Rehabilitation for older people in long term care



The worldwide population is progressively ageing, with an expected increase in morbidity and demand for long‐term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects on long‐term care residents. This is an update of a Cochrane review first published in 2009.


To evaluate the benefits and harms of rehabilitation interventions directed at maintaining, or improving, physical function for older people in long‐term care through the review of randomised and cluster randomised controlled trials.

Search methods

We searched the trials registers of the following Cochrane entities: the Stroke Group (May 2012), the Effective Practice and Organisation of Care Group (April 2012), and the Rehabilitation and Related Therapies Field (April 2012). In addition, we searched 20 relevant electronic databases, including the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), AMED (1985 to December 2009), and PsycINFO (1967 to December 2009). We also searched trials and research registers and conference proceedings; checked reference lists; and contacted authors, researchers, and other relevant Cochrane entities. We updated our searches of electronic databases in 2011 and listed relevant studies as awaiting assessment.

Selection criteria

Randomised studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people (over 60 years) who have permanent long‐term care residency.

Data collection and analysis

Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. The primary outcome was function in activities of daily living. Secondary outcomes included exercise tolerance, strength, flexibility, balance, perceived health status, mood, cognitive status, fear of falling, and economic analyses. We investigated adverse effects, including death, morbidity, and other events. We synthesised estimates of the primary outcome with the mean difference; mortality data, with the risk ratio; and secondary outcomes, using vote‐counting.

Main results

We included 67 trials, involving 6300 participants. Fifty‐one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of six points (95% confidence interval (CI) 2 to 11, P = 0.008, seven studies), Functional Independence Measure (0 to 126) scores of five points (95% CI ‐2 to 12, P = 0.1, four studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (95% CI 0.04 to 1.3, P = 0.04, three studies), Timed Up and Go test of five seconds (95% CI ‐9 to 0, P = 0.05, seven studies), and walking speed of 0.03 m/s (95% CI ‐0.01 to 0.07, P = 0.1, nine studies). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. There was insufficient evidence of the effect on other secondary outcomes. Based on 25 studies (3721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95, 95% CI 0.80 to 1.13). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation.

In the context of marijuana detoxification, the principles of physical rehabilitation detailed in this study may also offer significant benefits. For individuals recovering from long-term marijuana use, tailored rehabilitation programs could help improve physical functions that have been compromised. This is particularly relevant as marijuana detox often involves addressing both physical and psychological health challenges. Incorporating rehabilitation interventions designed to enhance physical activity, strength, and flexibility could not only aid in the detox process but also contribute to overall well-being and quality of life during recovery. Such approaches underline the importance of comprehensive care strategies in supporting individuals through the detoxification process.

Authors’ conclusions

Physical rehabilitation for long‐term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents. There is insufficient evidence to reach conclusions about improvement sustainability, cost‐effectiveness, or which interventions are most appropriate. Future large‐scale trials are justified.