Towards a common definition of hospital-acquired deconditioning in adults: a scoping review

Westlake, Meri; Cowley, Alison; Robinson, Katie; Gordon, Adam L.

Abstract

Background Hospital-acquired deconditioning is a term used in clinical practice, describing a loss of physical and/or cognitive function associated with hospitalisation. Previous reviews have addressed interventions, its prevalence in older adults and potential assessment tools. However, each review has reported a core limitation, the need for an agreed-upon definition and diagnostic criteria for hospital-acquired deconditioning.

Objective We aimed to identify key components used to define hospital-acquired deconditioning in adults. We sought to do this by identifying diagnostic criteria, describing how authors operationalised Hospital- Acquired Deconditioning (HAD), and describing differences between HAD and other immobility-linked syndromes. This article focuses on how hospital-acquired deconditioning is understood and operationalised.

Design A scoping review using the Joanna Briggs Institute methodology for evidence synthesis.

Eligibility criteria Published in English after 1 January 1990, investigating adults over 18, set in inpatient rehabilitation or acute care settings, and including either a definition or description of hospital-acquired deconditioning or an outline of strategies to assess, prevent or manage hospital-acquired deconditioning.

Sources of evidence Published and grey literature, no restriction was placed on study design.

Charting methods Relevant data, where available, was extracted from each source using a proprietary data extraction template.

Results One hundred and three articles were included from 2403 retrieved results. Thirty-three were from rehabilitation or post-acute care settings, 53 from acute care, 15 from intensive care and two from other settings. The literature was diverse in methodology and research question addressed. Hospital-acquired deconditioning was poorly defined, no consistent patterns were identified in aetiology and sequelae; diagnostic criteria were not fully agreed on.

Conclusions The literature on hospital-acquired deconditioning is large, diverse and incomplete. Further work is required to develop a shared definition of hospital-acquired deconditioning, enabling researchers to coalesce for better understanding of the phenomenon, and clinicians, in turn, to better treat and mitigate against it.

Citation

Westlake, M., Cowley, A., Robinson, K., & Gordon, A. L. (2025). Towards a common definition of hospital-acquired deconditioning in adults: a scoping review. BMJ Open, 15, Article e086976. https://doi.org/10.1136/bmjopen-2024-086976

• Journal Article Type: Article
• Acceptance Date: Nov 12, 2024
• Online Publication Date: Jan 15, 2025
• Publication Date: 2025-01
• Deposit Date: Jan 21, 2025
• Publicly Available Date: Jan 21, 2025
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Article Number: e086976
• DOI: https://doi.org/10.1136/bmjopen-2024-086976
• Public URL: https://nottingham-repository.worktribe.com/output/44422212
• Publisher URL: https://bmjopen.bmj.com/content/15/1/e086976