Organization of Rehabilitation Services in Randomized Controlled Trials: Which Factors Influence Functional Outcome? A Systematic Review

Cecilie Røe; Erik Bautz-Holter; Nada Andelic; Helene Lundgaard Søberg; Boya Nugraha; Christoph Gutenbrunner; Andrea Boekel; Marit Kirkevold; Grace Engen; Juan Lu

doi:10.1016/j.arrct.2022.100197

Organization of Rehabilitation Services in Randomized Controlled Trials: Which Factors Influence Functional Outcome? A Systematic Review

Arch Rehabil Res Clin Transl. 2022 Apr 13;4(2):100197. doi: 10.1016/j.arrct.2022.100197. eCollection 2022 Jun.

Authors

Cecilie Røe^{1

2

3}, Erik Bautz-Holter¹, Nada Andelic^{1

2}, Helene Lundgaard Søberg^{2

4}, Boya Nugraha⁵, Christoph Gutenbrunner⁵, Andrea Boekel⁵, Marit Kirkevold^{1

6}, Grace Engen¹, Juan Lu⁷

Affiliations

¹ Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
² Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
³ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁴ Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
⁵ Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany.
⁶ Institute of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet University, Oslo, Norway.
⁷ Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, Virginia.

Abstract

Objective: To identify factors related to the organization of rehabilitation services that may influence patients' functional outcome and make recommendations for categories to be used in the reporting of rehabilitation interventions.

Data sources: A systematic review based on a search in MEDLINE indexed journals (MEDLINE [OVID], Cumulative Index of Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials) until June 2019.

Study selection: In total 8587 candidate randomized controlled trials reporting on organizational factors of multidisciplinary rehabilitation interventions and their associations with functional outcome. An additional 1534 trials were identified from June 2019 to March 2021. Data Extraction: Quality evaluation was conducted by 2 independent researchers. The organizational factors were classified according to the International Classification for Service Organization in Health-related Rehabilitation 2.0.

Data synthesis: In total 80 articles fulfilled the inclusion criteria. There was a great heterogeneity in the terminology and reporting of service organization across all studies. Aspects of Settings including the Mode of Service Delivery was the most explicitly analyzed organizational category (44 studies). The importance of the integration of rehabilitation in the inpatient services was supported. Furthermore, several studies documented a lack of difference in outcome between outpatient vs inpatient service delivery. Patient Centeredness, Integration of Care, and Time and Intensity factors were also analyzed, but heterogeneity of interventions in these studies prohibited aggregation of results.

Conclusions: Settings and in particular the way the services were delivered to the users influenced functional outcome. Hence, it should be compulsory to include a standardized reporting of aspects of service delivery in clinical trials. We would also advise further standardization in the description of organizational factors in rehabilitation interventions to build knowledge of effective service organization.

Keywords: ICF, International Classification of Functioning, Disability, and Health; ICSO-R, International Classification System for Service Organization in Health-related Rehabilitation; RCT, randomized controlled trial; Rehabilitation.

Publication types

Review