Effectiveness of physical rehabilitation for physical functioning and quality of life in long-term care residents with dementia: a systematic review and meta-analysis
Authors: McArthur Caitlin , Alizadehsaravi Niousha , Affoo Rebecca , Cooke Karen , Douglas Natalie , Earl Marie , Flynn Trudy , Ghanouni Parisa , Hunter Susan , Kalu Michael , Middleton Laura , Moody Elaine , Smith Cheryl , Verlinden Linda , Weeks Lori 
Published: June 2024

Objective:
The objective of this review was to evaluate the effectiveness of physical rehabilitation vs non-rehabilitation comparators for physical functioning and quality of life in long-term care (LTC) residents with dementia.

Introduction:
LTC residents living with dementia often have impaired physical functioning and quality of life. Physical rehabilitation can improve physical functioning and quality of life for individuals living with dementia; however, many LTC residents with dementia do not receive physical rehabilitation and providers are unsure what interventions to employ. A synthesis of studies examining physical rehabilitation will help guide practice in the LTC sector where most residents live with dementia. Previous syntheses have focused on all residents in LTC, specific professions, interventions, or people with dementia in the community. Our review focused on LTC residents with dementia and used a broader definition of physical rehabilitation.

Inclusion criteria:
This review included studies that evaluated physical rehabilitation in comparison with non-rehabilitation controls among LTC residents with any severity of dementia. We included experimental and quasi-experimental studies that measured the effect on activities of daily living, performance-based physical functioning, and self- or proxy-rated quality of life.

Methods:
Searches were conducted in APA PsycINFO (EBSCOhost), CINAHL (EBSCOhost), PubMed (National Library of Medicine), Embase, Scopus, and the Cochrane CENTRAL database with no date or language limitations. Two independent reviewers assessed the studies against the inclusion criteria. Two independent reviewers extracted data and conducted a methodological quality assessment using standardized checklists from JBI. Certainty of evidence was ascertained using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Where possible, studies were pooled in meta-analyses; otherwise, a narrative synthesis was presented.

Results:
Thirty-three studies were included (n=3072 participants); 27 were randomized controlled trials and (RCTs) the remaining 6 were non-randomized trials. The overall risk of bias of the included studies was low to unclear. Many of the included studies focused on increasing activity or walking, while few were individually tailored or at an intensity appropriate to induce therapeutic effects on physical function. Physical function was measured via several outcome measures, limiting our ability to pool results. There was low-certainty evidence that physical rehabilitation improved activities of daily living assessed with multiple instruments (12 RCTs, 1348 participants, standardized mean difference [SMD] 0.78; 95% CI 0.27 to 1.30) and lower extremity function assessed with the Short Physical Performance Battery Score (3 RCTs, 258 participants, mean difference [MD] 3.01 points; 95% CI 1.37 to 4.66), compared with non-rehabilitation interventions. There was very low- to moderate-certainty evidence that physical rehabilitation demonstrated no change in the 30-Second Sit to Stand Test (2 RCTs, 293 participants, MD 0.79 repetitions; 95% CI –0.45 to 2.03), 6-Minute Walk Test (4 RCTs, 363 participants, MD 17.32 meters; 95% CI –29.41 to 64.05), Timed Walk Test (4 RCTs, 400 participants, MD 0.10 meters/seconds; 95% CI –0.02 to 0.22), Timed Up and Go Test (3 RCTs, 275 participants, MD –2.89 seconds; 95% CI –6.62 to 0.84), or quality of life (4 RCTs, 419 participants, SMD 0.20; 95% CI –0.08 to 0.47).

Conclusions:
This review demonstrates that physical rehabilitation may improve activities of daily living for LTC residents living with dementia, although the evidence is of low certainty. The effect of physical rehabilitation on specific functional tasks, such as gait speed and quality of life, are less clear. Future research should examine the effects of individualized, progressive interventions on outcome measures that reflect the capacity and preferences of LTC residents with more advanced dementia.

Review registration:
PROSPERO CRD42022308444