their admission. Participants were provided with appropriate assistive devices, and had ad hoc counselling regarding exercise postdischarge. Daily team conferences to discuss progress occurred.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the CGA unit was staffed by physicians specialising in internal medicine, family medicine or geriatrics (or a combination of these), licenced practising nurses, including specialised admission and discharge nurses, OTs and PTs. Nutritionists available for "counselling only".

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): 2 MÄVA (acute elderly care CGA units) wards with total of 48 beds; 1, 2, or 4‐bedded rooms. Wards already in existence for 4 years prior to study.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): not specified.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): care adjusted to needs of individuals as per CGA and multidisciplinary working.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): not specified.

Control arm

• TIDieR item 1: acute medical care unit.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: participants were admitted via the emergency department and received routine care as per clinical guidelines.

• TIDieR item 5: acute medicinal care units staffed by physicians specialising in internal medicine, and licenced practising nurses. Physiotherapists, OTs and nutritionists available for counselling only.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: wards of internal and emergency medicine; 1, 2, or 4‐bedded rooms.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

ADL staircase (0–9) assessed at T2 and T3

6‐minute walk test assessed at T2 and T3

Timed Up and Go assessed at T2 and T3

Quality of life (EQ‐5D VAS) assessed at T2 and T3

Mortality during hospitalisation

Length of hospital stay

Readmissions in first 3 months following discharge

Notes

Higher proportion of control group (38%) compared to the intervention group (29%) were from home living without help. Intervention group had a higher mean Charlson Co‐morbidity Index score than the control group (7.4 with intervention vs 6.2 with control).

Study characteristics

Methods

Design: RCT

Baseline time point (T1): first 24 hours of admission to hospital

Outcome time point (T2): discharge from hospital

Follow‐up time point (T3): 6 weeks, 3 and 6 months after randomisation

Participants

Inclusion criteria: aged ≥ 75 years, not on protocol treatment or require admission to coronary or intensive care; if their physician provided consent

Exclusion criteria: none

Exercise arm

• n at baseline: 221

• Age mean: 83.5 (SD 5.3) years

• Women (n (%)): 158 (71.5)

Control arm

• n at baseline: 215

• Age mean: 83.0 (SD 5.7) years

• Women (n (%)): 154 (71.6)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): senior care unit.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): it was hypothesised that if assessment was initiated early in a participant's stay, utilised existing personnel and was integrated into everyday practice of hospital staff, an interdisciplinary geriatric assessment process could prevent the decline of the older participants' physical, mental and emotional functions without increasing length of stay or hospital charges. Mortality expected to be similar for the 2 groups.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): a functional assessment was performed by nurses within their routine admission evaluations of older patients. A geriatric assessment team evaluated the participants. 3 clinic‐team meetings and 1 administrative team meeting per week occurred. Individualised care plans were developed, consultation care plans were placed in each participant's chart. Before participant discharge, an updated care plan documenting the problems that remained unresolved at discharge was prepared. The nurse co‐ordinator provided telephone follow‐up weekly for 1 month, and once at 2 months postdischarge. Participants who remained unstable at 1 month received weekly calls for up to 1 more month.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the geriatric assessment team included a physician specialising in geriatric medicine, the nurse co‐ordinator, a physiotherapist, a clinical pharmacist, a dietitian and a social worker. Experienced nurses undertook 4‐month rotations as co‐ordinators of the geriatric assessment team.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): participants were treated face‐to‐face by all members of the team except the geriatrician. See item 4 for description of telephone follow‐up reviews.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): 18‐bed medical ward.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): not specified.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): individual care plans created.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): house staff present 20% of the time. 84% of participants discussed at initial meeting and 91% at discharge meeting. Compliance for implementing recommendations from MDT meetings 0.65 (mean number generated per participant: 9.53 (SD 5.3), number implemented: 6.1 (SD 4.7)).

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: not specified.

• TIDieR item 5: not specified.

• TIDieR item 6: not specified.

• TIDieR item 7: traditional medical or surgical wards of the hospital.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Katz ADL (score of 0–5) at T3 only

Modified Mini‐Mental State Examination at T3 only

Mortality during hospitalisation

Length of hospital stay

New institutionalisation at discharge from hospital

Notes

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within 24 hours of hospital admission

Outcome time point (T2): hospital discharge

Follow‐up time point (T3): 1 and 3 months posthospital discharge

Participants

Inclusion criteria: all participants consecutively admitted to the geriatric unit between October 2018 and January 2020, if they were aged ≥ 65 years and if they were potentially able to walk, as assessed through geriatrician's clinical judgement based on participant's current and preadmission status

Exclusion criteria: independent walking ability at admission; diagnosis of femoral fractures or stroke (due to the presence of specific rehabilitation pathways for these patients), coma and severe dementia; unable to provide informed consent or refused to participate in the study

Exercise arm

• n at baseline: 193

• Age mean: 86.39 (SD 7.11) years

• Barthel Index (0–100) on admission: 64.92 (SD 16.62)

Control arm

• n at baseline: 194

• Age mean: 86.19 (SD 9.15) years

• Barthel Index (0–100) on admission: 61.84 (SD 16.06)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): individualised assisted walking programme.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): a number of cohort and randomised clinical trials have found the potential beneficial effects of hospital mobility in preventing loss of mobility associated with hospitalisation. The study aimed to see if a nurse‐led mobility programme is also beneficial.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): walking aids were provided if appropriate.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the intervention was described including: moving from the supine to sitting position with their legs hanging over the side of the bed, from sitting to standing and an active phase of walking with assistance. The nurse delivering the intervention also provided education to participants and carers to consider walking as a normal activity, and provided motivation and encouragement.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the intervention was delivered by an ad hoc registered nurse with specific training on assisted walking and experience in clinical research conducted each participant's session. Each day they met with the geriatrician in charge to discuss the suitability of each participant.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): individual and conducted face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): 32‐bed geriatric unit of the University Hospital of Bologna.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): intervention was offered from the first day after admission and continued until the day before discharge. Intervention consisted of daily sessions of 20–30 minutes' duration, for 5 consecutive days (excluding weekends).

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): a daily briefing session was held between the trained nurse and the geriatrician in charge before starting the intervention to assess the feasibility for each participant. Another important role of the trained nurse was to educate participants and reference carers to consider walking as a normal activity, and to provide motivation and encouragement.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): adherence to the intervention was defined as execution of postural changes and assisted walking for at least half of the inpatient days, except for weekend and days of admission and of discharge. This was assessed and recorded on a daily basis. The treatment was considered complete if a minimum of 2 days of individualised assisted walking programme was conducted.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): the mean number of intervention days for each participant was 5.84 (SD 4.17) days. Mobilisation or walking sessions occurred on the geriatric ward for a mean time of 32.10 (SD 10.25) minutes (range 10–67 minutes) with a mean distance of 89.19 (SD 70.26) m (range 0–260 m).

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: during the mornings of weekdays, participants were encouraged and helped by nursing staff to get out of bed as early as possible and to sit on wheelchair or at a table. Participants were also accompanied to the bathroom for hygienic care, based on their functional capacity.

• TIDieR item 5: nursing staff delivered mobility and rehabilitation interventions. No PT or OT were provided for either the intervention or control group participants.

• TIDieR item 6: not specified.

• TIDieR item 7: 32‐bed geriatric unit of the University Hospital of Bologna.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Barthel Index at T2

Mobility Barden Activity Subscale at T2

Falls during hospitalisation

Mortality during hospitalisation

Length of hospital stay

Hospital readmissions at T3

Notes

Unpublished data from email correspondence

Barthel Index: the mean scores at discharge (T2) were: 65.20 (SD 24.18) for the intervention group and 56.07 (SD 23.74) for the control group.

Mobility Barden Activity Subscale: the mean scores at discharge (T2) were: 3.43 (SD 0.64) for the intervention group and 2.80 (SD 0.69) for the control group.

Hospital readmissions: at 30‐day follow‐up (T3) 33/174 of intervention group vs 40/165 of control group had been readmitted.

Study characteristics

Methods

Design: RCT (3 arms)

Baseline time point (T1): within 48 hours of hospital admission

Outcome time point (T2): at hospital discharge

Follow‐up time point (T3): 1 and 3 months after hospital discharge

Participants

Inclusion criteria: aged ≥ 65 years, if their hospital admission with a medical diagnosis had been unplanned, and if they had been able to walk independently 2 weeks before admission (participants independently using walking aids were included)

Exclusion criteria: admission due to severe acute illness (immediately requiring intensive care); needing hospice care or surgery; having severe cognitive impairment; admitted for < 72 hours; or being diagnosed with an illness requiring activity restraint

Exercise arm

• n at baseline: 50

• Age mean: 76.00 (SD 7.06) years

• Women (n (%)): 27 (35.1)

'Reminder' arm (not included in meta‐analysis)

• n at baseline: 50

• Age mean: 77.08 (SD 6.57) years

• Women (n (%)): 25 (32.5)

Control arm

• n at baseline: 50

• Age mean: 77.26 (SD 7.20) years

• Women (n (%)): 25 (32.5)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): reablement (exercise programme with supervision or assistance, or both) and usual care.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): the intervention was designed to improve functional outcomes and quality of life. The simplified reablement programme in this study was based on a literature review and the developed programme was validated through expert consensus.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): mini‐pedal bike able to be used in supine and seated position.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the programme was tailored to the participant's ability and consisted predominantly of mobility activities designed to be carried out in a hospital setting. A researcher undertook the supervision and assistance each morning for the participant's assigned reablement intervention. The intervention activities included, sitting and standing balance training, use of a mini‐pedal bike in supine or seated position, ambulation training with or without assistance (assistance from family or walking aids).

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): not specified other than 'the researcher'.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): individually face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): the medical wards of a 1135‐bed tertiary‐care medical centre in southern Taiwan.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): the programme commenced within 48 hours of admission and continued throughout hospitalisation. Intervention duration for a maximum of 30 minutes per day (e.g. if a participant was able to walk independently and be assigned to level 4 (ambulation training), then that participant could choose to walk for 10 minutes 3 times per day or to walk for 30 minutes once per day if he/she could tolerate it).

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): the intervention consisted of 4 levels. Exercises progressed based on the participants functional ability, which was assessed daily.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): not specified.

'Reminder' arm (not included in meta‐analysis)

• TIDieR item 1: reminder group (reminding to complete exercise programme, no supervision or assistance).

• TIDieR item 2: the intervention was designed to minimise functional decline in older people and promote and optimise functional independence.

• TIDieR item 3: mini‐pedal bike able to be used in supine and seated position.

• TIDieR item 4: participants' functional level was assessed daily, and they received verbal encouragement from the researcher to continue their reablement assignments for 30 minutes each day.

• TIDieR item 5: not specified other than 'the researcher'.

• TIDieR item 6: individual, face‐to‐face reminders.

• TIDieR item 7: the medical wards of a 1135‐bed tertiary‐care medical centre in southern Taiwan.

• TIDieR item 8: the programme commenced within 48 hours of admission and continued throughout hospitalisation.

• TIDieR item 9: the intervention consisted of 4 levels. Exercises progressed based on the participants functional ability, which was assessed daily.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: usual care included medical intervention consistent with the participant's diagnosis and resources available on the acute medical wards.

• TIDieR item 5: not specified.

• TIDieR item 6: not specified.

• TIDieR item 7: the medical wards of a 1135‐bed tertiary‐care medical centre in southern Taiwan.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Katz ADL score (7–21)

EQ‐5D VAS at T2

Medical deterioration during hospitalisation

Mortality during hospitalisation

Length of hospital stay

Timed Up and Go at T2

Notes

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within 48 hours of admission

Outcome time point (T2): within 24 hours of discharge from hospital

Participants

Inclusion criteria: aged ≥ 65 years, admitted to a medical unit in the study area and in hospital for < 48 hours at the point of recruitment

Exclusion criteria: severe dysphasia rendering communication impossible; death expected within 24 hours; isolation for infection control; documented contraindication to mobilisation; admission to the stroke unit or to critical care (intensive or coronary care); planned admission of < 48 hours; major psychiatric diagnosis (e.g. schizophrenia); previous inclusion in the study; delirium documented in the admission notes; transfer from another hospital

Exercise arm

• n at baseline: 305

• Age mean: 79.6 (SD 7.5) years

• Women (n (%)): 168 (55)

• Barthel Index (0–100) on admission (mean): 91 (IQR 71–100)

• Confusion on admission – CAM (n (%)): 0 (0)

• Diagnosis of dementia (n (%)): 38 (13)

Control arm

• n at baseline: 343

• Age mean: 79.1 (SD 7.9) years

• Women (n (%)): 172 (50)

• Barthel Index (0–100) on admission (mean): 90 (IQR 71–100)

• Confusion on admission – CAM (n (%)): 0 (0–0)

• Diagnosis of dementia (n (%)): 50 (15)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): graded physical activity, orientation programme and usual care.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): physical activity and orientation intervention was designed to target 2 power risk factors of delirium, immobilisation and cognitive impairment.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): light weights used for some resistance exercises.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): commensurate with ability, participants were prescribed 1 of 4 exercise programmes: bed, seated, standing or rails. Gravity, body or light weights were used as resistance as appropriate. Resistance was increased whenever a participant could perform 10 repetitions at the previous level. The orientation programme comprised formal and informal elements. The formal element of the programme comprised 7 questions aimed at assessing and improving orientation (day, month, year, date, ward, bed number and name of primary nurse). The participant was asked the questions in sequence and prompted with the correct answer if they were unable to give a correct response. The informal element of the programme related to engaging in the exercise programme and in the social interaction with the allied health assistant or physiotherapist (or both).

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): a certified allied health assistant, trained in administering exercise programme, delivered the intervention after initial assessment of the participant by a physiotherapist.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face, hospital ward based.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): medical unit.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): twice per day until discharge, beginning the same day the participant was randomised. Participants received approximately 20–30 minutes of additional therapy per session during weekdays. Suitable participants were encouraged to continue the exercise programme over weekends.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): all programmes were customised to the participant's ability and were reviewed daily in order to ascertain if: the programme could be completed safely; the level of difficulty was appropriate to the participant's ability; there had been improvement or deterioration in the participant's condition necessitating a programme change; and if the allied health assistant was having any problems in delivering the programme. Exercise programmes were modified to ensure suitable progression for those participants who made significant gains.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): the allied health assistant or physiotherapist (or both) recorded adherence. All therapy encounters were recorded and reasons for non‐attendance were detailed. Exercise sheets were reviewed daily to monitor adherence to the programme. The amount (in minutes) of therapy received by participants was recorded. All routine PT and allied health assistant encounters were recorded on a hospital database.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): participants received a median of 1.4 (IQR 0.9–1.8) therapeutic encounters per day. Intervention participants received a median of 38 (IQR 25–52) minutes of therapy daily.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: usual care included 24 hours nursing care, daily medical assessment and allied health referral by medical, nursing or other staff. Allied health input was provided on referral only, but daily ward meetings were held to review participant progress and facilitate referrals. Participants with significant functional, cognitive or social issues could be referred to the Aged Care medical consultation service that performed a daily round and could offer advice regarding the recognition, investigation and management of geriatric syndromes including delirium.

• TIDieR item 5: usual ward‐based health professionals. Referral to allied health input provided but not routine provision.

• TIDieR item 6: face‐to‐face, hospital ward based.

• TIDieR item 7: medical unit.

• TIDieR item 8: as item 4.

• TIDieR item 9: as item 4.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: participants received 0.3 (IQR 0–0.6) therapeutic encounters per day and 8 (IQR 0–17) minutes of therapy per day.

Outcomes

Barthel Index at hospital discharge

Mini‐Mental State Examination at hospital discharge

Incidence of delirium during hospitalisation

Mortality during hospitalisation

Adverse events (composite score only) during hospitalisation

Length of hospital stay

New institutionalisation at hospital discharge

Notes

Unpublished data from email correspondence and author's PhD thesis:

Barthel Index: the median and IQR of scores at discharge (T2) were: 95 (IQR 78 to 100; 305 participants) in the intervention group, and 96 (IQR 77 to 100; 343 participants) in the control group.

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within 48 hours of admission

Outcome time point (T2): within 24 hours of discharge from hospital

Participants

Inclusion criteria: aged ≥ 65 years, general medical admission to the general medical wards; provided informed consent

Exclusion criteria: admitted from a nursing home or who were receiving nursing home level of care at home; medically unstable or where mobilisation was contraindicated by the treating medical team; admitted to the delirium management unit; non‐weight‐bearing; not assessed within 48 hours of admission; assessed as requiring palliative care; admitted to hospital with a diagnosis known to cause functional impairment; or who had an expected length of stay < 24 hours

Exercise arm

• n at baseline: 80

• Age mean: 81.9 (SD 8.0) years

• Women (n (%)): 43 (53.8)

• Barthel Index (0–100) on admission (median): 71 (IQR 51.5–83.0)

• Confusion on admission – CAM (n (%)): 30 (37.5)

Control arm

• n at baseline: 80

• Age mean: 82.9 (SD 7.6) years

• Women (n (%)): 49 (61.3)

• Barthel Index (0–100) on admission (median): 61 (IQR 40.5–82.5)

• Confusion on admission – CAM (n (%)): 37.5 (46)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): exercise intervention + usual care.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): hypothesised that an exercise programme + usual care in the acute setting may improve functional outcomes and reduce health service utilisation.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified other than not requiring expensive or specialist equipment.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): participants randomised to the intervention group were assigned to 1 of 4 levels of an exercise programme depending on their functional status as assessed at baseline. The exercise intervention focused on targeted strength, balance and functional exercises. Level 1: bed exercises including targeted lower, upper limb and abdominal strengthening exercises in supine position and sitting balance exercises. Level 2: sitting exercise programme includes targeted lower limb, upper limb and abdominal strengthening exercises in sitting position, sit to stand exercises, marching on the spot and standing balance exercises. Level 3: standing exercise programme including targeted lower limb, upper limb and abdominal strengthening exercises in standing position, sit to stand exercises, step up exercises, standing balance exercises and ambulation. Level 4: stairs exercise programme includes targeted lower limb, upper limb and abdominal strengthening exercises in standing position, step up exercises and walking up flights of stairs, standing balance exercises and ambulation.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): an allied health assistant supervised/assisted with the exercise programme.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): general medical wards.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): the exercise programme was carried out for approximately 30 minutes, twice daily.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): the exercise programmes were tailored to the individual's ability, consisted predominantly of strengthening and mobility exercises. Assigned to 1 of 4 levels of an exercise programme depending on their functional status as assessed at baseline.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): the amount of time (in minutes) spent by the person participating in the programme was recorded.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): the intervention group received a median of 100 minutes (IQR 37.5–225). In addition, the intervention group spent a median of 160 minutes (IQR 120–360) participating in the exercise intervention.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: medical, nursing and allied health intervention and discharge planning were consistent with the participant's diagnosis and resources available on the acute general medical wards. Usual care PT in an acute medical ward was focused on assessment and planning for discharge.

• TIDieR item 5: not specified.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: general medical wards.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: the control group received a median of 90 minutes (IQR 42.5–232.5) of 'usual care' PT intervention during their acute hospitalisation.

Outcomes

Barthel Index (score 0–100) at T2

Falls during hospitalisation

Medical deterioration during hospitalisation

Mortality during hospitalisation

Length of hospital stay

Timed Up and Go at T2

Notes

The control group had lower proportion of people from their own home compared to the intervention group (88.8% with intervention vs 76.3% with control). Mean modified Barthel Index was higher in the intervention group compared to the control (71 with intervention vs 61 with control).

Study characteristics

Methods

Design: RCT

Baseline time point (T1): hospital admission

Outcome time point (T2): 7 days after T1

Participants

Inclusion criteria: aged ≥ 70 years; admitted to the medical wards; unable to walk by themselves, or displayed inhibition going for a walk by themselves; a provisional diagnoses including heart‐, lung‐ and diabetes‐related morbidities

Exclusion criteria: unable to understand plain English statement and consent form; people with a stroke and undergoing rehabilitation with the physiotherapist; significant dementia precluding the possibility of gathering reliable exercise self‐efficacy data

Exercise arm

• n at baseline: 27

• Age mean: 84.00 (SD 6.19) years

• Barthel Index (0–100) on admission: 59.15

Control arm

• n at baseline: 28

• Age mean: 82.54 (SD 7.45) years

• Barthel Index (0–100) on admission: 58.07

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): supervised or assisted walking.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): due to benefits observed in walking programmes in other settings the authors aimed to test whether similar benefits are observed in functional independence and exercise self‐efficacy in older hospitalised people.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): walking aids as required.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): participants were supervised or assisted by nursing staff to go for a walk twice per day. Participants were provided with a chair to rest midway through their walk.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the nursing staff in the units were encouraged to attend a short education session that covered the intent of the research and the way in which the walking programme was to be implemented. They were instructed that the general intent was to encourage and enable a longer walk on each occasion.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face, individually.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): 3 medical units.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): twice per day, 7 days per week. The distance walked twice per day was the maximum distance able to be comfortably walked as decided by that individual at that time.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): the distance walked twice per day was the maximum distance able to be comfortably walked as decided by that individual at that time. Jirovec's (1991) technique was followed in determining their comfortable limit.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): the supervising staff member was asked to document the walk and the approximate distance.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): not specified other than 2 participants were excluded from analyses as they completed < 70% of their walks.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: the participants received normal levels of nursing care and assistance during their hospitalisation. They were encouraged to be 'normally ambulant'. Many, if not most of the sample had 1 or 2 visits from a physiotherapist.

• TIDieR item 5: not specified.

• TIDieR item 6: not specified.

• TIDieR item 7: 3 medical units.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Barthel Index at T2

Falls during hospitalisation

Mortality during hospitalisation

Maximum distance able to walk at T2

Notes

Excluded participants discharged before day 7 of hospitalisation (9 participants in intervention group vs 7 participants in control group), and those who completed < 70% of the intervention (2 participants).

Study characteristics

Methods

Design: RCT

Baseline time point (T1): admission

Outcome time point (T2): discharge

Follow‐up time point (T3): 3 month after discharge from hospital

Participants

Inclusion criteria: aged ≥ 70 years, admitted for general medical care

Exclusion criteria: people who were admitted to a speciality unit (e.g. intensive care, cardiology–telemetry, or oncology). At the time of admission beds were not available in both the intervention and usual care units

Exercise arm

• n at baseline: 327

• Age mean: 80.2 (SD 6.9) years

• Women (n (%)): 223 (68%)

• Diagnosis of dementia (n (%)): 31 (10)

Control arm

• n at baseline: 324

• Age mean: 80.1 (SD 6.6) years

• Women (n (%)): 212 (65%)

• Diagnosis of dementia (n (%)): 41 (13)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): Acute Care for Elders programme.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): the Acute Care for Elders programme was designed to help people maintain or achieve independence in basic ADL through the combined effects of 4 key elements: a specially designed environment, participant‐centred care, planning for discharge and review of medical care.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): environmental changes with carpeting, handrails, large clocks and calendars, elevated toilet seats and door levers described.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the Acute Care for Elders programme consisted of 4 key elements: a prepared environment (see item 3), participant‐centred care, planning for discharge and medical care review. The participant‐centred care included: daily assessment by nurses of physical, cognitive and psychosocial function; protocols to improve self‐care, continence, nutrition, mobility, sleep, skin care, mood, cognition (implemented by the primary nurse and based on their daily assessment); daily rounds by the MDT led by the medical and nursing directors with the primary nurse, social worker, nutritionist, physiotherapist and visiting‐nurse liaison. Planning for discharge included: early, ongoing emphasis on the goal of returning home; assessment of plans and needs for discharge by a nurse at the time of admission; early involvement of a social worker and home healthcare nurse, if needed. Medical care review included: daily review by the medical director of medicines and planned procedures; protocols to minimise the adverse effects of selected procedures and medications. Extramural grant support provided funds for increases in hours worked in the intervention unit by the medical and nursing directors, social worker, physiotherapist, OT and dietitian (equated to < 1 additional full‐time person per year).

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): as per item 4. Staff who provided services were the same in both groups.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): Acute Care for Elders unit with environment as per item 3.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): as described in item 4. Daily MDT rounds and assessment by nurses of physical cognitive and psychosocial function.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as described in item 4, participant‐centred care based on the daily assessment by the primary nurse. Daily MDT rounds.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): not specified.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: usual care unit, had same hospital‐supported staff‐to‐participant ratios and used the same hospital‐wide support services, including social work, PT and nutritionists.

• TIDieR item 5: staff who provided services were the same in both groups.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: general medical unit.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

ADL (score of 0–5) at T2 and T3

IADL (score of 0–7) at T3

Mini‐Mental State Examination at T2

Mortality during hospitalisation

Length of hospital stay

Readmissions in the first 3 months after discharge

Notes

Participants assigned to the intervention group reported better overall health status at admission (P = 0.04) and were less likely to have a clinical diagnosis of cerebrovascular disease (P = 0.05).

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within 48 hours of admission

Outcome time point (T2): discharge from hospital

Follow‐up time point (T3): 3 months after discharge

Participants

Inclusion criteria: aged ≥ 75 years; Barthel Index ≥ 60; able to ambulate with/without assistance; able to communicate and collaborate with the research team

Exclusion criteria: expected length of stay < 6 days; very severe cognitive decline (i.e. Global Deterioration Scale score 7); terminal illness; uncontrolled arrhythmias; acute pulmonary embolism; recent myocardial infarction; recent major surgery; extremity bone fracture in past 3 months

Exercise arm

• n at baseline: 185

• Age mean: 87.6 (SD 4.6) years

• Women (n (%)): 100 (54.1)

• Barthel Index (0–100) on admission (mean): 84 (SD 17)

• Confusion on admission – CAM (%): 17

Control arm

• n at baseline: 185

• Age mean: 87.1 (SD 5.2) years

• Women (n (%)): 109 (58.9)

• Barthel Index (0–100) on admission (mean): 83 (SD 17)

• Confusion on admission – CAM (%): 12

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): multicomponent exercise.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): exercise training would increase recovery and physical capabilities.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): weight‐training equipment, including 1 leg press machine, 1 bilateral knee extension machine, 1 seated bench press machine, dumbbells, ankle weights and handgrip balls.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): supplementary material includes video of exercises. Exercises were adapted from the multicomponent physical exercise programme Vivifrail to prevent weakness and falls. The morning sessions included individualised supervised progressive resistance, balance and walking training exercises. Balance and gait retraining exercises gradually progressed in difficulty and included the following: semi‐tandem foot standing, line walking, stepping practice, walking with small obstacles, proprioceptive exercises on unstable surfaces (foam pads sequence), altering the base of support, and weight transfer from 1 leg to the other. The evening session consisted of functional unsupervised exercises using light loads (i.e. 0.5–1 kg anklets and handgrip ball), such as knee extension and flexion, hip abduction and daily walking in the corridor of the acute care unit with a duration based on the clinical physical exercise guide Vivifrail.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): 1 physiotherapist, and a researcher with a PhD background in exercise physiology.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): morning sessions were face‐to‐face with supervision from fitness specialist or physiotherapist. Evening sessions unsupervised.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): each session was performed in a room equipped ad hoc in the Acute Care of the Elderly unit.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): the intervention began when the clinician in charge of the participant considered that their haemodynamic situation was acceptable and the participant could collaborate. The intervention was programmed in 2 daily sessions (morning and evening) of 20 minutes' duration during 5–7 consecutive days (including weekends). The resistance exercises were tailored to the individual's functional capacity using variable resistance training machines aiming at 2–3 sets of 8–10 repetitions with a load equivalent to 30–60% of the 1‐repetition maximum. Participants performed 3 exercises involving mainly lower‐limb muscles (squats rising from a chair, leg press and bilateral knee extension) and 1 involving the upper body musculature. They were instructed to perform the exercises at a high speed to optimise muscle power output, and care was taken to ensure proper exercise execution.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): see items 4 and 8.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): adherence to the exercise intervention programme was documented in a daily register. A session was considered completed when ≥ 90% of the programmed exercises were successfully performed.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): the mean number of completed sessions per participant was 5 (SD 1) in the morning and 4 (SD 1) in the evening. Adherence to the intervention was 95.8% for the morning sessions (i.e. 806 successfully completed sessions of 841 total possible sessions) and 83.4% in the evening sessions (574 of 688 successfully completed sessions).

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: usual care consists of standard PT focused on walking exercises for restoring the functionality conditioned by potentially reversible abnormalities.

• TIDieR item 5: not specified.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: Acute Care for Elders unit.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Barthel Index (score 0–100) at T2

Short Physical Performance Battery at T2

Mini‐Mental State Examination at T2

Incidence of delirium/confusion during hospitalisation

EQ‐5D at T2

Falls during hospitalisation

Mortality during hospitalisation

Medical deterioration during hospitalisation

Length of hospital stay

Readmissions within the first 3 months of discharge

Notes

Unpublished data from email correspondence

Barthel Index: mean scores at discharge (T2): 84.5 (SD 14.5; 146 participants) for the intervention group and 78.2 (SD 19.5; 143 participant) for the control group.

Short Physical Performance Battery: mean scores at discharge (T2): 6.79 (SD 3.21; 150 participants) for the intervention group and 4.91 (SD 2.89; 153 participants) for the control group.

Delirium: 152 participants were assessed for delirium in the intervention group, 157 participants in the control group.

EQ‐5D: mean scores at discharge (T2): 69.5 (SD 18.8; 139 participants) in the intervention group and 57.5 (SD 20.6; 135 participants) for the control group.

Falls: 0 falls/139 participants were recorded in the intervention group, 4 falls/146 participants were recorded in the control group.

Readmissions: 29 participants were readmitted in the intervention group, 31 participants were readmitted in the control group.

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within the first 48 hours of admission to hospital

Outcome time point (T2): within 24 hours of planned discharge from hospital

Follow‐up time point (T3): 2–3 months following discharge from hospital

Participants

Inclusion criteria: irrespective of ward allocation, medical inpatients aged ≥ 65 years, needing an aid or assistance to walk (or both) on admission, and admitted from and planned for discharge home (rather than for institutional care), with an anticipated hospital stay ≥ 3 days were recruited

Exclusion criteria: inpatients admitted for > 48 hours prior to screening; unable to follow simple commands in the English language; admitted with an acute psychiatric condition, or requiring end‐of‐life or critical care; ordered bedrest, or contraindications to walking (e.g. hip fracture or high ventricular rate atrial fibrillation); baseline Short Physical Performance Battery score 0/1; participated in the trial within the previous 12 months

Exercise arm

• n at baseline: 95

• Age mean: 79.7 (SD 7.5) years

• Women (n (%)): 61 (64)

Control arm

• n at baseline: 95

• Age mean: 81.7 (SD 7.3) years

• Women (n (%)): 29 (41)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): augmented prescribed exercise programme + usual care.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): it was hypothesised that a simple exercise programme could be easy to implement but effective in preventing acute sarcopenia, health and hospital outcomes.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): the exercise intervention did not require specialist equipment and weights were not used due to infection control regulations.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the intervention group were assisted or supervised in complete strengthening, balance and gait exercises. Exercises were designed to improve the participant's transfer ability, balance and walking endurance. Strengthening and balance exercises were completed at the bedside. They were lower limb strengthening exercises completed in sitting, sit to stand exercises, transfer training (bed to chair, chair to chair) and balance exercises. The initial treatment was kept simple and straightforward to maintain participant compliance and the intensity was increased as tolerated in the subsequent sessions. Those able to walk safely and independently were strongly encouraged to walk ≥ 3 times daily independently. Family members were encouraged to "go for a walk" with the participants during visits. Advice and education about walking, general physical fitness and performance was given to the participants and their carers as required.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): a senior physiotherapist who specialised in geriatric care prescribed the tailored exercise programme. The exercises were prescribed and assisted by her only.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face, individual sessions, as well as in some cases encouragement to walk independently or with family members.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): all wards admitting older medical patients in a 350‐bed general teaching hospital. Most of the exercise programme occurred on the participant's ward; however, participants could carry out the strengthening and balance exercises off the ward, in a quiet open area of the hospital.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): the sessions occurred twice daily, Monday to Friday, with session duration 20–40 minutes (depending upon the participant's exercise tolerance).

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): the initial treatment was kept simple and straightforward to maintain participant compliance and the intensity was increased as tolerated in the subsequent sessions. Exercises were progressed by increasing the number of repetitions, increasing the speed and the challenge of the exercises.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): no protocol deviations relating to the intervention.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): the research physiotherapist kept a register of the exercises completed as well as the total number of sessions that the participants could have possibly completed, number that were actually completed and the reason for missed sessions such as absence from ward, refusal, medical status or care in isolation.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): 63/95 participants completed ≥ 75% of possible exercise sessions; 16/95 participants completed 50–74% of possible exercise sessions. 13/95 participants completed 25–49% of possible exercise sessions. 3/95 participants completed < 25% of possible exercise sessions.

Control arm

• TIDieR item 1: sham exercises + usual care.

• TIDieR item 2: to act as a control intervention.

• TIDieR item 3: not specified.

• TIDieR item 4: the control group completed sham exercises that mainly consisted of stretching and relaxation exercises. They were completed either in the lying or sitting position only. While the participants were encouraged to talk about their condition and exercise, none were given education, encouragement or were assisted to exercise or walk more. The exercises were not progressed but rather repeated at each session. Session duration 20–30 minutes depending on the participants' ability.

• TIDieR item 5: a senior physiotherapist who specialised in geriatric care prescribed the tailored exercise programme. The exercises were prescribed and assisted by her only.

• TIDieR item 6: face‐to‐face, individual sessions.

• TIDieR item 7: all wards admitting older medical patients in a 350‐bed general teaching hospital.

• TIDieR item 8: the sessions occurred twice daily, Monday to Friday, with session duration 20–30 minutes (depending upon the participant's exercise tolerance).

• TIDieR item 9: the exercises were not progressed but rather repeated at each session.

• TIDieR item 10: no protocol deviations relating to the intervention.

• TIDieR item 11: the research physiotherapist kept a register of the exercises completed as well as the total number of sessions that the participants could have possibly completed, number that were actually completed and the reason for missed sessions such as absence from ward, refusal, medical status or care in isolation.

• TIDieR item 12: 57/95 participants completed ≥ 75% of possible exercise sessions; 18/95 participants completed 50–74% of possible exercise sessions. 14/95 participants completed 25–49% of possible exercise sessions. 5 participants completed < 25% of possible exercise sessions, 1 participant dropped out and did not receive the sham intervention.

Outcomes

Short physical performance battery at T2 and T3

6‐Item Cognitive Impairment Test at T2

EQ‐5D‐5L VAS at T2 and T3

Falls during hospitalisation

Length of hospital stay

Mortality during hospitalisation

Hospital readmissions in the 3 months following discharge

Notes

There was a higher proportion of women in the intervention group (64%) compared to the control group (41%). The mean of the intervention group was 79.9 (SD 7.5) and the control group was 81.6 (SD 7.33) (P = 0.07). All multivariate analyses adjusted for age.

Unpublished data from email correspondence

Delirium: the number of participants with delirium at discharge that was not present at admission were 2 in the intervention group and 3 in the control group.

Length of hospital stay: mean 9.88 (SD 7.12) days in the intervention group and 11.42 (SD 9.46) days in the control group.

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within 48 hours of admission

Outcome time point (T2): day of discharge from hospital or day 7 of hospital admission if earlier

Participants

Inclusion criteria: aged > 65 years; admitted to hospital within the preceding 48 hours; able to sit in a chair independently and follow 1‐stage commands; expected length of stay at least a further 48 hours

Exclusion criteria: terminally ill or moribund; needing isolation precautions; bed bound prior to admission; who had a condition that made them unable to use the pedal exerciser (e.g. lower limb fracture, lower limb pain, leg amputation or foot deformity)

Exercise arm

• n at baseline: 24

• Age mean: 87.1 (SD 9.2) years

• Women (n (%)): 16 (67)

• Barthel Index (0–20) on admission (mean): 15.71 (SD 3.93)

• Diagnosis of dementia (n (%)): 23.46 (4.85)

Control arm

• n at baseline: 24

• Age mean: 82.9 (SD 5.7) years

• Women (n (%)): 13 (54)

• Barthel Index (0–20) on admission (mean): 16.17 (SD 3.85)

• Diagnosis of dementia (n (%)): 22.88 (6.33)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): chair‐based pedal exercises.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): it was hypothesised that resistance training as part of pedal exercise may improve muscle strength and physical activity.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): Able2‐pedal exerciser with pedometer (Able2 UK Ltd).

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): participants were asked to perform 5 minutes of chair‐based pedal exercise 3 times per day with no specified targets on number of pedal revolutions using an Able2‐pedal exerciser with pedometer.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the ward team would facilitate the pedal exercises and remind participants of it, but not be expected to remain with the participant throughout the exercise.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): as per item 5.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): 3 acute medical wards for older people.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): started in first 48 hours of admission, finished on day 7. 5 minutes of chair‐based pedal exercise 3 times per day.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): none other than the intensity was driven by the participant.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): adherence was measured by time spent on the exerciser and total revolutions performed.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): the median number of revolutions cycled throughout the entire study period with the pedal exerciser was 152 (IQR 421, 43.5–464.5) revolutions. The median time spent on the pedal exerciser was 5.08 (IQR 18.02, 2.03–20.05) minutes across the whole study period.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: not specified.

• TIDieR item 5: not specified.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: 3 acute medical wards for older people.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Elderly Mobility Scale at hospital discharge

Length of hospital stay

Notes

Intervention group was older (87 in intervention group vs 83 in control group) with a greater proportion of women (67% in intervention group vs 54% in control group).

Study characteristics

Methods

Design: quasi‐RCT

Baseline time point (T1): within 48 hours of admission to hospital

Outcome time point (T2): within 48 hours of discharge from hospital

Participants

Inclusion criteria: aged ≥ 65 years, admitted to an internal medicine unit for ≥ 3 days and received at least some of their care on the designated intervention or control ward

Exclusion criteria: already fully dependent before their admission; came from a high‐level residential care facility or were medically too unstable for early assessment or terminally ill; discharged or transferred within 72 hours; died in hospital; or did not gain admission to study wards during their admission

Exercise arm

• n at baseline: 62

• Age mean: 81.7 (SD 7.8) years

• Women (n (%)): 35 (56.6)

• Barthel Index (0–100) on admission (median): 71.5 (IQR 58–83)

• Diagnosis of dementia (n (%)): 6 (9.7)

Control arm

• n at baseline: 62

• Age mean: 82.4 (SD 7.4) years

• Women (n (%)): 37 (59.7)

• Barthel Index (0–100) on admission (median): 72.5 (IQR 56–85)

• Diagnosis of dementia (n (%)): 5 (8.1)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): focused programme of physical exercise and cognitive stimulation + usual care.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): a multidisciplinary care model for general medical inpatients that was previously implemented demonstrated significant reductions in functional decline and inpatient mortality. Study authors aimed to assess whether the focused programme could further improve functional outcomes.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): the PT component included written advice about the exercise programme. A participant diary was provided to record daily activity. Ward nursing and multidisciplinary component included posters, and information resources including a walking map of ward and surrounds.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the intervention consisted of 3 components: a graduated exercise programme prescribed and supervised by the unit physiotherapist; education of ward and MDT staff, participants and carers to actively encourage mobility and functional independence; and a cognitive intervention delivered in groups by psychology students supervised by a senior psychologist.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): physiotherapist provided early review (within 48 hours), prescribed the exercise programme, and provided daily reviews as needed. Cognitive intervention delivered by psychology students under supervision of senior clinical psychologist.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): PT component was individual and face‐to‐face. Ward nursing and MDT component delivered both via face‐to‐face strategies (e.g. teaching) and using strategies such as posters. Cognitive component delivered via group sessions face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): medical ward.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): PT component started within first 48 hours. Bed, sitting, standing or ambulation‐based exercises were performed twice daily (in addition to any specific recommendations by unit physiotherapist relating to presenting complaint). Ward nursing and MDT component described as 'intensive'. Cognitive component 3–4 afternoons per week.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as per items 4, 5 and 8.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): participant activity on the ward was measured using direct observation. Participants were observed for 2‐ to 3‐hour periods at varying times of the morning and afternoon shifts over 7 days. 76 patient‐hours of observation were undertaken during each observation period, divided equally between the control and intervention ward. Time spent in bed, seated, standing and walking was recorded.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): in the intervention group, initial physiotherapist assessment and institution of an appropriate exercise programme was completed in a median of 2 days (IQR 0–4 days). More participants in the intervention group had a physiotherapist visit recorded (96.8% with intervention vs 82.3% with control), but there was no difference in mean number of physiotherapist visits per participant between groups (3.21 with intervention vs 3.37 with control; P = 0.53). 92% of participants in the intervention group received an exercise diary and made some record of exercise; about 33% completed their diary every day. 50% of the intervention group attended ≥ 1 cognitive group session. Observation of participant mobility in 34 elderly participants before the trial showed low levels of mobility on both trial wards, with < 10% of observed time spent standing or walking. During the intervention, participants on the intervention ward were much less likely to be observed in bed and spent significantly more time standing or walking within the ward.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: control group participants received usual care from the MDT, including daily discussion of participant progress and discharge plan, and referral to the team physiotherapist or OT by medical or nursing staff if there were concerns about mobility or function.

• TIDieR item 5: physiotherapists and other healthcare providers as required.

• TIDieR item 6: not specified.

• TIDieR item 7: medical ward.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: as per exercise group.

• TIDieR item 12: mobility patterns on the control ward were unchanged, with < 10% of observed time spent standing or walking.

Outcomes

Barthel Index (score of 0–100) at T2

Incidence of delirium during hospitalisation

Falls during hospitalisation

Mortality during hospitalisation

Length of hospital stay

Readmissions within 30 days of hospital discharge

New institutionalisation at hospital discharge

Timed Up and Go at T2 (categorised scores only)

Notes

Study characteristics

Methods

Design: quasi‐RCT

Baseline time point (T1): admission to hospital

Outcome time point (T2): discharge from hospital

Follow‐up time point (T3): 3 months after discharge

Participants

Inclusion criteria: aged > 75 years, admitted to an acute care of the elderly unit

Exclusion criteria: non‐ambulatory or dependent in all basic ADLs at baseline (i.e. 2 weeks before admission, as assessed by retrospective interview), had unstable cardiovascular disease or any other major medical condition contraindicating exercise, terminal illness, severe dementia (i.e. ≥ 8 errors in the Spanish version of the Short Portable Mental Status Questionnaire), an expected length of hospitalisation < 3 days, were transferred from another hospital unit or had a scheduled admission (which was usually associated with a length of hospitalisation < 3 days)

Exercise arm

• n at baseline: 143

• Age mean: 88 (SD 5) years

• Women (n (%)): 86 (60)

• Diagnosis of dementia (n (%)): 34 (27)

Control arm

• n at baseline: 125

• Age mean: 88 (SD 5) years

• Women (n (%)): 68 (54)

• Diagnosis of dementia (n (%)): 34 (27)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): inpatient exercise programme + usual care.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): exercise programmes believed to improve participants' functional status at discharge as well as to reduce the length and cost of hospital stays.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): no specialist exercise equipment. Exercise loads recorded in a notebook.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): supervised exercises 1–3 times per day. Exercises were rising from a seated to an upright position (using armrests/assistance if necessary) in the participant's room and supervised walking exercises along the corridor of the ward. Standing and walking exercises were separated by a rest period of up to 5 minutes. Videos of exercise sessions available via supplementary material.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): exercise sessions were supervised by 1 of 2 fitness specialists.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face, individually.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): acute care of the elderly unit.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): exercise sessions began day after admission. 1–3 sessions per day on weekdays only (approximately 20 minutes in total each day). Participants began with 1 session per day and this increased to 3 sessions depending on participants physical capacity. Sit‐to‐stand exercise from a chair: maximum of 10 repetitions and 1–3 sets, depending on the participant's physical capacity. Walking exercise duration 3–10 minutes depending on the participant's physical capacity.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as item 8.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): training loads were recorded in a notebook.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): participants in the intervention group performed a median of 3 training days (IQR 2) and 2 training sessions per day (IQR 2), with a mean total exercise time per day of 20 minutes (for each session, the median duration of the walking section was 5 minutes (IQR 4, range 0–10), and participants performed a mean of 9 (SD 6, range 0–30) sit‐to‐stands).

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: not specified.

• TIDieR item 5: not specified.

• TIDieR item 6: not specified.

• TIDieR item 7: acute care of the elderly unit.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

ADL (score 0–6) at T2 and T3

Short Physical Performance Battery at T2

Functional Ambulatory Category at T2 and T3

Mortality during hospitalisation

Falls

Length of hospital stay

Readmissions within 3 months of hospital discharge

Notes

Intervention group had higher proportion of participants with a diagnosis of dementia (27% in intervention vs 12% in control), depression (32% in intervention vs 18% in control), history of falls (36% in intervention vs 16% in control), lower mean baseline ADL scores (4.0 in intervention vs 4.6 in control) and admission ADL scores (2.3 in intervention vs 3.1 in control).

Study characteristics

Methods

Design: RCT

Baseline time point (T1): admission to hospital

Outcome time point (T2): within the first week after discharge from hospital

Follow‐up time point (T3): 4 weeks after discharge and 6 months after discharge

Participants

Inclusion criteria: aged ≥ 65 years, admitted with acute illness from their own home to the emergency department of hospital

Exclusion criteria: terminal illness; in treatment for diagnosed cancer; diagnosis of COPD and participation in a COPD rehabilitation programme; living outside the 3 included municipalities; inability to speak or understand Danish; inability to cooperate in tests/exercises; transfer to the intensive care unit; isolation‐room stay; expected hospitalisation lasting < 24 hours; inability to stand

Exercise arm

• n at baseline: 42

• Age mean: 82.1 (SD 7.4) years

• Women (n (%)): 30 (71.4)

• Barthel Index (0–20) on admission (median): 20 (IQR 19–20)

Control arm

• n at baseline: 43

• Age mean: 82.5 (SD 7.5) years

• Women (n (%)): 26 (60.5)

• Barthel Index (0–20) on admission (median): 20 (IQR 19–20)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): progressive strength training and protein supplementation + usual care.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): it was hypothesised that strength training and protein supplementation would prevent functional deterioration and muscle wasting during illness.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): written exercise training and progression protocol was used. After each training session, participants were asked to consume a protein supplement (Nutridrink Compact Protein from Nutricia A/S) containing milk‐based protein 18 g and 300 kcal. Weight vest (Titan Box 1–30 kg), and weight cuffs were used for some exercises.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): training sessions were delivered every weekday during hospitalisation and 3 days per week for 4 weeks in their own home after discharge. Every training session consisted of a warm‐up programme for the lower extremities followed by 2 progressive strength training exercises, a sit‐to‐stand exercise followed by a heel raise exercise. Both exercises followed predefined models of progression allowing for performance of the exercise from a seated position to performing the exercise unilaterally with extra load.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): training sessions were delivered by physiotherapists (2 physiotherapists with 3 years of experience supervised in hospital exercise, 5 physiotherapists with 4–15 years of experience supervised the home‐based exercises). The primary investigator performed preintervention meetings with all physiotherapists. Training covered both the warm‐up programme and the strength training protocol. If physiotherapists who were delivering the intervention had questions that arose during the study they could contact a senior physiotherapist.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): training sessions were delivered face‐to‐face 1:1.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): training sessions occurred in the hospital in the participants' bedrooms and in the participants own home for 4 weeks after discharge.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): during hospitalisation, participants were seen every weekday. After discharge participants were seen 3 times per week for 4 weeks (maximum 12 sessions over 5 weeks) in their own homes. Participants were asked to perform 3 sets of 12 repetitions of each exercise. Exercises were designed to correspond to 60–70% of a 1 repetition maximum.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): exercises were progressed/regressed based on number of repetitions achieved in each exercise session (> 8 repetitions = progression, < 8 repetitions = regression) as per protocol.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): no modifications reported.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): the supervising physiotherapist completed an exercise diary consisting of information about the level of exercise attained according to the progression models, the extra load added (kg), and the number of sets and repetitions performed at each level. The physiotherapist registered reasons for non‐participation and the amount of protein consumed after each training session. High compliance was defined as completion of 80% of training sessions with a minimum of 2 sets performed each session.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): significant dropout rate during study. 78.8% of participants started the intervention between 0 and 2 days after admission (range 0–4). Overall, 43% (18/42) of participants randomised to the intervention group were very compliant with the intervention. Of those who remained in the study at 4 weeks, 60% (18/30) were very compliant and 23% (7/30) were moderately compliant with the intervention (minimum 8/12 (67%) sessions performed with 2 sets of 8 repetition maximums). All participants consumed the amount of protein stated in the protocol. Between week 1 and week 4 of the intervention, there was a general increase in the level of exercise performed in both the sit‐to‐stand exercise and the heel‐raise exercise. Thus, in the sit‐to‐stand exercise, 20% more participants trained at levels 6–7 in week 4 compared to week 1, and in the heel‐raise exercise, 24% more participants trained at levels 5–7 in week 4 compared to week 1. Also, in both exercises, those training with a weighted vest increased their load by 1.5 kg (P < 0.01) for sit‐to‐stand level 6 and 2 kg (P < 0.01) for heel‐raise level 5.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: standard care as per hospital. National targets to assess function and nutrition and make an appropriate plan within 24–48 hours of admission. Rehabilitation often starts during hospitalisation and continues after discharge.

• TIDieR item 5: not specified.

• TIDieR item 6: not specified.

• TIDieR item 7: acute medical ward and internal medicine ward.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Barthel Index (score of 0–20) at T2 and T3

de Morton Mobility Index at T2 and T3

Mortality during hospitalisation

Adverse events (composite score) during hospitalisation

Length of hospital stay

Readmissions within first 4 weeks and first 6 months after discharge (numbers not reported)

Walking speed at T2 and T3

Notes

Intervention group had higher percentage of women (71.4% in intervention vs 60.5% in control).

Unpublished data from email correspondence

Hospital readmissions: at 4 weeks' follow‐up (T3), 8/43 participants of intervention group vs 6/42 participants of control group had been readmitted.

Study characteristics

Methods

Design: RCT

Baseline time point (T1): within 36 hours of admission to hospital

Outcome time point (T2): within the first week after discharge from hospital

Follow‐up time point (T3): 91 days after discharge

Participants

Inclusion criteria: aged ≥ 70 years; general practitioner registered within the Nottingham City Clinical Commissioning Group's catchment area only (UK)

Exclusion criteria: bed bound prior to admission or moribund on admission; receiving palliative care; previously included in the trial on an earlier admission; unable to be screened and recruited by the research team within 36 hours of admission to the study ward; nursing home residents

Exercise arm

• n at baseline: 125

• Age mean: 83.6 (SD 6.6) years

• Women (n (%)): 82 (66)

• Barthel Index (0–20) on admission (mean): 11.0 (SD 6.1)

Control arm

• n at baseline: 125

• Age mean: 84.5 (SD 5.9) years

• Women (n (%)): 79 (63)

• Barthel Index (0–20) on admission (mean): 10.5 (SD 5.4)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): CIRACT service.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): CIRACT service aims to facilitate seamless care for patients on discharge from hospital and prevent avoidable hospital readmissions.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): none specified.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): following randomisation, the CIRACT service undertook a comprehensive assessment of the participant's ability to perform certain tasks and formed a rehabilitation plan. While in hospital participants were treated daily and the duration of rehabilitation they received depended on their needs. During the participant's hospital stay, the team liaised with the participant and their carer(s) to visit the participant's home to assess and provide recommendations for equipment and make adaptations or modifications (or both) as required. In more complex cases, the CIRACT team took the participant out of the hospital for a home visit prior to discharge. Following discharge, the CIRACT team visited the participant at home to assess the level of rehabilitation required, further follow‐up visits as deemed necessary and appropriate referral to additional community services.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the CIRACT service consisted of a senior occupational therapist (transition coach), senior physiotherapist and assistant practitioner linked directly to a social services practitioner.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): as item 4.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): general medical elderly care wards.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): after randomisation (first 36 hours of hospitalisation), participants were treated daily if appropriate. Duration of rehabilitation based on their needs.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as item 4 and 8.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): there were 15 protocol deviations in the CIRACT group.

Control arm

• TIDieR item 1: usual care (THB‐Rehab).

• TIDieR item 2: ward therapy teams – senior OT and senior PT weekdays only. Provided assessment and recommendations for rehabilitation. Referred to community‐based services and rehabilitation on discharge.

• TIDieR item 3: not specified.

• TIDieR item 4: the standard THB‐Rehab service was on weekdays only. The service referred the participants to the appropriate community‐based services for provision of equipment at home, personal care and ongoing rehabilitation where appropriate at discharge. Once discharged from hospital, the participant had no direct contact with the THB‐Rehab service but where referred, continued further rehabilitation with community services.

• TIDieR item 5: the standard THB‐Rehab service was provided by the ward therapy teams (usually a senior OT and a senior physiotherapist).

• TIDieR item 6: as item 4.

• TIDieR item 7: general medical elderly care wards.

• TIDieR item 8: 5 days per week.

• TIDieR item 9: as item 4.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: there were 8 protocol deviations in the THB‐Rehab group.

Outcomes

Barthel Index (score of 0–20) at T3 only

EQ‐5D‐3L at T3 only

Falls

Mortality during hospitalisation

Length of hospital stay

Hospital readmissions in the first 28 after hospital discharge.

Notes

Study characteristics

Methods

Design: quasi‐RCT

Baseline time point (T1): admission to hospital

Outcome time point (T2): discharge from hospital

Follow‐up time point (T3): 6 months (readmissions)

Participants

Inclusion criteria: aged ≥ 75 years, and referred to department of general medicine

Exclusion criteria: admitted for day treatment

Exercise arm

• n at baseline: 140

• Age mean: 82.5 (SD 4.9) years

• Women (n (%)): 94 (67.1)

Control arm

• n at baseline: 97

• Age mean: 83.2 (SD 5.1) years

• Women (n (%)): 73 (75.3)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): multidisciplinary joint treatment by geriatric team + usual care.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): psychogeriatric disciplinary intervention hypothesised to improve hospital and functional outcomes.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): MDT consisted of a geriatrician, specialised geriatric liaison nurse and a physiotherapist. Staff‐to‐participant ratio was increased by 3 nurses. The main task of the team was assessment on admission, generating and implementing the treatment plans, and planning and management of discharge. Intervention included daily PT assessment. A weekly MDT meeting was held, attended by the geriatric team, nurses, social worker, dietitian, psychiatrist and other occasionally invited consultants. The geriatrician was present at the weekly ward rounds with the attending physician and the 2 resident physicians. In addition, the geriatric team had their own ward rounds every week.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): MDT consisted of a geriatrician, specialised geriatric liaison nurse and a physiotherapist. The geriatrician was also trained in geriatric psychiatry.

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): most physiotherapists' time was in direct contact with participants on the ward. The geriatrician spent approximately 2 hours per day in direct contact with participants or their family members.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): general medical unit.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): as item 4: daily multidisciplinary input.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): as item 4.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): not specified.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: not specified.

• TIDieR item 5: not specified.

• TIDieR item 6: care provided by staff in another general medical unit, who were not involved in the intervention unit.

• TIDieR item 7: general medical unit.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

ADL (score of 0–7) at T2 (categorised only)

Help index (score of 0–12) at T2 (categorised only)

Mobility (score of 0–4) at T2 (categorised only)

Length of hospital stay

Readmissions within first 6 months of discharge from hospital

Mortality during hospitalisation

Notes

There were more women in intervention group (75.3%) than in the control group (67.1%). Participants were more likely to be married in the intervention group (43.6%) than the control group (27.8%).

Study characteristics

Methods

Design: quasi‐RCT

Baseline time point (T1): within 72 hours of admission

Outcome time point (T2): day of discharge

Participants

Inclusion criteria: aged ≥ 65 years and admitted for an acute medical pathology to a geriatric care unit

Exclusion criteria: dependent in all basic ADL before admission; admitted to intensive care; transferred from other services; intubated patients; severe dementia; terminal cancer; severe aphasia; discharged in < 24 hours; admitted for specific procedures; patients from the internal medicine service to the geriatric care team for treatment

Exercise arm

• n at baseline: 68

• Age mean: 42 (SD 56) years

• Women (n (%)): 42 (61.8%)

Control arm

• n at baseline: 75

• Age mean: 76.1 (SD 7.2) years

• Women (n (%)): 42 (56%)

Interventions

Exercise arm

• TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): geriatric care unit.

• TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): it was hypothesised that the geriatric care unit could favour a reduction in the incidence of functional decline with a favourable impact on quality of life without an increase in care costs.

• TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified.

• TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): based on protocol of Landefeld and colleagues 1995. Medical interventions included: geriatric assessment upon admission, evaluation of problems, early removal of endovenous and urinary catheters, prevention and early diagnosis of adverse events, early discharge planning and the co‐ordination of the continuity of treatment at an appropriate level. Multidisciplinary interventions included: functional evaluation, early rehabilitation, promotion of self‐care, neurosensory stimulation, orientation for the family or carer (or both). Nursing interventions included: incontinence management, prevention of pressure ulcers and promotion of self‐care. Furthermore, an interdisciplinary meeting was set up once per week (with the chief physician, resident, therapists and a social worker); daily information, education and active participation by family or carer.

• TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): 1 geriatric physician, 1 medical resident of the speciality, general care nurses, a physiotherapist, an OT and a social worker (once per week).

• TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face.

• TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): the geriatric unit contained 10 beds.

• TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): as item 4.

• TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): not specified.

• TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

• TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

• TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): not specified.

Control arm

• TIDieR item 1: usual care.

• TIDieR item 2: not specified.

• TIDieR item 3: not specified.

• TIDieR item 4: routine medical care and nursing care, typical for an acute care unit – this was a different hospital unit as the comparison at the same time as the other site.

• TIDieR item 5: internist physician, a medical resident to this speciality, general care nurses, access to PT and OT and a social worker by means of referral.

• TIDieR item 6: face‐to‐face.

• TIDieR item 7: acute medical unit.

• TIDieR item 8: not specified.

• TIDieR item 9: not specified.

• TIDieR item 10: not specified.

• TIDieR item 11: not specified.

• TIDieR item 12: not specified.

Outcomes

Katz ADL (score 0–6) at T2 (categorised scores only)

Length of hospital stay

Notes

Intervention group was older (79.6 years in intervention vs 76.1 years in control), was more likely to be admitted with renal conditions (14.7% in intervention vs 6.7% in control) and less likely to have cardiovascular problems (9.9% in intervention vs 25.3% in control).