Ryo Momosaki1, Hideo Yasunaga2, Hiroki Matsui2, Hiromasa Horiguchi3, Kiyohide Fushimi4, Masahiro Abo5. 1. Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan. Electronic address: momosakiryo@gmail.com. 2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan. 3. Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan. 4. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan. 5. Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Abstract
OBJECTIVE: To clarify the effect of early rehabilitation by physical therapists on in-hospital mortality among elderly patients with aspiration pneumonia. DESIGN: A retrospective cohort study. SETTING: A total of 1161 acute-care hospitals across Japan. PARTICIPANTS: Consecutive patients (age, 70-100 y) (N=68,584) from July 2010 to March 2012 in the Japanese Diagnosis Procedure Combination inpatient database with aspiration pneumonia on admission who underwent early physical therapist-guided rehabilitation (n=16,835) and who did not undergo rehabilitation administered by physical therapists (n=51,749). INTERVENTIONS: Early rehabilitation was defined as physical rehabilitation administered by a physical therapist, initiated within 3 days of admission, and undertaken for at least 7 days. MAIN OUTCOME MEASURE: Thirty-day in-hospital mortality. RESULTS: The 30-day in-hospital mortality rates were 5.1% and 7.1% in the early rehabilitation group and the control group, respectively. The multivariable logistic regression model showed that the early rehabilitation group had a significantly lower in-hospital mortality rate (odds ratio, .71; 95% confidence interval [CI], .64-.79; P<.001). Among patients without severe pneumonia, we found no significant difference in mortality rates between patients who underwent early rehabilitation and those who did not undergo rehabilitation by physical therapists. The instrumental variable analysis confirmed that early rehabilitation was associated with a reduced risk for in-hospital mortality (risk difference, -1.9%; 95% CI, -2.3% to -1.5%; P<.001; number needed to treat, 53 [95% CI, 43-67]). CONCLUSIONS: The data suggest that early rehabilitation by physical therapists was associated with a reduction in 30-day in-hospital mortality rates in elderly patients with severe aspiration pneumonia.
OBJECTIVE: To clarify the effect of early rehabilitation by physical therapists on in-hospital mortality among elderly patients with aspiration pneumonia. DESIGN: A retrospective cohort study. SETTING: A total of 1161 acute-care hospitals across Japan. PARTICIPANTS: Consecutive patients (age, 70-100 y) (N=68,584) from July 2010 to March 2012 in the Japanese Diagnosis Procedure Combination inpatient database with aspiration pneumonia on admission who underwent early physical therapist-guided rehabilitation (n=16,835) and who did not undergo rehabilitation administered by physical therapists (n=51,749). INTERVENTIONS: Early rehabilitation was defined as physical rehabilitation administered by a physical therapist, initiated within 3 days of admission, and undertaken for at least 7 days. MAIN OUTCOME MEASURE: Thirty-day in-hospital mortality. RESULTS: The 30-day in-hospital mortality rates were 5.1% and 7.1% in the early rehabilitation group and the control group, respectively. The multivariable logistic regression model showed that the early rehabilitation group had a significantly lower in-hospital mortality rate (odds ratio, .71; 95% confidence interval [CI], .64-.79; P<.001). Among patients without severe pneumonia, we found no significant difference in mortality rates between patients who underwent early rehabilitation and those who did not undergo rehabilitation by physical therapists. The instrumental variable analysis confirmed that early rehabilitation was associated with a reduced risk for in-hospital mortality (risk difference, -1.9%; 95% CI, -2.3% to -1.5%; P<.001; number needed to treat, 53 [95% CI, 43-67]). CONCLUSIONS: The data suggest that early rehabilitation by physical therapists was associated with a reduction in 30-day in-hospital mortality rates in elderly patients with severe aspiration pneumonia.
Authors: Adam Simning; Thomas V Caprio; Sarah L Szanton; Helena Temkin-Greener; Yeates Conwell Journal: Geriatr Nurs Date: 2019-07-09 Impact factor: 2.361
Authors: R Carroll; P Corcoran; E Griffin; I Perry; E Arensman; D Gunnell; C Metcalfe Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2016-06-14 Impact factor: 4.328