Incorporating "moving more and sitting less" into daily activities of hospitalised older medical patients: a stakeholder-directed systematic review with meta-analysis of complex interventions

Abstract

To evaluate the benefits and harms of increasing body movement throughout the day, via activities of daily living (ADLs), in older adults (≥50 years) hospitalised with an acute medical illness. Prospectively registered systematic review (PROSPERO CRD42023438101). Five databases were searched until September 2024. Risk of bias was assessed using Cochrane Risk of Bias tools. Random-effects meta-analyses were conducted of randomised controlled trials (RCTs) and non-randomised studies separately, for use of the GRADE approach to establish evidence certainty. Main outcomes selected by stakeholders, including consumers, were: functional maintenance/improvement, independence in ADLs, self-efficacy, wellbeing, quality of life and clinical deterioration (delirium, other complications) at hospital discharge. Nineteen studies were included, with 15 suitable for meta-analysis. Estimates of effect from RCTs (n = 2) provided low-certainty evidence, favouring the intervention for independence in ADLs (SMD 0.29, 95%CI 0.05,0.52). Very low-certainty evidence from non-randomised studies favoured the intervention for maintaining/improving function (OR 1.95, 95%CI 1.53,2.50; n = 3 studies), positive beliefs about mobility (OR 2.11, 95%CI 1.28,3.48; n = 1 study), reduced pressure injury prevalence (OR 0.53, 95%CI 0.32,0.89; n = 1 study) and LOS (MD -1.01, 95%CI -0.14,-1.87; n = 9 studies). Maximising movement opportunities in hospital may improve some outcomes for older adults at risk of functional decline.