A systematic review of outcomes for older people living with frailty or multiple long-term conditions in community rehabilitation

Introduction
Community rehabilitation supports older adults living with frailty or multiple long-term conditions to maintain independence and remain at home. However, wide variation in outcome measurement limits comparison between interventions and evidence synthesis. This systematic review aimed to identify and categorise outcome measures used in community rehabilitation research and examine their consistency and breadth.

Methods
A systematic review was conducted according to best-practice guidance and registered with PROSPERO (CRD420261296268). MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science, PEDro and relevant grey-literature sources were searched. Studies evaluating community- or home-based physical rehabilitation interventions for adults with frailty or multiple long-term conditions were included. Outcomes were extracted and mapped to the World Health Organization International Classification of Functioning, Disability and Health domains: body functions and structures, activities and participation, environmental factors, and multidimensional or unmapped outcomes. Descriptive counts and narrative synthesis examined outcome frequency, range and consistency.

Results
Forty-four studies reported 324 outcome entries. Measurement was dominated by impairments of function (n=191), particularly neuromusculoskeletal and movement functions, including strength, balance, frailty-related physical characteristics and physical performance. Mental functions and self-care were also frequently assessed. Activity and participation outcomes accounted for 78 entries and were predominantly mobility-related. Environmental factors accounted for 23 entries, including support and relationships, products and technology, and services, systems and policies. A further 32 entries could not be mapped to a single ICF domain, including multidimensional measures of quality of life, frailty, functional independence and broader rehabilitation outcomes. Considerable heterogeneity existed in instruments, definitions and follow-up time points. Equality, diversity and inclusion characteristics were inconsistently reported, and no studies analysed outcomes by these characteristics.

Conclusions
Outcome measurement is heterogeneous and weighted towards impairment-level outcomes. Activity, participation, environmental, service-level, economic, equity-related and multidimensional outcomes are less consistently represented. A Core Outcome Set is needed to support person-centred, consistent evaluation across community rehabilitation research, practice and service delivery.