Multicomponent rehabilitation to improve independence and functioning in elderly patients with common age-associated diseases: a scoping review

Abstract

Objective: Multicomponent rehabilitation (MR) could restore functioning in elderly patients after hospitalisation, even beyond geriatrics, but specific evidence seems lacking. This review mapped the evidence on MR in elderly patients following hospitalisation for age-related conditions regarding functioning-related outcomes.

Design: Scoping review.

Data sources: PubMed, Cochrane Library, International Clinical Trials Registry Platform and ClinicalTrials.gov (searched through 24 June 2024).

Eligibility criteria: We included randomised controlled trials (RCT) and controlled cohort studies (CCS) comparing centre-based MR with usual care (medical care excluding exercise training) in patients ≥75 years, hospitalised for age-related cardiac, neurological, oncological and orthopaedic diseases. MR was defined as exercise training and at least one additional component (eg, nutritional counselling), starting within 3 months after hospital discharge. RCTs and CCS were included from inception, without language restriction. Care dependency, physical function, health-related quality of life (HRQL) and activities of daily living (ADL) after ≥6 months follow-up were the outcomes of interest.

Data extraction and synthesis: Four reviewers independently screened titles, abstracts and full texts for inclusion and extracted data. MR components and the typology of outcome assessments used were mapped at the final data synthesis level.

Results: Out of 20 409 records, nine studies were investigated in the final data synthesis. Throughout these studies, disease education was the most frequent MR component besides exercise training, while physical function, HRQL and ADL were commonly assessed outcomes. One RCT (cardiac rehabilitation, 80±0.3 years, MR/usual care n=24/23) fully met the inclusion criteria and reported improvements in physical function (2 months) and in HRQL (2, 8, 14 months post intervention) in MR patients.

Conclusions: Evidence on MR regarding functioning-related outcomes in ≥75-year-old patients is sparse beyond geriatrics. There is an essential need for studies investigating the capabilities of MR in this growing and under-represented patient population.

Trial registration number: OSF (https://doi.org/10.17605/OSF.IO/GFK5C).

Keywords: Aged; Chronic Disease; Patient Participation; Patient Reported Outcome Measures; Patient-Centred Care; REHABILITATION MEDICINE.

Figure 1. Preferred Reporting Items for Systematic review and Meta-Analyses study selection flowchart. Green boxes indicate studies included in the final data synthesis (eligibility criteria predominantly or entirely met). MR=multicomponent rehabilitation.

Figure 2. ICF-compliant key design characteristics of studies on multicomponent rehabilitation in elderly patients. Based on the International Classification of Functioning, Disability and Health (ICF), rehabilitation provides a holistic approach focusing on patients’ functioning, as should be reflected in appropriate study characteristics. ADL, activities of daily living; HRQL, health-related quality of life.