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Tremblay A.-C.1, Chamberland J.1, Ruel J.1, Salesse J.1, Beaulieu-Ringuette R.1, Hudon O.1, Ribeiro F.2
1Université du Québec à Chicoutimi, Saguenay, Canada, 2Université du Québec à Chicoutimi, Health Sciences - Physiotherapy, Saguenay, Canada
Background: Rehabilitation exercise programs are certainly the logical choice to counter or prevent adverse effects of physical inactivity to which most of the patients are susceptible during a hospitalization. However, to compare the effects from one study to the other may be complicated by several factors: interventions and assessment tools are very variable, exercise program parameters are poorly defined, most of the studies focus in one single group of patients based on their underlying diseases (ie. COPD exacerbations) or on a clinical setting (ie. early mobilization in ICU). Therefore, once individuals are hospitalized, physiotherapists´ old questions remain: considering the growing older and multicomorbidities population are there clear evidences that an exercise program more effective than usual care and, if so, for which outcomes?
Purpose: Therefore, the purpose of this systematic review and meta-analysis was to assess the effectiveness of a rehabilitation exercise program on physical functional status and health status of hospitalized adults.
Methods: The search was performed in the following databases: MEDLINE, PubMed, CINAHL, PEDro, AMED and Embase. Physical functional status was defined by any outcome that measured functional capacity or functional performance as defined by the WHO International Classification of Functioning, Disability and Health. Health status outcomes included quality of life, one-year readmission and one-year mortality rates. We included , controlled clinical trials (CCTs), randomized controlled trials (RCTs) and quasi-RCTs, that compared an exercise intervention initiated after the beginning of hospitalization versus usual care, any other intervention or a control group. A description of exercise intensity must have been present in the selected studies.
Results: We included 20 studies, where 16 were RCTs (2409 adult participants). Almost 60% of the selected studies included cardiorespiratory underlying conditions. All the participants were older than 50 years, being only 40% women. Risk of biais was variable but mostly low for blinding of outcome. Most of the studies measured and reported improvements of functional exercise capacity measured by 6-minute walk-test which made possible to perform a meta-analysis, in which the intervention, namely a rehabilitation exercise program promoted higher improvements on functional exercise capacity compared to usual care. On the other hand, effects on readmission and mortality rates, quality of life and physical activity levels were similar between exercise programs and usual care or control groups.
Conclusion(s): In this review, we were able to determine an overall effect of rehabilitation exercise programs on functional exercise capacity as measured by 6MWT during hospitalization. However, high methodological variability and the lack of proper description of exercise prescription parameters were the main issues to establish conclusive comparisons of other outcomes as physical activity, quality of life, readmission and mortality rates.
Implications: This review demonstrates that the lack well defined parameters of exercise prescription in hospital setting is an issue in providing evidence of its effectiveness, especially for populations with other conditions than cardiorespiratory diseases.
Funding acknowledgements: None
Topic: Research methodology & knowledge translation
Ethics approval: Not required for a systematic review in our institutions
All authors, affiliations and abstracts have been published as submitted.
