Occupational therapy interventions to address hospital associated deconditioning among older people: A scoping review protocol

Background

Deconditioning syndrome is defined as a ‘condition of physiological, psychological and functional decline that occurs as a result of complex physical changes following prolonged bed rest and the associated loss of muscle strength’ (Arora, 2022). Among older people hospital-associated deconditioning, also known as post-hospital syndrome, is well recognized, with up to 30% of older people experiencing functional decline following admission (Loyd et al., 2020).

For older people, hospital-acquired deconditioning is associated with increased risk of mortality, increased likelihood of re-hospitalization and institutionalization within 12 months (Hoyer et al., 2014; van Rijn et al., 2016). Moreover, for communities, hospital-acquired deconditioning is associated with higher healthcare spending and increased burden of care (Falvey et al., 2015). For this reason, there is an urgent need to identify effective approaches to prevent hospital-acquired deconditioning and to manage the impact on individuals and societies.

Existing research has focused on exercised-based interventions, typically delivered by physiotherapists or exercise physiologists. A recent systematic review indicated limited evidence to support the use of such interventions (Smith et al., 2020) and other authors have suggested that deconditioning interventions should adopt a more holistic approach and address both physical and cognitive functioning (Chen et al., 2022).

Occupational therapy has a potential role to play in prevention and treatment of hospital-associated deconditioning among older people. However, little is known about occupational therapy practice in this area and to date, no rigorous review of occupational therapy practice in this area has been published. A preliminary search of JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews and PROSPERO was completed in March 2024 and found no relevant completed or ongoing systematic or scoping reviews.

Aim

This scoping review will identify the following (i) what occupational therapy interventions exist to address deconditioning among older people and (ii) the intervention characteristics including outcomes used and impact observed.

Inclusion criteria

Methods

The Joanna Briggs Institute (JBI) scoping review methodological framework (Peters et al., 2022) will be used. Study selection and analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for scoping reviews guidelines (Tricco et al., 2018) for conducting a scoping review.

Data analysis

The results of the search will be reported in full in the final scoping review report and presented in a PRISMA flow diagram. A narrative summary will be prepared to map where and how occupational therapy contributes to prevention and/or management of hospital acquired deconditioning among older people. Where appropriate data will be synthesised to provide a comprehensive account of assessment and intervention practices. The overall review questions will be used to present results and if appropriate gaps in current knowledge will be identified.

Study status

Database searches have been completed and title and abstract screening is currently underway.