Background: Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase. Objective: To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients’ and caregivers’ quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR. Methods: Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients’ quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped. Results: We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = −2.41 days, 95%CI: [−4.61—0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver. Conclusion: This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR
BACKGROUND: Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase.OBJECTIVE: To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients' and caregivers' quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR.METHODS: Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients' quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped.RESULTS: We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = -2.41 days, 95%CI: [-4.61-0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver.CONCLUSION: This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.
MULTIFILE
Schepen in moeilijkheden op zee leveren vaak besluitvormingsproblemen op tussen de scheepseigenaar/kapitein en de kuststaat. Kuststaten en met name de lokale overheden willen een probleem schip graag zo ver mogelijk weg sturen van hun gebied terwijl de eigenaar/kapitein zijn schip graag zo snel mogelijk naar de kust, een beschutte locatie of haven wil brengen. Het onderzoek geeft onderbouwing voor de besluitvorming rond schepen in moeilijkheden, zowel voor de zeescheepvaart als de betrokken besluitvormers van oeverstaten. Het product van het project is: een, op uitgewerkte scenario’s per scheepstype en lading gebaseerde besluitvormingsprocedure voor zeeschepen in moeilijkheden
