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 2.35days (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].
| Discipline Area | Score |
|---|---|
| Physician |  |
| Nurse | |
| Rehab Clinician (OT/PT) | |
Nurse rater
This is a well thought out and executed review despite the bias of considering only English publications. As a manager, I see that this is an interesting study because it explores an option to speed up the rehabilitation processes of dependent patients; although, its applicability outside their own organisational environment is limited.
Nurse rater
This interesting article supports my thoughts that a continuous rehabilitation program is of benefit for patients when it is deemed safe for them to participate. Of note is that it is not for all.
Nurse rater
This paper helps to make a decision to implement weekend Allied Health services especially in rehab settings.
Physician rater
I would have expected these results.
Physician rater
Interesting paper that shows the importance of additional service for patients during the weekend.
Rehab Clinician (OT/PT) rater
This will the new reality for many centres in Montreal very soon. The challenge will be to select the clients who will truly benefit as this is when trails at home are often attempted for CVA pts for example.
, McMaster University