Bulletin of Science Education · Aug 29, 2026
Effectiveness of Nursing Interventions on Functional Independence in Older Adults Following Surgery: A Systematic Review and Meta-Analysis
By Wijayanti Y, Mulyatsih E, Sulistyaningsih DR et al.
Older surgical patients are at high risk of functional decline from immobilisation, pain, delirium, malnutrition, and perioperative complications. Evidence on nursing interventions' effect on postoperative Activities of Daily Living (ADL) remains scattered and unsynthesised quantitatively. To analyse the effectiveness of nursing interventions on postoperative functional independence in older adults versus standard care. This review followed PRISMA 2020 guidance based on a PRISMA-P-informed protocol with locked PICOS criteria (patients ≥60 years post-surgery; nurse-led/coordinated intervention; standard-care comparator; validated ADL outcome; RCT/quasi-experimental design). Articles were drawn from an author-compiled collection of indexed journals plus a supplementary confirmatory search. Risk of bias was assessed with Cochrane RoB 2. As ADL instruments differed across studies, data were pooled as Hedges' g using a DerSimonian-Laird random-effects model, per the protocol's rule for differing ADL instruments. 24 full-text-assessed articles (20 from the initial search, 4 from a supplementary confirmatory search), ten study reports (11 studies: 9 RCTs and 2 non-randomized, n=1,562) met eligibility. Eight of ten studies showed statistically significant ADL improvement favouring nursing intervention. The pooled random-effects Hedges' g was 0.73 (95% CI 0.41–1.04; Z=4.51; p<0.001), with high heterogeneity (I²=87.3%; τ²=0.212). Overall GRADE certainty was low. Nursing interventions improve postoperative functional independence in older adults, with a more precise pooled estimate after expanding the evidence base, although between-study heterogeneity remains high. Multicentre trials with standardised ADL instruments/time-points and prospective protocol registration are needed