PDF(Pubmed)
Abstract：
BACKGROUND: Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home, continuing to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. Existing literature demonstrates the concept having a reduced length of stay in stroke inpatients and medical older adults. This systematic review aims to explore the totality of evidence for the use of ESD in older adults hospitalised with orthopaedic complaints.
METHODS: A literature search of Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE, CINAHL and MEDLINE in EBSCO was carried out on January 10th, 2024. Randomised controlled trials or quasi-randomised controlled trials were the study designs included. For quality assessment, The Cochrane Risk of Bias Tool 2.0 was used and GRADE was applied to evaluate the certainty of evidence. Acute hospital length of stay was the primary outcome. Secondary outcomes included the numbers of fallers and function. A pooled meta-analysis was conducted using RevMan software 5.4.1.
RESULTS: Seven studies with a population of older adults post orthopaedic surgery met inclusion criteria, with five studies included in the meta-analysis. Study quality was predominantly of a high risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (FEM, MD = -5.57, 95% CI -7.07 to -4.08, I2 = 0%). No statistically significant effects favouring ESD interventions were established in secondary outcomes.
CONCLUSIONS: In the older adult population with orthopaedic complaints, ESD can have a statistically significant impact in reducing hospital length of stay. This review identifies an insufficient existing evidence base to establish the key benefits of ESD for this population group. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.
METHODS: A literature search of Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE, CINAHL and MEDLINE in EBSCO was carried out on January 10th, 2024. Randomised controlled trials or quasi-randomised controlled trials were the study designs included. For quality assessment, The Cochrane Risk of Bias Tool 2.0 was used and GRADE was applied to evaluate the certainty of evidence. Acute hospital length of stay was the primary outcome. Secondary outcomes included the numbers of fallers and function. A pooled meta-analysis was conducted using RevMan software 5.4.1.
RESULTS: Seven studies with a population of older adults post orthopaedic surgery met inclusion criteria, with five studies included in the meta-analysis. Study quality was predominantly of a high risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (FEM, MD = -5.57, 95% CI -7.07 to -4.08, I2 = 0%). No statistically significant effects favouring ESD interventions were established in secondary outcomes.
CONCLUSIONS: In the older adult population with orthopaedic complaints, ESD can have a statistically significant impact in reducing hospital length of stay. This review identifies an insufficient existing evidence base to establish the key benefits of ESD for this population group. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.
摘要：
背景：早期支持放电（ESD）旨在将急性和社区护理联系起来，允许住院患者回家，继续从医疗保健专业人员那里获得必要的投入，否则他们将在医院接受。现有文献表明，该概念在中风住院患者和医疗老年人中的住院时间缩短。本系统评价旨在探讨在骨科投诉住院的老年人中使用ESD的全部证据。
方法：对Cochrane库（CENTRAL）中的Cochrane对照试验中央登记册进行文献检索，EMBASE,CINAHL和MEDLINE在EBSCO于1月10日进行，2024.研究设计包括随机对照试验或准随机对照试验。对于质量评估，使用Cochrane偏差风险工具2.0，并应用GRADE评估证据的确定性。急性住院时间是主要结果。次要结果包括下降人数和功能。使用RevMan软件5.4.1进行汇总荟萃分析。
结果：七项针对骨科手术后老年人群的研究符合纳入标准，5项研究纳入荟萃分析。研究质量主要是偏倚的高风险。有利于ESD干预的统计学显著影响仅在住院时间方面可见(FEM，MD=-5.57，95%CI-7.07至-4.08，I2=0%）。在次要结局中，没有统计学意义的影响有利于ESD干预。
结论：在患有骨科疾病的老年人群中，ESD可以在减少住院时间方面具有统计学上显著的影响。这项审查确定了现有的证据基础不足，无法确定ESD对该人群的主要好处。该领域需要进一步开展更高质量的研究，使用标准化的干预措施和结果措施。
方法：对Cochrane库（CENTRAL）中的Cochrane对照试验中央登记册进行文献检索，EMBASE,CINAHL和MEDLINE在EBSCO于1月10日进行，2024.研究设计包括随机对照试验或准随机对照试验。对于质量评估，使用Cochrane偏差风险工具2.0，并应用GRADE评估证据的确定性。急性住院时间是主要结果。次要结果包括下降人数和功能。使用RevMan软件5.4.1进行汇总荟萃分析。
结果：七项针对骨科手术后老年人群的研究符合纳入标准，5项研究纳入荟萃分析。研究质量主要是偏倚的高风险。有利于ESD干预的统计学显著影响仅在住院时间方面可见(FEM，MD=-5.57，95%CI-7.07至-4.08，I2=0%）。在次要结局中，没有统计学意义的影响有利于ESD干预。
结论：在患有骨科疾病的老年人群中，ESD可以在减少住院时间方面具有统计学上显著的影响。这项审查确定了现有的证据基础不足，无法确定ESD对该人群的主要好处。该领域需要进一步开展更高质量的研究，使用标准化的干预措施和结果措施。
