Palliative rehabilitation and quality of life: systematic review and meta-analysis

Importance International guidelines recommend the integration of multidisciplinary rehabilitation into palliative care services but its impact on quality of life across disease types is not well understood. Objective To determine the effect of multidisciplinary palliative rehabilitation on quality of life and healthcare service outcomes for adults with an advanced, life-limiting illness. Data sources Electronic databases CINAHL, EMBASE, MEDLINE and PEDro were searched from the earliest records to February 2024. Study selection Randomised controlled trials examining the effect of multidisciplinary palliative rehabilitation in adults with an advanced, life-limiting illness and reported quality of life were eligible. Data extraction and synthesis Study characteristics, quality of life and health service usage data were extracted, and the methodological quality was assessed using PEDro. Meta-analyses using random effects were completed, and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied. Main outcomes Quality of life and healthcare service outcomes. Results 27 randomised controlled trials (n=3571) were included. Palliative rehabilitation was associated with small improvements in quality of life (standardised mean difference (SMD) 0.40, 95% CI 0.23 to 0.56). These effects were significant across disease types: cancer (SMD 0.22, 95% CI 0.03 to 0.41), heart failure (SMD 0.37, 95% CI 0.61 to 0.05) and non-malignant respiratory diagnoses (SMD 0.77, 95% CI 0.29 to 1.24). Meta-analysis found low-certainty evidence, palliative rehabilitation reduced the length of stay by 1.84 readmission days. Conclusions and relevance Multidisciplinary palliative rehabilitation improves quality of life for adults with an advanced, life-limiting illness and can reduce time spent in hospital without costing more than usual care. Palliative rehabilitation should be incorporated into standard palliative care. PROSPERO registration number CRD42022372951.