Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards

a systematic review

Mitchell N. Sarkies, Jennifer White, Kate Henderson, Romi Haas, John Bowles, Evidence Translation in Allied Health (EviTAH) Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Question: Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? Design: Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. Participants: Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. Intervention: All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. Outcome measures: Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. Results: Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35 days (95% CI 0.45 to 4.24, I2 = 0%), and may be a cost-effective way to improve function (SMD 0.09, 95% CI –0.01 to 0.19, I2 = 0%), and health-related quality of life (SMD 0.10, 95% CI –0.01 to 0.20, I2 = 0%). For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. Conclusion: The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals. Registration: PROSPERO CRD76771. [Sarkies MN, White J, Henderson K, Haas R, Bowles J, Evidence Translation in Allied Health (EviTAH) Group (2018) Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. Journal of Physiotherapy 64: 142–158]

Original languageEnglish
Pages (from-to)142-158
Number of pages17
JournalJournal of Physiotherapy
Volume64
Issue number3
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • Allied health
  • Meta-analysis
  • Physical therapy
  • Systematic review
  • Weekend

Cite this

@article{b0a466eee07141ddaa821354406a451a,
title = "Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review",
abstract = "Question: Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? Design: Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. Participants: Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. Intervention: All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. Outcome measures: Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. Results: Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35 days (95{\%} CI 0.45 to 4.24, I2 = 0{\%}), and may be a cost-effective way to improve function (SMD 0.09, 95{\%} CI –0.01 to 0.19, I2 = 0{\%}), and health-related quality of life (SMD 0.10, 95{\%} CI –0.01 to 0.20, I2 = 0{\%}). For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. Conclusion: The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals. Registration: PROSPERO CRD76771. [Sarkies MN, White J, Henderson K, Haas R, Bowles J, Evidence Translation in Allied Health (EviTAH) Group (2018) Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. Journal of Physiotherapy 64: 142–158]",
keywords = "Allied health, Meta-analysis, Physical therapy, Systematic review, Weekend",
author = "Sarkies, {Mitchell N.} and Jennifer White and Kate Henderson and Romi Haas and John Bowles and {Evidence Translation in Allied Health (EviTAH) Group} and Terry Haines and Morris, {Meg E} and Leeanne Carey and Taylor, {Nicholas F} and Holland, {Anne E} and Anne Bardoel and Cylie Williams and Lisa O'Brien and Skinner, {Elizabeth Hope} and Kathleen Philip and Kelly-Ann Bowles",
year = "2018",
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day = "1",
doi = "10.1016/j.jphys.2018.05.004",
language = "English",
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Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards : a systematic review. / Sarkies, Mitchell N.; White, Jennifer; Henderson, Kate; Haas, Romi; Bowles, John; Evidence Translation in Allied Health (EviTAH) Group.

In: Journal of Physiotherapy, Vol. 64, No. 3, 01.07.2018, p. 142-158.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards

T2 - a systematic review

AU - Sarkies, Mitchell N.

AU - White, Jennifer

AU - Henderson, Kate

AU - Haas, Romi

AU - Bowles, John

AU - Evidence Translation in Allied Health (EviTAH) Group

AU - Haines, Terry

AU - Morris, Meg E

AU - Carey, Leeanne

AU - Taylor, Nicholas F

AU - Holland, Anne E

AU - Bardoel, Anne

AU - Williams, Cylie

AU - O'Brien, Lisa

AU - Skinner, Elizabeth Hope

AU - Philip, Kathleen

AU - Bowles, Kelly-Ann

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Question: Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? Design: Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. Participants: Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. Intervention: All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. Outcome measures: Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. Results: Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35 days (95% CI 0.45 to 4.24, I2 = 0%), and may be a cost-effective way to improve function (SMD 0.09, 95% CI –0.01 to 0.19, I2 = 0%), and health-related quality of life (SMD 0.10, 95% CI –0.01 to 0.20, I2 = 0%). For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. Conclusion: The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals. Registration: PROSPERO CRD76771. [Sarkies MN, White J, Henderson K, Haas R, Bowles J, Evidence Translation in Allied Health (EviTAH) Group (2018) Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. Journal of Physiotherapy 64: 142–158]

AB - Question: Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? Design: Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. Participants: Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. Intervention: All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. Outcome measures: Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. Results: Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35 days (95% CI 0.45 to 4.24, I2 = 0%), and may be a cost-effective way to improve function (SMD 0.09, 95% CI –0.01 to 0.19, I2 = 0%), and health-related quality of life (SMD 0.10, 95% CI –0.01 to 0.20, I2 = 0%). For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. Conclusion: The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals. Registration: PROSPERO CRD76771. [Sarkies MN, White J, Henderson K, Haas R, Bowles J, Evidence Translation in Allied Health (EviTAH) Group (2018) Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. Journal of Physiotherapy 64: 142–158]

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KW - Meta-analysis

KW - Physical therapy

KW - Systematic review

KW - Weekend

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U2 - 10.1016/j.jphys.2018.05.004

DO - 10.1016/j.jphys.2018.05.004

M3 - Article

VL - 64

SP - 142

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JO - Journal of Physiotherapy

JF - Journal of Physiotherapy

SN - 1836-9553

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ER -