Effectiveness of Community-Based Rehabilitation (CBR) Centers for Improving Physical Fitness for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Abstract

To synthesise the best available evidence for the effectiveness of interventions delivered in community-based rehabilitation (CBR) centers on physical fitness, for community-dwelling older adults living in Asian countries. This study is a systematic review and meta-analysis. Seven English and two Chinese electronic databases were searched for randomised controlled trials (RCTs) and quasi-experimental studies that were conducted by centers providing CBR. Independent reviewers screened, quality-appraised and extracted data. The primary outcome was physical fitness measured by validated assessment tools, including the Timed Up and Go Test (TUG), gait speed, hand grip strength, Functional Reach Test (FRT), and one-leg standing test. Assessments of activity of daily living and quality of life using tools including the Barthel Index, Short Form (SF)-12, and SF-36 were secondary outcomes. After screening 5,272 studies, 29 studies were included (16 RCTs, 13 quasi-experimental studies) from four countries. Meta-analyses found that CBR programs significantly decreased TUG time (mean difference [MD], -1.89 seconds; 95% confidence interval [95% CI], -2.84 to -0.94; I2=0%; Z=3.90, p<0.0001), improved gait speed (MD, 0.10 m/s; 95% CI, 0.01-0.18; I2=0%; Z=2.26, p=0.02), and increased one-leg standing time (MD, 2.81 seconds; 95% CI, 0.41-5.22; I2=0%; Z=2.29, p=0.02). Handgrip strength and FRT showed no statistically significant improvement in the meta-analyses. CBR may improve aspects of physical fitness for older adults in Asian countries. However, variability in intervention components and measurement tools reduced the ability to pool individual studies. Further trials are required with robust designs including standardised measures of physical fitness.

Keywords: Community; Elderly; Physical fitness; Rehabilitation.

Fig. 1.

Effects of CBR program on TUG. Values are in second. CBR, community-based rehabilitation; TUG, Timed Up and Go Test; SD, standard deviation; IV, inverse variance; 95% CI, 95% confidence interval; df, degrees of freedom.

Fig. 2.

Forest plot of the effects of CBR on gait speed Values are in meter per second (m/s). CBR, community-based rehabilitation; SD, standard deviation; IV, inverse variance; 95% CI, 95% confidence interval; df, degrees of freedom.

Fig. 3.

Forest plot of the effects of CBR on handgrip strength. Values are in kilogram. CBR, community-based rehabilitation; SD, standard deviation; IV, inverse variance; 95% CI, 95% confidence interval; df, degrees of freedom.

Fig. 4.

Forest plot of the effects of CBR on one-leg standing time. Values are in second. CBR, community-based rehabilitation; SD, standard deviation; IV, inverse variance; 95% CI, 95% confidence interval; df, degrees of freedom.

Fig. 5.

Forest plot of the effects of CBR on Functional Reach Test Values are given centimeter. CBR, community-based rehabilitation; SD, standard deviation; IV, inverse variance; 95% CI, 95% confidence interval; df, degrees of freedom.

Fig. 6.

Forest plot (un-pooled) of the effects of CBR on physical fitness Fugl-Meyer Assessment on older adults with stroke Values are given point. CBR, community-based rehabilitation; SD, standard deviation; IV, inverse variance; 95% CI, 95% confidence interval; df, degrees of freedom.

Fig. 7.

Forest plot (un-pooled) of the effects of CBR measured using the Barthel Index. Values are given point. CBR, community-based rehabilitation; SD, standard deviation; IV, inverse variance; 95% CI, 95% confidence interval; df, degrees of freedom.

Fig. 8.

Forest plot of the effects of CBR on health-related quality of life (SF-36) on older adults Values are given point. CBR, community-based rehabilitation; SF, Short Form; SD, standard deviation; IV, inverse variance; 95% CI, 95% confidence interval; df, degrees of freedom.

Fig. 9.

Forest plot of the effects of CBR on health -related quality of life (SF-12) on older adults Values are given point. CBR, community-based rehabilitation; SF, Short Form; SD, standard deviation; IV, inverse variance; 95% CI,  95% confidence interval; df, degrees of freedom.