Effect of early versus delayed mobilization by physical therapists on oral intake in patients with sarcopenic dysphagia after pneumonia.

BACKGROUND AND PURPOSE: Older pneumonia patients with sarcopenic dysphagia have difficulty with oral intake. Physical rehabilitation might be beneficial in the treatment of sarcopenic dysphagia. This study aimed to test the hypothesis that early mobilization by physical therapists enhances oral intake after pneumonia in sarcopenic dysphagia. METHODS: This retrospective observational study used data on consecutive pneumonia patients with sarcopenic dysphagia aged over 65 years hospitalized in the acute care ward from May 2017 to October 2017. We compared characteristics and outcomes between the early mobilization group and the delayed mobilization group. The outcomes were total oral intake and functional oral intake scale score at discharge. RESULTS: Applying the exclusion criteria, 125 patients were eligible. Patients with early mobilization were 33.6% of all pneumonia patients. There were no significant differences in baseline characteristics between both groups. Total oral intake rates at discharge were higher in the early mobilization group compared with the delayed mobilization group (75.6% vs 51.8%; p = 0.012). Functional oral intake scale scores were higher in the early mobilization group than the delayed mobilization group (p = 0.001). On multiple logistic regression analysis, early mobilization was significantly associated with total oral intake at discharge (odds ratio, 3.06; p = 0.01). Multiple linear regression analysis revealed that early mobilization was a significant factor affecting functional oral intake scale score at discharge (coefficient, 0.25; p = 0.01). CONCLUSION: Our cohort analysis demonstrated that early mobilization by a physical therapist is associated with improved total oral intake in patients with sarcopenic dysphagia after pneumonia.

Impact of oral health status on oral intake ability prognosis after pneumonia in older patients: a retrospective cohort study.

BACKGROUND AND PURPOSE: Older dysphagic patients with pneumonia are frequently managed with a nil per os regimen on admission. This practice could lead to worse oral health and outcomes after pneumonia. The aim of this study is to examine the hypothesis that oral health status has an effect on oral intake prognosis after pneumonia in older adults. METHODS: This retrospective observational study evaluated data on consecutive in-patients with pneumonia aged > 65 years in an acute care ward. We compared baseline characteristics and outcomes between two groups with or without oral health problems assessed using the Oral Health Assessment Tool. Primary outcome was attaining total oral intake (Functional Oral Intake Scale) at discharge. Secondary outcome was length of hospital stay. RESULTS: After applying exclusion criteria, 162 patients were eligible for analysis; 113 (70.0%) had oral health problems. Patients without oral health problems had higher rates of total oral intake at discharge than patients with oral health problems (69.4% vs. 49.6%; p = 0.03). Patients without oral health problems had shorter length of hospital stay than patients with oral health problems (mean, 30.6 days vs. 41.3 days; p = 0.03). Multiple logistic regression analysis identified oral health problems as a significant factor for total oral intake at discharge (odds ratio, 0.45; 95% confidence interval, 0.21-0.98). Multiple linear regression analysis revealed that oral health problems significantly affected length of hospital stay (coefficient, 11.0; 95% confidence interval, 1.2-20.7). CONCLUSION: Our data demonstrated that poor oral health status was associated with poor oral intake ability prognosis in patients with pneumonia in acute care.

Rehabilitation Characteristics in High-Performance Hospitals after Acute Stroke.

BACKGROUND: Rehabilitation characteristics in high-performance hospitals after acute stroke are not clarified. This retrospective observational study aimed to clarify the characteristics of high-performance hospitals in acute stroke rehabilitation. METHODS: Patients with stroke discharged from participating acute hospitals were extracted from the Japan Rehabilitation Database for the period 2006-2015. We found 6855 patients from 14 acute hospitals who were eligible for analysis in this study after applying exclusion criteria. We divided facilities into high-performance hospitals and low-performance hospitals using the median of the Functional Independent Measure efficiency for each hospital. We compared rehabilitation characteristics between high- and low-performance hospitals. RESULTS: High-performance hospitals had significantly shorter length of stay. More patients were discharged to home in the high-performance hospitals compared with low-performance hospitals. Patients in high-performance hospitals received greater amounts of physical, occupational, and speech therapy. Patients in high-performance hospitals engaged in more self-exercise, weekend exercise, and exercise in wards. There was more participation of board-certified physiatrists and social workers in high-performance hospitals. CONCLUSIONS: Our data suggested that amount, timing, and type of rehabilitation, and participation of multidisciplinary staff are essential for high performance in acute stroke rehabilitation.

Effectiveness of weekend physical rehabilitation for functional recovery in geriatric patients with hip fracture.

AIM: To test the hypothesis that the functional outcome of hip fracture patients who receive weekend rehabilitation is better than that of similar patients who undergo non-weekend rehabilitation. METHODS: The present retrospective observational study used data from the Japan Rehabilitation Database spanning 2005-2015. We identified in-hospital hip fracture patients admitted to acute hospitals. After applying exclusion criteria, 469 patients were eligible. The primary outcome was motor Functional Independence Measure (FIM) efficiency. RESULTS: Of the patients with hip fracture, 68.0% received weekend rehabilitation. The patients who received weekend rehabilitation had significantly higher scores in motor FIM efficiency (mean 1.08 vs 0.73, P < 0.001), FIM efficiency (mean 1.12 vs 0.79, P = 0.001) and shorter length of stay (mean 32 vs 54, P < 0.001) than the patients without weekend rehabilitation. Multivariate linear regression analysis identified the weekend rehabilitation as a significant factor in motor FIM efficiency (coefficient 0.237, 95% confidence interval 0.074-0.400, P = 0.004), FIM efficiency (coefficient 0.235, 95% confidence interval 0.079-0.391, P = 0.003) and length of stay (coefficient -9.649, 95% confidence interval -18.194 to -1.104, P = 0.027). CONCLUSIONS: The present cohort analysis showed that weekend rehabilitation for hip fracture patients can lead to functional recovery and reduce the length of stay. Geriatr Gerontol Int 2018; 18: 1143-1146.