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Meta-Analysis
. 2013 Feb 28;2013(2):CD004294.
doi: 10.1002/14651858.CD004294.pub3.

Physical rehabilitation for older people in long-term care

Tom Crocker  1 , Anne Forster, John Young, Lesley Brown, Seline Ozer, Jane Smith, John Green, Jo Hardy, Eileen Burns, Elizabeth Glidewell, Darren C Greenwood
Affiliations
Meta-Analysis

Physical rehabilitation for older people in long-term care

Tom Crocker et al. Cochrane Database Syst Rev. .

Abstract

Background: The worldwide population is progressively ageing, with an expected increase in morbidity and demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects on long-term care residents. This is an update of a Cochrane review first published in 2009.

Objectives: To evaluate the benefits and harms of rehabilitation interventions directed at maintaining, or improving, physical function for older people in long-term care through the review of randomised and cluster randomised controlled trials.

Search methods: We searched the trials registers of the following Cochrane entities: the Stroke Group (May 2012), the Effective Practice and Organisation of Care Group (April 2012), and the Rehabilitation and Related Therapies Field (April 2012). In addition, we searched 20 relevant electronic databases, including the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), AMED (1985 to December 2009), and PsycINFO (1967 to December 2009). We also searched trials and research registers and conference proceedings; checked reference lists; and contacted authors, researchers, and other relevant Cochrane entities. We updated our searches of electronic databases in 2011 and listed relevant studies as awaiting assessment.

Selection criteria: Randomised 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.

Data collection and analysis: Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. 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. We investigated adverse effects, including death, morbidity, and other events. We synthesised estimates of the primary outcome with the mean difference; mortality data, with the risk ratio; and secondary outcomes, using vote-counting.

Main results: We included 67 trials, involving 6300 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 six points (95% confidence interval (CI) 2 to 11, P = 0.008, seven studies), Functional Independence Measure (0 to 126) scores of five points (95% CI -2 to 12, P = 0.1, four studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (95% CI 0.04 to 1.3, P = 0.04, three studies), Timed Up and Go test of five seconds (95% CI -9 to 0, P = 0.05, seven studies), and walking speed of 0.03 m/s (95% CI -0.01 to 0.07, P = 0.1, nine 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 (3721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95, 95% CI 0.80 to 1.13). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation.

Authors' conclusions: 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. There is insufficient evidence to reach conclusions about improvement sustainability, cost-effectiveness, or which interventions are most appropriate. Future large-scale trials are justified.

PubMed Disclaimer

Conflict of interest statement

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

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

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

Figures

1
1
Review update flow diagram
2
2
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies
3
3
Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.1 Barthel Index.
4
4
Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.4 TUG test
5
5
Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.5 Walking speed
6
6
Funnel plot of comparison: 1 Rehabilitation versus control, outcome: 1.6 Death
7
7
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study
1.1
1.1. Analysis
Comparison 1 Rehabilitation versus control, Outcome 1 Barthel Index.
1.2
1.2. Analysis
Comparison 1 Rehabilitation versus control, Outcome 2 Functional Independence Measure (FIM).
1.3
1.3. Analysis
Comparison 1 Rehabilitation versus control, Outcome 3 Rivermead Mobility Index (RMI).
1.4
1.4. Analysis
Comparison 1 Rehabilitation versus control, Outcome 4 Timed Up and Go (TUG) Test.
1.5
1.5. Analysis
Comparison 1 Rehabilitation versus control, Outcome 5 Walking speed.
1.6
1.6. Analysis
Comparison 1 Rehabilitation versus control, Outcome 6 Death.
1.7
1.7. Analysis
Comparison 1 Rehabilitation versus control, Outcome 7 Barthel Index (by risk of bias).
1.8
1.8. Analysis
Comparison 1 Rehabilitation versus control, Outcome 8 Barthel Index (by duration of intervention).
1.9
1.9. Analysis
Comparison 1 Rehabilitation versus control, Outcome 9 Barthel Index (by mode of delivery).
1.10
1.10. Analysis
Comparison 1 Rehabilitation versus control, Outcome 10 Barthel Index (by baseline Barthel Index score).
1.11
1.11. Analysis
Comparison 1 Rehabilitation versus control, Outcome 11 Barthel Index (by age).
1.12
1.12. Analysis
Comparison 1 Rehabilitation versus control, Outcome 12 Barthel Index (by gender).
1.13
1.13. Analysis
Comparison 1 Rehabilitation versus control, Outcome 13 Functional Independence Measure (by risk of bias).
1.14
1.14. Analysis
Comparison 1 Rehabilitation versus control, Outcome 14 Functional Independence Measure (by duration of intervention).
1.15
1.15. Analysis
Comparison 1 Rehabilitation versus control, Outcome 15 Functional Independence Measure (by mode of delivery).
1.16
1.16. Analysis
Comparison 1 Rehabilitation versus control, Outcome 16 Functional Independence Measure (by baseline FIM score).
1.17
1.17. Analysis
Comparison 1 Rehabilitation versus control, Outcome 17 Functional Independence Measure (by age).
1.18
1.18. Analysis
Comparison 1 Rehabilitation versus control, Outcome 18 Functional Independence Measure (by gender).
1.19
1.19. Analysis
Comparison 1 Rehabilitation versus control, Outcome 19 Rivermead Mobility Index (by risk of bias).
1.20
1.20. Analysis
Comparison 1 Rehabilitation versus control, Outcome 20 Rivermead Mobility Index (by duration of intervention).
1.21
1.21. Analysis
Comparison 1 Rehabilitation versus control, Outcome 21 Rivermead Mobility Index (by mode of delivery).
1.22
1.22. Analysis
Comparison 1 Rehabilitation versus control, Outcome 22 Rivermead Mobility Index (by baseline RMI score).
1.23
1.23. Analysis
Comparison 1 Rehabilitation versus control, Outcome 23 Rivermead Mobility Index (by age).
1.24
1.24. Analysis
Comparison 1 Rehabilitation versus control, Outcome 24 Rivermead Mobility Index (by gender).
1.25
1.25. Analysis
Comparison 1 Rehabilitation versus control, Outcome 25 TUG Test (by risk of bias).
1.26
1.26. Analysis
Comparison 1 Rehabilitation versus control, Outcome 26 TUG Test (by duration of intervention).
1.27
1.27. Analysis
Comparison 1 Rehabilitation versus control, Outcome 27 TUG Test (by mode of delivery).
1.28
1.28. Analysis
Comparison 1 Rehabilitation versus control, Outcome 28 TUG Test (by baseline TUG score).
1.29
1.29. Analysis
Comparison 1 Rehabilitation versus control, Outcome 29 TUG Test (by age).
1.30
1.30. Analysis
Comparison 1 Rehabilitation versus control, Outcome 30 TUG Test (by gender).
1.31
1.31. Analysis
Comparison 1 Rehabilitation versus control, Outcome 31 Walking speed (by risk of bias).
1.32
1.32. Analysis
Comparison 1 Rehabilitation versus control, Outcome 32 Walking speed (by duration of intervention).
1.33
1.33. Analysis
Comparison 1 Rehabilitation versus control, Outcome 33 Walking speed (by mode of delivery).
1.34
1.34. Analysis
Comparison 1 Rehabilitation versus control, Outcome 34 Walking speed (by baseline walking speed).
1.35
1.35. Analysis
Comparison 1 Rehabilitation versus control, Outcome 35 Walking speed (by age).
1.36
1.36. Analysis
Comparison 1 Rehabilitation versus control, Outcome 36 Walking speed (by gender).
1.37
1.37. Analysis
Comparison 1 Rehabilitation versus control, Outcome 37 Walking speed (by distance walked).
1.38
1.38. Analysis
Comparison 1 Rehabilitation versus control, Outcome 38 Death (by risk of bias).
1.39
1.39. Analysis
Comparison 1 Rehabilitation versus control, Outcome 39 Death (by duration of intervention).
1.40
1.40. Analysis
Comparison 1 Rehabilitation versus control, Outcome 40 Death (by mode of delivery).
1.41
1.41. Analysis
Comparison 1 Rehabilitation versus control, Outcome 41 Death (by age).
1.42
1.42. Analysis
Comparison 1 Rehabilitation versus control, Outcome 42 Death (by gender).
1.43
1.43. Analysis
Comparison 1 Rehabilitation versus control, Outcome 43 Sensitivity analysis: Barthel Index (fixed‐effect).
1.44
1.44. Analysis
Comparison 1 Rehabilitation versus control, Outcome 44 Sensitivity analysis: Barthel Index (cluster trials).
1.45
1.45. Analysis
Comparison 1 Rehabilitation versus control, Outcome 45 Sensitivity analysis: Functional Independence Measure (fixed‐effect).
1.46
1.46. Analysis
Comparison 1 Rehabilitation versus control, Outcome 46 Sensitivity analysis: Rivermead Mobility Index (fixed‐effect).
1.47
1.47. Analysis
Comparison 1 Rehabilitation versus control, Outcome 47 Sensitivity analysis: TUG Test (fixed‐effect).
1.48
1.48. Analysis
Comparison 1 Rehabilitation versus control, Outcome 48 Sensitivity anlaysis: TUG Test (cluster trials).
1.49
1.49. Analysis
Comparison 1 Rehabilitation versus control, Outcome 49 Sensitivity analysis: TUG Test (re‐including Christofoletti 2008).
1.50
1.50. Analysis
Comparison 1 Rehabilitation versus control, Outcome 50 Sensitivity analysis: Walking speed (fixed‐effect).
1.51
1.51. Analysis
Comparison 1 Rehabilitation versus control, Outcome 51 Sensitivity analysis: Walking speed (cluster trials).
1.52
1.52. Analysis
Comparison 1 Rehabilitation versus control, Outcome 52 Sensitivity analysis: Death (random‐effects: odds ratio).
1.53
1.53. Analysis
Comparison 1 Rehabilitation versus control, Outcome 53 Sensitivity analysis: Death (random‐effects: risk difference).
1.54
1.54. Analysis
Comparison 1 Rehabilitation versus control, Outcome 54 Sensitivity analysis: Death (fixed‐effect).
1.55
1.55. Analysis
Comparison 1 Rehabilitation versus control, Outcome 55 Sensitivity analysis: Death (fixed‐effect: Peto odds ratio).
1.56
1.56. Analysis
Comparison 1 Rehabilitation versus control, Outcome 56 Sensitivity analysis: Death (cluster trials).
1.57
1.57. Analysis
Comparison 1 Rehabilitation versus control, Outcome 57 Sensitivity analysis: Death (including Brittle 2009).
2.1
2.1. Analysis
Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 1 TUG Test.
2.2
2.2. Analysis
Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 2 Death.
2.3
2.3. Analysis
Comparison 2 Rehabilitation (experimental) versus rehabilitation (control), Outcome 3 Sensitivity analysis: TUG Test (fixed‐effect).
See this image and copyright information in PMC

Update of

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Schoenfelder 2004 {published data only}
    1. Schoenfelder DP, Rubenstein LM. An exercise program to improve fall‐related outcomes in elderly nursing home residents. Applied Nursing Research. 2004;17:21‐31. - PubMed
Sihvonen 2004 {published data only}
    1. Sihoven SE, Sipilä S, Era P. Changes in postural balance in frail elderly women during a 4‐week visual feedback training: a randomized controlled trial. Gerontology 2004;50:87‐95. - PubMed
Stamford 1972 {published data only}
    1. Stamford BA. Physiological effects of training upon institutionalized geriatric men. Journal of Gerontology 1972;27(4):451‐5. - PubMed
Stevens 2006 {published data only}
    1. Stevens J, Kileen M. A randomised controlled trial testing the impact of exercise on cognitive symptoms and disability of residents with dementia. Contemporary Nurse 2006;21:32‐40. - PubMed
Sung 2009 {published data only}
    1. Sung K. The effects of 16‐week group exercise program on physical function and mental health of elderly Korean women in long‐term assisted living facility. The Journal of Cardiovascular Nursing 2009;24(5):344‐51. - PubMed
Taboonpong 2008 {published data only}
    1. Taboonpong S, Puthsri N, Kong‐In W, Saejew A. The effects of Tai Chi on sleep quality, well‐being and physical performances among older adults. Thai Journal of Nursing Research 2008;12(1):1‐13.
Tappen 1994 {published data only}
    1. Tappen RM. The effect of skill training on functional abilities of nursing home residents with dementia. Research in Nursing & Health 1994;17(4):159‐65. - PMC - PubMed
Tappen 2000 {published data only}
    1. Tappen RM, Roach KE, Applegate EB, Stowell P. Effect of a combined walking and conversation intervention on functional mobility of nursing home residents with Alzheimer Disease. Alzheimer Disease and Associated Disorders 2000;14(4):196‐201. - PMC - PubMed
Urbscheit 2001 {published data only}
    1. Urbscheit NL, Wiegand MR. Effect of two exercise programs on balance scores in elderly ambulatory people. Physical and Occupational Therapy in Geriatrics 2001;19(4):49‐58.
Yoder 1989 {published data only}
    1. Yoder RM, Nelson DL, Smith DA. Added‐purpose versus rote exercise in female nursing home residents. The American Journal of Occupational Therapy 1989;43(9):581‐6. - PubMed

References to studies excluded from this review

Alessi 1995b {published data only}
    1. Alessi CA, Schnelle JF, MacRae PG, Ouslander JG, Al‐Samarrai N, Simmons SF, et al. Does physical activity improve sleep in impaired nursing home residents?. Journal of the American Geriatrics Society 1995;43:1098‐102. - PubMed
Alexander 2001 {published data only}
    1. Alexander NB, Galecki AT, Genier ML, Nyquist LV, Hofmeyer MR, Grunawalt JC, et al. Task‐specific resistance training to improve the ability of activities of daily living‐impaired older adults to rise from a bed and from a chair. Journal of the American Geriatrics Society 2001;49:1418‐27. - PubMed
    1. Alexander NB, Grunawalt JC, Carlos S, Augustine J. Bed mobility task performance in older adults. Journal of Rehabilitation Research and Development 2000;37:633‐8. - PubMed
Backman 1986 {published data only}
    1. Backman SJ, Mannell RC. Removing attitudinal barriers to leisure behavior and satisfaction: a field experiment among the institutionalized elderly. Therapeutic Recreation Journal 1986;20:46‐53. - PubMed
Beck 2009 {published data only}
    1. Beck AM, Damkjaer K, Tetens I. Lack of compliance of staff in an intervention study with focus on nutrition, exercise and oral care among old (65+ yrs) Danish nursing home residents. Aging Clinical and Experimental Research 2009;21(2):143‐9. - PubMed
Becker 2003 {published data only}
    1. Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter‐Jung B, et al. Effectiveness of a multifaceted intervention on falls in nursing home residents. American Geriatrics Society 2003;51(3):306‐13. - PubMed
Binder 1995 {published data only}
    1. Binder EF. Implementing a structured exercise program for frail nursing home residents with dementia: issues and challenges. Journal of Aging and Physical Activity 1995;3:383‐95.
Blair 1996 {published data only}
    1. Blair CE, Lewis R, Vieweg V, Tucker R. Group and single‐subject evaluation of a programme to promote self‐care in elderly nursing home residents. Journal of Advanced Nursing 1996;24:1207‐13. - PubMed
Brill 1999b {published data only}
    1. Brill PA, Cornman CB, Davis DR, Lane MJ, Mustafa T, Sanderson M, et al. The value of strength for older adults. Home Care Provider 1999;4(2):62‐6. - PubMed
    1. Brill PA, Matthews M, Mason J, Davis D, Mustafa T, Macera C. Improving functional performance through a group‐based free weight strength training program in residents of two assisted living communities. Physical and Occupational Therapy in Geriatrics 1998;15(3):57‐69.
Carmeli 2000 {published data only}
    1. Carmeli E, Reznick AZ, Coleman R, Carmeli V. Muscle strength and mass of lower extremities in relation to functional abilities in elderly adults. Gerontology 2000;46:249‐57. - PubMed
Collier 2007 {published data only}
    1. Collier L. The use of multi‐sensory stimulation to improve functional performance in older people with dementia: a randomised single blind trial. England, University of Southampton (United Kingdom) 2007:219.
de Carvalho Bastone 2004 {published data only}
    1. Carvalho Bastone A, Wilson JF. Effect of an exercise program on functional performance of institutionalized elderly. Journal of Rehabilitation Research & Development 2004;41(5):659‐68. - PubMed
Dyer 2004 {published data only}
    1. Dyer CAE, Taylor GJ, Reed M, Dyer CA, Robertson DR, Harrington R. Falls prevention in residential care homes: a randomised controlled trial. Age and Ageing 2004;33:596‐602. - PubMed
Eggermont 2009 {published data only}
    1. Eggermont LH, Swaab DF, Hol EM, Scherder EJ. Walking the line: a randomised trial on the effects of a short term walking programme on cognition in dementia. Journal of Neurology, Neurosurgery, and Psychiatry 2009;7:802‐4. - PubMed
Evans 1995 {published data only}
    1. Evans WJ. Effects of exercise on body composition and functional capacity of the elderly. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1995;50A(Special Issue):147‐50. [DOI: 10.1093/gerona/50A.Special_Issue.147] - DOI - PubMed
Fisher 1991 {published data only}
    1. Fisher NM, Pendergast DR, Calkins E. Muscle rehabilitation in impaired elderly nursing home residents. Archives of Physical Medicine and Rehabilitation 1991;72:181‐5. - PubMed
Fitzimmons 2001 {published data only}
    1. Fitzsimmons S, Buettner LL. Easy rider wheelchair biking: a nursing‐recreation therapy clinical trial for the treatment of depression. Journal of Gerontological Nursing 2001;27(5):14‐23. - PubMed
Fox 2000 {published data only}
    1. Fox P, Richardson J, McInnes B, Tait D, Bedard M. Effectiveness of a bed positioning program for treating older adults with knee contractures who are institutionalized. Physical Therapy 2000;80(4):363‐72. - PubMed
Friedman 1991 {published data only}
    1. Friedman R, Tappen RM. The effect of planned walking on communication in Alzheimer's disease. Journal of the American Geriatrics Society 1991;39:650‐4. - PubMed
Goldberg 1980 {published data only}
    1. Goldberg WG, Fitzpatrick JJ. Movement therapy with the aged. Nursing Research 1980;29(6):339‐46. - PubMed
Hagen 2003 {published data only}
    1. Hagen B, Armstrong‐Esther C, Sandilands M. On a happier note: validation of musical exercise for older persons in long‐term care settings. International Journal of Nursing Studies 2003;40:347‐57. - PubMed
Hara 2007 {published data only}
    1. Hara T, Shimada T. Effects of exercise on the improvement of the physical functions of the elderly. Journal of Physical Therapy Science 2007;19(1):15‐26.
Hopman‐Rock 1999 {published data only}
    1. Hopman‐Rock M, Staats PGM, Tak EC, Dröes RM. The effects of a psychomotor activation programme for use in groups of cognitively impaired people in homes for the elderly. Journal of Geriatric Psychiatry 1999;14:633‐42. - PubMed
Ikezoe 2005 {published data only}
    1. Ikezoe T, Tsutou A, Asakawa Y, Tsuboyama T. Low intensity training for frail elderly women: long‐term effects on motor function and mobility. Journal of Physical Therapy Science 2005;17(1):43‐9.
Jensen 2002 {published data only}
    1. Jensen J, Lundin‐Olsson L, Nyberg L, Gustafson Y. Fall and injury prevention in older people living in residential care facilities: a cluster randomized trial. Annals of Internal Medicine 2002;136(10):733‐41. - PubMed
Jensen 2004 {published data only}
    1. Jensen J, Nyberg L, Rosendahl E, Gustafson Y, Lundin‐Olsson L. Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities. Aging Clinical and Experimental Research 2004;16(4):283‐92. - PubMed
Judge 1993 {published data only}
    1. Judge JO, Underwood M, Gennosa T. Exercise to improve gait velocity in older persons. Archives of Physical Medicine and Rehabilitation 1993;74:400‐6. - PubMed
Kapasi 2007 {published data only}
    1. Kapasi Z, Ignatius J, Kuhn B, Master P, Schnelle J, Fahey J. Effects of an exercise intervention on the relationship between muscle strength and immune cells in frail elderly nursing home residents. Journal of Geriatric Physical Therapy 2007;30(3):142‐3.
Kelly 1983 {published data only}
    1. Kelly GR, McNally E, Chambliss L. Therapeutic recreation for long‐term care patients. Therapeutic Recreation Journal 1983;1:33‐41. - PubMed
Kerse 2004 {published data only}
    1. Kerse N, Butler M, Robinson E, Todd M. Fall prevention in residential care: a cluster, randomized, controlled trial. Journal of American Geriatrics Society 2004;52:524‐31. - PubMed
Koc 2008 {published data only}
    1. Koc A, Turgut G, Kilic M, Karabulut N, Tufekci FG, Kockar C. Exercise therapy for vital symptoms and daily functioning. International Journal of Stroke 2008;3 Suppl 1:297 (Abst. PO02‐135).
Krishnamurthy 2007 {published data only}
    1. Krishnamurthy MN, Telles S. Assessing depression following two ancient Indian interventions: effects of yoga and ayurveda on older adults in a residential home. Journal of Gerontological Nursing 2007;33(2):17‐23. - PubMed
Light 1984 {published data only}
    1. Light KE, Nuzik S, Personius W, Barstrom A. Low‐load prolonged stretch vs. high‐load brief stretch in treating knee contractures. Physical Therapy 1984;64(3):330‐3. - PubMed
MacRae 1996 {published data only}
    1. MacRae PG, Asplund LA, Schnelle JF, Ouslander JG, Abrahamse A, Morris C. A walking program for nursing home residents: effects on walk endurance, physical activity, mobility, and quality of life. Journal of the American Geriatrics Society 1996;44:175‐80. - PubMed
McMurdo 2000 {published data only}
    1. McMurdo ME, Millar AM, Daly F. A randomized controlled trial of fall prevention strategies in old peoples' homes. Gerontology 2000;46:83‐7. - PubMed
Moye 1996 {published data only}
    1. Moye J, Hanlon S. Relaxation training for nursing home patients: suggestions for simplifying and individualizing treatment. Clinical Gerontologist 1996;16(3):37‐48.
Mozley 2007 {published data only}
    1. Mozley CG, Schneider J, Cordingley L, Molineux M, Duggan S, Hart C, et al. The care home activity project: does introducing an occupational therapy programme reduce depression in care homes?. Aging & Mental Health 2007;11(1):99‐107. - PubMed
Nowalk 2001 {published data only}
    1. Nowalk MP, Prendergast JM, Bayles CM, D'Amico FJ, Colvin GC. A randomized trial of exercise programs among older individuals living in two long‐term care facilities: The FallsFREE Program. Journal of the American Geriatrics Society 2001;49:859‐65. - PubMed
O'Hagan 1994 {published data only}
    1. O'Hagan CM, Smith DM, Pileggi KL. Exercise classes in rest homes: effect on physical function. The New Zealand Medical Journal 1994;107:39‐40. - PubMed
Ray 1997 {published data only}
    1. Ray WA, Taylor JA, Meador KG, Thapa PB, Brown AK, Kajihara HK, et al. A randomized trial of a consultation service to reduce falls in nursing homes. JAMA: Journal of the American Medical Association 1997;278(7):557‐62. - PubMed
Remsburg 1999 {published data only}
    1. Remsburg RE, Armacost KA, Radu C, Bennett RG. Two models of restorative nursing care in the nursing home: designated versus integrated restorative nursing assistants. Geriatric Nursing 1999;20(6):321‐6. - PubMed
Rydwik 2004 {published data only}
    1. Rydwik E, Frändin K, Akner G. Physical training in institutionalized elderly people with multiple diagnoses ‐ a controlled pilot study. Archives of Gerontology and Geriatrics 2005;40:29‐44. - PubMed
Sato 2007 {published data only}
    1. Sato D, Kaneda K, Wakabayashi H, Nomura T. Some effect of water exercise frequency on functional mobility in nursing care elderly. Japanese Journal of Physical Fitness and Sports Medicine 2007;56(1):141‐8.
Sherrington 1997 {published data only}
    1. Sherrington C, Lord SR. Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 1997;78:208‐12. - PubMed
Shimada 2003 {published data only}
    1. Shimada H, Obuchi S, Furuna T, Suzuki T. New intervention program for preventing falls among frail elderly people. American Journal of Physical Medicine and Rehabilitation 2004;83(7):493‐9. - PubMed
    1. Shimada H, Uchiyama Y, Kakurai S. Specific effects of balance and gait exercises on physical function among the frail elderly. Clinical Rehabilitation 2003;17:472‐9. - PubMed
Shumway‐Cook 1997 {published data only}
    1. Shumway‐Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in the community‐dwelling older adults. Physical Therapy 1997;77(1):46‐57. - PubMed
Stasi 2004 {published data only}
    1. Stasi MF, Amati D, Costa C, Resta D, Senepa G, Scarafioiti C, et al. Pet‐Therapy: a trial for institutionalized frail elderly patients. Archives of Gerontology and Geriatrics 2004;9:407‐12. - PubMed
Steffen 1995 {published data only}
    1. Steffen TM, Mollinger LA. Low‐load, prolonged stretch in the treatment of knee flexion contractures in nursing home residents. Physical Therapy 1995;75(10):886‐97. - PubMed
Stones 1993 {published data only}
    1. Stones MJ, Dawe D. Acute exercise facilitates semantically cued memory in nursing home residents. Journal of the American Geriatrics Society 1993;41:531‐4. - PubMed
Tan 2004 {published data only}
    1. Tan YSC, Alina I, Chua SH, Lee SL, Kumari PM, Vasanthi V. The effects of exercise on the functional status of the elderly persons living in the long‐term care setting of a psychiatric hospital. Annals Academy of Medicine 2004;33(5):S22‐4. - PubMed
Tseng 2006 {published data only}
    1. Tseng CN, Chen CC, Wu SC, Lin LC. Effects of a range‐of‐motion exercise programme. Journal of Advanced Nursing 2006;57(2):181‐91. - PubMed
van Heugten 2000 {published data only}
    1. Heugten CM, Dekker J, Deelman BG, Stehmann‐Saris JC, Kinebanian A. Rehabilitation of stroke patients with apraxia: the role of additional cognitive and motor impairments. Disability and Rehabilitation 2000;22(12):547‐54. - PubMed
Wolf 2001 {published data only}
    1. Wolf B, Feys H, Weerdt W, Meer J, Noom M, Aufdemkampe G. Effect of a physical therapeutic intervention for balance problems in the elderly: a single‐blind, randomized, controlled multicentre trial. Clinical Rehabilitation 2001;15:624‐36. - PubMed
Yip 2004 {published data only}
    1. Yip YB, Sit JWH, Wong DYS. A quasi‐experimental study on improving arthritis self‐management for residents of an aged people's home in Hong Kong. Psychology Health and Medicine 2004;9(2):235‐46.

References to studies awaiting assessment

Cakar 2010 {published data only}
    1. Cakar E, Dincer U, Kiralp MZ, Cakar DB, Durmus O, Kilac H, et al. Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long‐term care facility. European Journal of Physical and Rehabilitation Medicine 2010;46(1):59‐67. - PubMed
Chang 2010 {published data only}
    1. Chang SH, Fang MC, Chang HY. Enhancing three bliss concepts among nursing home elders in Taiwan. Journal of Clinical Nursing 2010;19(5‐6):682‐90. - PubMed
Chen 2010a {published data only}
    1. Chen KM, Fan JT, Wang HH, Wu SJ, Li CH, Lin HS. Silver yoga exercises improved physical fitness of transitional frail elders. Nursing Research 2010;59(5):364‐70. - PubMed
Ciairano 2010 {published data only}
    1. Ciairano S, Liubicich ME, Rabaglietti E. The effects of a physical activity programme on the psychological wellbeing of older people in a residential care facility: an experimental study. Ageing & Society 2010;30(4):609‐26.
Dechamps 2010 {published data only}
    1. Dechamps A, Alban R, Jen J, Decamps A, Traissac T, Dehail P. Individualized cognition‐action intervention to prevent behavioral disturbances and functional decline in institutionalized older adults: a randomized pilot trial. International Journal of Geriatric Psychiatry 2010;25(8):850‐60. - PubMed
Dechamps 2010a {published data only}
    1. Dechamps A, Diolez P, Thiaudière E, Tulon A, Onifade C, Vuong T, et al. Effects of exercise programs to prevent decline in health‐related quality of life in highly deconditioned institutionalized elderly persons: a randomized controlled trial. Archives of Internal Medicine 2010;170(2):162‐9. - PubMed
de Greef 2006 {published data only}
    1. Greef MH, Weening‐Dijksterhuis B, Buren M, Hardeman F, Slutter K. The effect of a physiotherapeutic exercise programme on disability in older adults. Nederlands tijdschrift voor Fysiotherapie 2006;5:106‐10. [ISSN 0377 208X]
Deschamps 2009 {published data only}
    1. Deschamps A, Onifade C, Decamps A, Bourdel‐Marchasson I. Health‐related quality of life in frail institutionalized elderly: effects of a cognition‐action intervention and Tai Chi. Journal of Aging and Physical Activity 2009;17(2):236‐48. - PubMed
Fonseca 2010 {published data only}
    1. Fonseca MD, Cader SA, Dantas EHM, Bacelar SC, Silva EB, Leal SM. Respiratory muscle training programs: impact on the functional autonomy of the elderly. Revista da Associação Médica Brasileira 2010;56(6):642‐8. - PubMed
Frändin 2009 {published data only}
    1. Andresen M, Runge U, Hoff M, Puggaard L. Perceived autonomy and activity choices among physically disabled older people in nursing home settings: a randomized trial. Journal of Aging and Health 2009;21(8):1133‐58. - PubMed
    1. Bergland A, Narum I, Grönstedt H, Hellström K, Helbostad JL, Puggaard L, et al. Evaluating the feasibility and intercorrelation of measurements on the functioning of residents living in Scandinavian nursing homes. Physical & Occupational Therapy in Geriatrics 2010;28(2):154‐69.
    1. Frändin K, Borell L, Grönstedt H, Bergland A, Helbostad J L, Puggaard L, et al. A Nordic multi‐center study on physical and daily activities for residents in nursing home settings: design of a randomized, controlled trial. Aging Clinical and Experimental Research 2009;21(4‐5):314‐22. - PubMed
    1. Vinsnes AG, Helbostad JL, Nyronning S, Granbo R, Seim A. A general physical training programme for residents in nursing homes and the effect on urinary incontinence: a randomized controlled trial. Neurourology and Urodynamics 2010;29(6):852‐3.
Gallon 2011 {published data only}
    1. Gallon D, Rodacki ALF, Hernandez SG, Drabovski B, Outi T, Bittencourt LR, et al. The effects of stretching on the flexibility, muscle performance and functionality of institutionalized older women. Brazilian Journal of Medical and Biological Research 2011;44(3):229‐35. - PubMed
Gerritsen 2011 {published data only}
    1. Gerritsen DL, Smalbrugge M, Teerenstra S, Leontjevas R, Adang EM, Vernooij‐Dassen MJFJ, et al. Act In case of Depression: the evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol. BMC Psychiatry 2011;11(91):1‐7. [Netherlands Trial Register (NTR): NTR1477] - PMC - PubMed
Holmerová 2010 {published data only}
    1. Holmerová I, Machácovv K, Vanková H, Veleta P, Jurasková B, Hrnciariková D, et al. Effect of the Exercise Dance for Seniors (EXDASE) program on lower‐body functioning among institutionalized older adults. Journal of Aging and Health 2010;22(1):106‐19. - PubMed
Hsu 2011 {published data only}
    1. Hsu JK, Thibodeau R, Wong SJ, Zukiwsky D, Cecile S, Walton DM. A "Wii" bit of fun: the effects of adding Nintendo Wii® Bowling to a standard exercise regimen for residents of long‐term care with upper extremity dysfunction. Physiotherapy Theory and Practice 2011;27(3):185‐93. - PubMed
Jeon 2009 {published data only}
    1. Jeon EY, Kim SY, Yoo HS. Effects of music therapy and rhythmic exercise on quality of life, blood pressure and upper extremity muscle strength in institution‐dwelling elderly women. Journal of Korean Academy of Nursing 2009;39(6):829‐39. - PubMed
Kemoun 2010 {published data only}
    1. Kemoun G, Thibaud M, Roumagne N, Carette P, Albinet C, Toussaint L, et al. Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dementia and Geriatric Cognitive Disorders 2010;29(2):109‐14. - PubMed
Lee 2007 {published data only}
    1. Lee YK. Promoting psychosocial health of elderly residential care home residents: implementation of a Tai Chi program. Chinese University of Hong Kong (People's Republic Of China) 2007.
Lee 2010 {published data only}
    1. Lee LY, Lee DT, Woo J. The psychosocial effect of Tai Chi on nursing home residents. Journal of Clinical Nursing 2010;19(7‐8):927‐38. - PubMed
Montgomery 2010 {published data only}
    1. Montgomery CA. Effects of quantitative progressive exercise rehabilitation on muscle function, functional performance, and quality of life of assisted living residents. Dissertation Abstracts International: Section B: The Sciences and Engineering, 2010.
Nalbant 2009 {published data only}
    1. Nalbant O, Toktaş N, Toraman NF, Ogüş C, Aydin H, Kaçar C, et al. Vitamin E and aerobic exercise: effects on physical performance in older adults. Aging Clinical and Experimental Research 2009;21(2):111‐21. - PubMed
Pan 2011 {published data only}
    1. Pan T‐L, Lin S‐Y. Ameliorating elder frailty in nursing home residents: the efficacy of group play. Journal of Nursing & Healthcare Research 2011;7(1):54.
Piedras‐Jorge 2010 {published data only}
    1. Piedras‐Jorge C, Meléndez‐Moral JC, Tomás‐Miguel JM. Benefits of physical activity in nursing home residents. Revista Española de Geriatría y Gerontología 2010;45(3):131‐5. - PubMed
Resnick 2009 awaiting {published data only}
    1. Resnick B, Cayo J, Galik E, Pretzer‐Aboff I. Implementation of the 6‐week educational component in the Res‐Care intervention: process and outcomes. Journal of Continuing Education in Nursing 2009, issue 8:353‐60. - PubMed
Rosendahl 2006 awaiting {published data only}
    1. Carlsson M, Littbrand H, Gustafson Y, Lundin‐Olsson L, Lindelöf N, Rosendahl E, et al. Effects of high‐intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial. Journal of Nutrition, Health & Aging 2011;15(7):554‐60. - PubMed
    1. Conradsson M, Littbrand H, Lindelof N, Gustafson Y, Rosendahl E. Effects of a high‐intensity functional exercise programme on depressive symptoms and psychological well‐being among older people living in residential care facilities: a cluster‐randomized controlled trial. Aging & Mental Health 2010;14(5):565‐76. - PubMed
    1. Littbrand H, Carlsson M, Lundin‐Olsson L, Lindelöf N, Håglin L, Gustafson Y, et al. Effect of a high‐intensity functional exercise program on functional balance: preplanned subgroup analyses of a randomized controlled trial in residential care facilities. Journal of the American Geriatrics Society 2011;59(7):1274‐82. - PubMed
    1. Rosendahl E. Fall prediction and a high‐intensity functional exercise programme to improve physical functions and to prevent falls among older people living in residential care facilities. Umeå University Medical Dissertations, 2006.
Sackley 2010 {published data only}
    1. Health Technology Assessment. A cluster randomised controlled trial of an occupational therapy intervention for residents with stroke living in UK care‐homes (Project record). Health Technology Assessment 2010.
Serra‐Rexach 2011 {published data only}
    1. Serra‐Rexach JA, Bustamante‐Ara N, Hierro Villarán M, González Gil P, Sanz Ibáñez MJ, Blanco Sanz N, et al. Short‐term, light‐ to moderate‐intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial. Journal of the American Geriatrics Society 2011;59(4):594‐602. - PubMed
Sung 2007 {published data only}
    1. Sung KW. The effect of a health maintenance program on physical function and mental health of the elderly in nursing homes. Daehan Ganho Haghoeji 2007;37(4):478‐89. - PubMed
Swiniarek 2009 {published data only}
    1. Swiniarek D, Elchner G, Kleist B, Beyer WF. Effects of 3‐month whole‐body vibration training on hip density trunk muscle strength, and balance in elderly people. Manuelle Medizin 2009;47(2):117‐22.
Takeuchi 2011 {published data only}
    1. Takeuchi R, Hatano Y, Yamasaki M. The influence of different exercise intervention programs on changes in quality of life and activity of daily living levels among geriatric nursing home residents. Journal of Physical Therapy Science 2011;23(1):133‐6.
Tse 2010 {published data only}
    1. Tse MM. Therapeutic effects of an indoor gardening programme for older people living in nursing homes. Journal of Clinical Nursing 2010;19(7‐8):949‐58. - PubMed
Żak 2006 {published data only}
    1. Żak M. Physical rehabilitation regimens designed to aid the frail elderly in executing postural shifts safely and coping after incidental falls. Postępy Rehabilitacji [Advances in Rehabilitation] 2006;20(1):17‐24.

References to ongoing studies

ISRCTN43769277 {published data only}
    1. ISRCTN43769277. Older people's exercise intervention in residential and nursing accommodation. http://www.controlled‐trials.com/ISRCTN43769277 (accessed November 2007).
NCT00105807 {published data only}
    1. NCT00105807. The effect of exercise on muscle, function and cost in VA nursing home residents. http://clinicaltrials.gov/show/NCT00105807 (accessed December 2007).
NCT00218842 {published data only}
    1. NCT00218842. Physical and daily activity for residents in a nursing home setting ‐ A Nordic multi‐centre study. http://www.clinicaltrials.gov/ct2/show/NCT00218842 (accessed November 2007).
Serra‐Rexach 2009 {published data only}
    1. Serra‐Rexach JA, Ruiz JR, Bustamante‐Ara N, Villarán MH, Gil PG, Sanz Ibáñez MJ, et al. Health enhancing strength training in nonagenarians (STRONG): rationale, design and methods. BMC Public Health 2009;9:152. - PMC - PubMed

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