Pre-discharge home assessment visits in assisting patients' return to community living: A systematic review and meta-analysis.

OBJECTIVE To determine the effectiveness of pre-discharge home assessment visits by occupational therapists in assisting hospitalized patients from a range of settings to return to community living. DATA SOURCES Electronic databases MEDLINE, CINAHL, Embase, PsychINFO, Cochrane Central Register of Controlled Trials and OTseeker were searched until February 2014. STUDY SELECTION Quantitative and qualitative studies were included if they evaluated pre-discharge home assessment visits by an occupational therapist. Of 1,778 potentially relevant articles, 14 studies met the inclusion criteria. DATA EXTRACTION After data extraction, study quality was assessed using check-lists. DATA SYNTHESIS Pre-discharge home assessment visits reduced the risk of falling (risk ratio 0.68, 95% confidence interval (95% CI) 0.49-0.94) and increased participation levels (standardized mean difference 0.49; 95% CI 0.01-0.98) in geriatric and mixed rehabilitation settings. The risk of readmission to hospital was also reduced (risk ratio 0.47, 95% CI 0.33-0.66), but not for patients following stroke. There was no effect on activity or quality of life. Patients and carers perceived that home assessment visits were beneficial and were satisfied with the process. CONCLUSION There is low-to-moderate quality evidence that pre-discharge home assessment visits reduce patients' risk of falling and increase participation. The risk of readmission to hospital is also reduced, but not for patients following stroke.