Preventing hospital-associated disability in older adults: a living systematic review
Notice bibliographique
Résumé
Background During hospitalisation, older adults are at risk of experiencing functional decline unrelated to their initial condition, known as hospital-associated disability (HAD). HAD affects 37% of hospitalised older adults. The population of older adults is expected to grow in the coming years, likely leading to an increase in cases of HAD. Published systematic reviews have certain limitations, leaving several questions unanswered about the prevention of HAD. Randomised controlled studies (RCT) with multiple training components (such as different strengthening and balance or walking components) are difficult to compare against single-component programmes. The aim of the study was to systematically evaluate the effectiveness of (single or multi-component) physical exercise programmes on the prevention of HAD in people over 65 years of age hospitalised in an acute care setting measured at hospital discharge. Methods Living systematic review with network meta-analysis of RCTs. As this study represents a living systematic review, findings are continuously updated. Physical exercise programmes were analysed as multi-component interventions. Risk of bias was evaluated using the ROBUST-RCT tool. Results In total 5967 records were screened for eligibility; 546 full texts were assessed, and 75 studies were included in the evidence synthesis. We analysed 19 pair-wise comparisons at discharge. Inconsistency in the network-analysis was low with I2 = 8.6%. The most effective programme was strengthening compared against usual care (SMD: 0.65; 95% CI: 0.06; 1.24). The exercise programme with the highest precision was balance+strengthening+walking (SMD: 0.50; 95% CI: 0.33; 0.67). Training focused on a single-component of basic daily activities was not more effective than usual care (SMD: –0.13; 95% CI –0.44; 0.18). Conclusion This work enhances the understanding of how to prevent HAD by providing detailed insights into specific components of physical exercise. Currently, the intervention with the highest precision suggests using a multi-component approach involving balance, strengthening, and walking components to prevent HAD in an acute care setting. A major issue with traditional systematic reviews is the lengthy publication process, which often results in findings becoming outdated by the time they are published. This living systematic review enables clinicians to stay current by rapidly integrating new findings into the evidence synthesis of HAD prevention.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,049 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,010 | 0,010 |
| Bibliométrie | 0,009 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».