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. 2022 Nov 10;2022(11):CD005955. doi: 10.1002/14651858.CD005955.pub3

Fretwell 1990.

Study characteristics
Methods Design: RCT
Baseline time point (T1): first 24 hours of admission to hospital
Outcome time point (T2): discharge from hospital
Follow‐up time point (T3): 6 weeks, 3 and 6 months after randomisation
Participants Inclusion criteria: aged 75 years, not on protocol treatment or require admission to coronary or intensive care; if their physician provided consent
Exclusion criteria: none
Exercise arm
  • n at baseline: 221

  • Age mean: 83.5 (SD 5.3) years

  • Women (n (%)): 158 (71.5)


Control arm
  • n at baseline: 215

  • Age mean: 83.0 (SD 5.7) years

  • Women (n (%)): 154 (71.6)

Interventions Exercise arm
  • TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): senior care unit.

  • TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): it was hypothesised that if assessment was initiated early in a participant's stay, utilised existing personnel and was integrated into everyday practice of hospital staff, an interdisciplinary geriatric assessment process could prevent the decline of the older participants' physical, mental and emotional functions without increasing length of stay or hospital charges. Mortality expected to be similar for the 2 groups.

  • TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): not specified.

  • TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): a functional assessment was performed by nurses within their routine admission evaluations of older patients. A geriatric assessment team evaluated the participants. 3 clinic‐team meetings and 1 administrative team meeting per week occurred. Individualised care plans were developed, consultation care plans were placed in each participant's chart. Before participant discharge, an updated care plan documenting the problems that remained unresolved at discharge was prepared. The nurse co‐ordinator provided telephone follow‐up weekly for 1 month, and once at 2 months postdischarge. Participants who remained unstable at 1 month received weekly calls for up to 1 more month.

  • TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): the geriatric assessment team included a physician specialising in geriatric medicine, the nurse co‐ordinator, a physiotherapist, a clinical pharmacist, a dietitian and a social worker. Experienced nurses undertook 4‐month rotations as co‐ordinators of the geriatric assessment team.

  • TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): participants were treated face‐to‐face by all members of the team except the geriatrician. See item 4 for description of telephone follow‐up reviews.

  • TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): 18‐bed medical ward.

  • TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): not specified.

  • TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): individual care plans created.

  • TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): not specified.

  • TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): not specified.

  • TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): house staff present 20% of the time. 84% of participants discussed at initial meeting and 91% at discharge meeting. Compliance for implementing recommendations from MDT meetings 0.65 (mean number generated per participant: 9.53 (SD 5.3), number implemented: 6.1 (SD 4.7)).


Control arm
  • TIDieR item 1: usual care.

  • TIDieR item 2: not specified.

  • TIDieR item 3: not specified.

  • TIDieR item 4: not specified.

  • TIDieR item 5: not specified.

  • TIDieR item 6: not specified.

  • TIDieR item 7: traditional medical or surgical wards of the hospital.

  • TIDieR item 8: not specified.

  • TIDieR item 9: not specified.

  • TIDieR item 10: not specified.

  • TIDieR item 11: not specified.

  • TIDieR item 12: not specified.

Outcomes Katz ADL (score of 0–5) at T3 only
Modified Mini‐Mental State Examination at T3 only
Mortality during hospitalisation
Length of hospital stay
New institutionalisation at discharge from hospital
Notes