Interventions for reducing hospital-associated deconditioning: A systematic review and meta-analysis

To determine the effectiveness of hospital-based interventions designed to reduce Hospital-Associated Deconditioning (HAD) for people in inpatient hospital settings.

Systematic literature search of published and unpublished databases was conducted from (inception to 01 June 2020). Randomised and non-randomised controlled trials investigating the effectiveness of enhanced inpatient programmes aimed to reduce HAD in adults admitted to a hospital ward were included. Evidence was appraised using the Cochrane Risk of Bias tool and outcomes evaluated against the GRADE criteria. Where appropriate, data were pooled in meta-analyses and presented as risk difference (RD) or standardised mean difference with 95 % confidence intervals (CI).

Seven studies recruiting 12,597 participants (7864 enhanced programmes; 4349 usual care) were included. There was low-quality evidence for reduced risk of decline in physical performance for those in the enhanced programmes compared to usual care (RD: -0.04; 95 % CI: -0.08 to -0.01; N = 2085). There was low- or very-low quality evidence reporting no benefit of enhanced programmes for mobility on discharge, length of hospital stay, hospital readmission, and mortality within the first three-months post-admission (p > 0.05). There was low-quality evidence that nursing home placement and mortality at 12-months was superior through enhanced inpatient programmes compared to usual care.

Enhanced inpatient programmes targeted at HAD may offer benefit over usual care for some outcomes. There remain uncertainty in relation to how applicable the findings are to non-North American countries, which elements of an enhanced programme are most important to reduce HAD, and longer-term sequelae.