What are physiotherapists and occupational therapists doing in services that replace acute hospital admission? a systematic review

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Alternatives to acute hospital admission are required to accommodate the increasing pressures on health services. Since physiotherapists and occupational therapists are integral to inpatient teams, they may also be integral to admission replacement services, and thus their roles in these services merit investigation.

Primarily to determine the presence and roles of physiotherapists and occupational therapists in services replacing acute hospital admission. The secondary outcome is to determine the impact of therapists in such services.

Five electronic databases were searched, with keywords related to therapy, discharge and admission replacement. Inclusion criteria were that studies explicitly described at least one therapist role within a service replacing acute hospital admissions. Two authors independently reviewed all potentially eligible studies. Two reviewers independently assessed data extracted from included studies into a standardised data extraction form.

Fifteen studies (3 Hospital at Home, 12 Early Supported Discharge) were included. Both clinical (e.g. exercise prescription) and non-clinical (e.g. organisation and study outcome assessments) therapist roles were described in different admission substitution services. Some roles were only reported among teams, not individually ascribed to therapists.

The roles of therapists in services that replace hospital admission are rarely described in detail, with wide variation in reported roles, including across service types and patient populations. This review could not determine the impact of individual therapists on patient or service-level outcomes. Future studies need to more clearly define therapist roles and impact.

Trial registration: PROSPERO registration number: CRD42018110172
Original languageEnglish
Article numbere13462
Pages (from-to)1-14
Number of pages14
JournalInternational Journal of Clinical Practice
Early online date12 Dec 2019
Publication statusE-pub ahead of print - 12 Dec 2019


  • admission replacement
  • ambulatory care
  • physiotherapy
  • occupational therapy
  • hospital at home
  • early supported discharge


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