Table 1.
Characteristics of the included studies. Sorted by (i) inpatient geriatric rehabilitation and (ii) geriatric rehabilitation at day hospital
| Author and year | Patient | Intervention | Comparator | Setting | Team members | Sample size (I/C) | Risk of bias |
|---|---|---|---|---|---|---|---|
| Inpatient geriatric rehabilitation | |||||||
| Applegate 1990 | Medical/surgical mix, age > 65 | Geriatric assessment unit, a 10-bed unit in a rehabilitation hospital | Usual care (47% home health care and 22% rehab units) | Rehabilitation hospital, USA | PT, OT, RN, SW, MD, SLP, audiology, dietitian, psychologist | 78/77 | High risk |
| Cohen 2002 | Medical/surgical mix with frailty, age > 65, excluded LTC | 2 × 2 factorial. Inpatient geriatric unit x outpatient geriatric clinic. Twice weekly team meetings | Usual care inpatient x usual care outpatient | 11 VA medical centres, USA | RN, SW, geriatrician. PT, OT, dietitian, pharmacist on request | 694/694 | Low risk |
| Fleming 2004 | Medical/surgical mix, age > 65 | Rehabilitation service based in social services old people’s homes | Usual health and social care | Residential facilities with rehab services in Nottingham, UK | OT/rehab assistants for all. PT, RN, MD on request | 81/84 | Low risk |
| Hinkka 2007 | Age > 65, community dwelling, functional decline, at risk of LTC in next 2 years | Multidisciplinary geriatric rehab program. Three inpatient periods (5, 11, and 5 days) over a period of 8 months. Includes CGA, rehab, classes, recreation, physical activation | Usual local social and health care services | Network of rehabilitation hospitals, local health service providers, and community organization/ churches, Finland | MD, PT, SW, OT | 321/324 | Some concerns |
| Kakutani 2018 | Age ≥ 65 with admission for acute heart failure | Critical pathway, including ADL rehab, physical exercise, education (medication adherence, smoking, sodium, weight etc.). Includes multidisciplinary component. Detailed in separate paper (Circ Rep 2019; 1: 123–130) | Usual care, multidisciplinary care team, including PT | Japan | PT, dietitian, pharmacist, RN, MD | 50/64 | Some concerns |
| Karppi 1995 | Medical/surgical mix, age > 65, community dwelling in supervised home care population | Comprehensive multidisciplinary geriatric assessment in an inpatient geriatric assessment unit | Usual home care | Joint ward (8 beds) with a rehabilitation unit (8 beds), Finland | PT, OT, RN, SW, PSW, geriatrician, psychiatrist | 104/208 | High risk |
| Rubenstein 1984 | Medical/surgical mix, age > 65 | Geriatric evaluation unit (15 beds on a 29-bed ward in intermediate-care area of the hospital, not acute care) | Usual care through the acute care process, no outpatient geriatric follow up | Veterans Centre, USA | Geriatrician, PT, OT, RN, SW, PSW, audiology, geriatric dentist, psychologist, public health nurse, physician assistant | 63/60 | Some concerns |
| Saltvedt 2002 | Acute medical, age > 75 | Geriatric evaluation and management unit. Comprehensive assessment, prevention of complications by interdisciplinary approach. Early mobilization, optimize ADLs, early rehabilitation | Usual care | University hospital, Norway | PT, OT, RN, geriatrician, dentist. SW on request | 127/127 | Some concerns |
| Cameron 1993 |
Hip fracture, age > 50 (Meta-analysis only included those not from LTC) |
“Accelerated rehab” LTC patients: quick discharge and visiting PT for LTC rehab Others: 2xPT per day, 5 days per week plus multidisciplinary care |
Usual care (LTC patients discharged when orthopedically appropriate; other patients referred to rehab and geriatrics a few days after surgery; then rehab ward) | Hospital ward, Australia |
For LTC patients: only PT For others: PT, OT, RN, SW on request, geriatrician, physiatrist, dietitian on request |
79/79 | Some concerns |
| Fordham 1986 | Hip fracture, female only, age > 65 | Orthogeriatric joint management in an acute care unit and a postacute rehab unit, if a longer stay was needed. Team rounds once a week and joint decision making regarding transfer and discharge | Usual orthopedic care | St. Luke's Hospital (long stay hospital) and District General Hospital in York, UK | Geriatrician and orthopedic doctors, RN, PT, OT, SW | 50/58 | High risk |
| Gilchrist 1988 | Hip fracture, female only, age > 65 | Orthogeriatric unit with weekly team rounds | Separate ward with no case conference or routine geriatric consult | General hospital in Glasgow, UK | Weekly rounds by geriatrician, orthopedic resident, RN, PT, OT, SW | 97/125 | Some concerns |
| Huusko 2000 | Hip fracture, age > 64 | Geriatric ward for about 2 weeks of intensive rehabilitation to promote early ambulation, self-motivation and function; PT twice a day | “Local hospital wards for standard care” | Geriatric ward in general hospital, Finland | PT, OT, RN, SW, geriatrician, physiatrist, neurologist, psychiatrist | 120/123 | High risk |
| Kennie 1988 | Hip fracture, female only, age > 65 | Geriatrician ward rounds twice a week plus a weekly multidisciplinary case conference. Same PT/OT, orthotic services as control group | Stayed on ortho ward or short stay ward. Got PT, OT, orthotic services etc | Separate hospital orthopedic ward 5km away in Stirling, UK | Geriatrician, GP, PT, OT, orthotic | 54/54 | Low risk |
| Naglie 2002 | Hip fracture, age > 70 from community and LTC |
Multidisciplinary card ward for older adults staffed by geriatrician with early mobilization. Separate ward in acute care hospital PT twice a day, Monday to Friday |
Separate usual care ward. Allied health and geriatric consult upon request | University general hospital, Canada | Geriatrician, RN, PT, OT, CNS, SW | 141/138 | Low risk |
| Prestmo 2015 | Hip fracture, age > 70 from community only (excluded LTC) | Multidisciplinary comprehensive geriatric ward, including geriatric syndromes, mental health, functional status, social situation, early discharge planning and early mobilization and initiation of rehab | Orthopedic card in orthopedic trauma ward, staffed by ortho surgeon, RN, PT (No OT in control group) | Central hospital, Norway | Geriatrician, RN, PT, OT | 198/199 | Low risk |
| Sanchez Ferrin 1999 | Hip fracture, age > 64 | Geriatric functional unit, geriatric assessment and team meeting, could directly consult rehabilitation service for admission even if trauma service did not request it | Usual care from trauma service with consultations on request. Trauma service initiates rehab request | Hospital in Barcelona, Spain | Geriatrician, nurse, SW, PT, psychologist | 103/103 | Some concerns |
| Shyu 2005 | Hip fracture, age > 60 | Geriatric consultation, rehabilitation program and discharge-planning service (3 part intervention). Includes in home rehab after hospitalization | Usual care, variable PT coverage depending on insurance. Discharge home after 7 days, no in-home rehab | Large hospital, Taiwan | PT, RN, geriatrician, physiatrist | 80/82 | Some concerns |
| Shyu 2013 | Hip fracture, age ≥ 60, excluded LTC |
3-arm study, with 2 intervention groups 1. Multidisciplinary care, including geriatric consultation, rehabilitation program (daily PT), discharge planning with post-hospital services 2. Comprehensive care model, above components PLUS in-home rehab, nutritional consultation, depression management, falls prevention |
Usual care, including nursing and PT care with discharge around 5–7 days | Large hospital, Taiwan | Geriatrician, PT, RN, dietitian, psychiatrist | 200/99 | Some concerns |
| Stenvall 2007 | Hip fracture, age > 70 | Geriatric ward with a special intervention program, early mobilization, treatment of geriatric syndromes, multidisciplinary care | Conventional care in an orthopedic ward. Can be transferred to separate geriatric unit for longer rehab | Hospital, Sweden | PT, OT, RN, geriatrician | 102/97 | Some concerns |
| Swanson 1998 | Hip fracture, age > 55 | Early surgery, minimal narcotic analgesia, intense daily therapy and close monitoring of patient needs via a multidisciplinary approach. Twice a day PT; daily OT/SW | Standard orthopedic management. Geriatrician consult on request. Daily PT. OT/SW on request | Orthopedic ward of teaching hospital, Australia | PT, OT, SW, geriatrician | 36/31 | Some concerns |
| Tseng 2019 | Hip fracture, age ≥ 60 | Multidisciplinary geriatric rehab (geriatrics consultation, in hospital and in home rehab) plus diabetes care (diet, BP, dyslipidemia, education). Daily PT | Usual care, including nursing and PT care with discharge around 5–7 days | Large hospital, Taiwan | Geriatrician, PT, RN, dietitian | 88/88 | Some concerns |
| Vidan 2005 | Hip fracture, age > 65 | Geriatrician MRP daily round, rehab specialist coordinated PT. Weekly case conference | Usual care on same orthopedic wards as intervention group. Managed by surgeon and nurses | Orthopedic ward in a university hospital, Spain | Geriatrician, PT, RN, SW, rehab doctor | 155/164 | Some concerns |
| Watne 2014 | Hip fracture, no age cutoff | Orthogeriatric ward, including CGA, daily team meetings, early intensive mobilization, nutrition, discharge planning | Usual care on orthopedic ward | Oslo University Hospital, Norway | Geriatrician, nurse, PT, OT, nursing assistant. Dietitian and SW on request | 163/166 | Some concerns |
| Geriatric day hospital rehabilitation | |||||||
| Conroy (Masud) 2010 | Age > 70 with falls, from GP practices | Falls prevention program in geriatric day hospital | Usual care (can be referred to other falls prevention exercise programs, all outpatient) | 8 rural and urban GP practices, East Midlands, UK | PT, OT, geriatrician | 183/181 | Low risk |
| Eagle 1991 | Age > 65, either referred from community or prior to discharge from acute care hospitalization | Day hospital, 2 days/week, each visit 4–5 h. Multidisciplinary care and rehab | Usual care (inpatient GAU/outpatient clinic/early discharge and community follow up) | Chedoke-McMaster Day Hospital in Canada | PT, RN, SW, SLP, MD with training in geriatrics. Dietitian and pharmacist on request | 55/58 | Some concerns |
| Hui 1995 | Acute stroke age > 65. Excluded dementia | Geriatrician MRP in hospital and geriatric day hospital after discharge | Neurologist MRP in hospital and usual outpatient clinic after discharge | New Territories East region, Hong Kong | Multidisciplinary but no details | 59/61 | Some concerns |
| Tucker 1984 | Age > 55 requiring rehab | Day hospital, attended 2–3 days per week, 5.5h/visit, for 6–8 weeks | Usual care (inpatient, outpatient, domiciliary, GP, day centre, as before day hospital program) | New Zealand | PT, OT, RN, SW, MD, SLP | 62/58 | Some concerns |
| Weissert 1980 | Medicare eligible patients with functional impairment without 24h care need | Day care with strong health care orientation and physical rehabilitation | Usual care | 4 USA cities: 2 in New York, 1 in Kentucky and 1 in California | PT, OT, RN, SW, SLP, audiology, dietitian, eye care, podiatry | 253/270 | High risk |
| Woodford 1962 | Postacute older adults, age > 60, living alone in community, previous inpatients at a Geriatric Unit. With physical limitations | Day hospital, 1 day/week, 8 h per visit | Usual care | Sunderland, UK | PT, OT, MD, volunteers, admin staff | 168/163 | High risk |
LTC long-term care, CGA comprehensive geriatric assessment, PT physiotherapist, OT occupational therapist, RN registered nurse, SW social worker, MD medical doctor, SLP speech language pathologist, CNS clinical nurse specialist, I/C number of participants in the intervention and control groups