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  • Updated Cochrane Review: Rehabilitation for Long-term Care Residents

    Physical rehabilitation for long‐term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents, say authors of an updated Cochrane review first published in 2009. There is insufficient evidence to reach conclusions about improvement sustainability, cost‐effectiveness, or which interventions are most appropriate, they add. Future large‐scale trials are justified.

    For this update, the authors searched the trials registers of Cochrane entities, trials and research registers, and conference proceedings; checked reference lists; contacted authors, researchers, and other relevant Cochrane entities; and updated searches of electronic databases in 2011 and listed relevant studies as awaiting assessment. They selected randomized studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people (over 60 years) who have permanent long-term care residency.

    Two review authors independently assessed risk of bias and extracted data. The primary outcome was function in activities of daily living. Secondary outcomes included exercise tolerance, strength, flexibility, balance, perceived health status, mood, cognitive status, fear of falling, and economic analyses. The authors investigated adverse effects, including death, morbidity, and other events. They synthesized estimates of the primary outcome with the mean difference; mortality data with the risk ratio; and secondary outcomes, using vote-counting.

    The authors included 67 trials involving 6,300 participants. Fifty-one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of 6 points (7 studies), Functional Independence Measure (0 to 126) scores of 5 points (4 studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (3 studies), Timed Up and Go Test of 5 seconds (7 studies), and walking speed of 0.03 m/s (9 studies). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. There was insufficient evidence of the effect on other secondary outcomes. Based on 25 studies (3,721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation, say the authors.

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