Article

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.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.
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Langue : ANGLAIS