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Aging and disease    2015, Vol. 6 Issue (3) : 174-179     DOI: 10.14336/AD.2014.0801
Original Article |
Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and DecliningPhysical Function
Kim Sun Jung1, Lee Joo Hun2, Han Boram3, Lam Julia4, Bukowy Elizabeth5, Rao Avinash4, Vulcano Jordan6, Andreeva Anelia6, Bertelson Heather6, Shin Hyun Phil7, Yoo Ji Won8,*()
1Department of Health Policy and Management, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
2Department of Communication and Mass Media, Hanyang University College of Social Sciences, Seoul, Korea
3Department of Medicine, Kosin University College of Medicine, Busan, Korea
4Department of Medicine, University of Wisconsin School of Medicine and Public Health
5Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois, USA
6Department of Internal Medicine, Aurora Health Care, Milwaukee, Wisconsin, USA
7Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
8Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Abstract  

To examine whether hospital-based physical therapy is associated with functional changes and early hospital readmission among hospitalized older adults with community-acquired pneumonia and declining physical function. Study design was a retrospective observation study. Participants were community-dwelling older adults admitted to medicine floor for community-acquired pneumonia (n = 1,058). Their physical function using Katz activities of daily living (ADL) Index declined between hospital admission and 48 hours since hospital admission (Katz ADL Index 6→5). The intervention group was those receiving physical therapy for ≥ 0.5 hour/day. Outcomes were Katz ADL Index at hospital discharge and all-cause 30-day hospital readmission rate. The intervention and control groups did not differ in the Katz ADL Index at hospital discharge (p = 0.11). All-cause 30-day hospital readmission rate was lower in the intervention than in control groups (OR = 0.65, p = 0.02). Hospital-based physical therapy has the benefits toward reducing 30-day hospital readmission rate of acutely ill older adults with community-acquired pneumonia and declining physical function.

Keywords hospitalization      patient outcome assessment      physical therapy      pneumonia     
Corresponding Authors: Yoo Ji Won     E-mail: yoo36@wisc.edu
About author:

present address: Kunming Biomed International, Kunming, Yunnan, 650500, China

Issue Date: 01 June 2015
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Kim Sun Jung
Lee Joo Hun
Han Boram
Lam Julia
Bukowy Elizabeth
Rao Avinash
Vulcano Jordan
Andreeva Anelia
Bertelson Heather
Shin Hyun Phil
Yoo Ji Won
Cite this article:   
Kim Sun Jung,Lee Joo Hun,Han Boram, et al. Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and DecliningPhysical Function[J]. Aging and disease, 2015, 6(3): 174-179.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2014.0801     OR     http://www.aginganddisease.org/EN/Y2015/V6/I3/174
Figure 1.  Selection strategy for study participants.
Covariates Interventionn = 524 Controln = 534 P
Age, median (interquartile range) 86.2 (79.1 - 93.7) 85.3 (78.5 - 94.2) 0.45
Female 310, 59.2% 327, 61.2% 0.58
Non-Whites 160, 30.5% 165, 31.0% 0.77
Education year, median (interquartile range) 9.7 (7.7 - 10.8) 10.1 (8.1 - 11.3) 0.26
Severity of illness Mild 68, 12.9% 85, 16.0% 0.18
Moderate 130, 24.9% 129, 24.1%
Major 193, 36.9% 186, 34.9%
Extreme 133, 25.3% 137, 25.0%
Cognitive impairment 151, 28.8% 161, 30.2% 0.46
Charlson comorbidity index, median (interquartile range) 3.45 (2.30 - 5.38) 3.41 (2.24 - 5.49) 0.63
Hospital length of stay (interquartile range) 5.36 (4.31 - 6.79) 5.59 (4.44 - 7.62) 0.39
Table 1  Subject characteristics by study groups
Outcomes Intervention n = 524 Control n = 534 p
Katz Activities of daily living Index at hospital discharge Mean (95% confidence intervals)
4.89 (3.91 - 5.63) 4.23 (3.65 - 5.30) 0.07
All-cause 30-day hospital readmission rate %, n
11.2%, 59/524 16.3%, 87/534 0.03
Table 2  Unadjusted Katz Activity of Daily Living Index at Hospital Discharge and All-cause 30-day Hospital Readmission Rate
Covariates Parameter estimates p
Age Reference = 65 - 74
75 - 84 - 0.27 0.33
≥ 85 - 1.18 0.01
Gender Reference = Male
Female 0.36 0.21
Ethnicity Reference = Whites
Non-Whites - 0.40 0.19
Education Reference = < High school graduate
≥ High school graduate 0.08 0.74
Severity of illness Reference = Mild
Moderate 0.15 0.62
Major - 1.16 0.07
Extreme - 2.08 < 0.001
Cognitive impairment Reference = No
Yes - 1.43 0.003
Charlson comorbidity index Reference = 0 -1
2 - 3 - 0.94 0.058
≥ 4 - 3.15 < 0.001
Study groups Reference = Control
Intervention 0.62 0.11
Table 3  Multivariate Regressions of Katz Activity of Daily Living Index at Hospital Discharge
Covariates Estimates Odds ratio p
Age Reference = 65 - 74
75 - 84 0.06 1.22 0.18
≥ 85 0.29 2.08 < 0.001
Gender Reference = Male
Female - 0.07 0.74 0.08
Ethnicity Reference = Whites
Non-Whites 0.08 1.32 0.054
Education Reference = < High school graduate
≥ High school graduate 0.04 1.14 0.27
Severity of illness Reference = Mild
Moderate 0.15 1.71 0.02
Major 0.18 1.86 0.004
Extreme 0.42 2.70 < 0.001
Cognitive impairment Reference = No
Yes 0.37 2.19 < 0.001
Charlson comorbidity index Reference = 0 -1
2 - 3 0.04 1.26 0.15
≥ 4 0.22 1.73 0.01
Study groups Reference = Control
Intervention - 0.09 0.65 0.02
Table 4  Multivariate Logistic Regressions of All-cause 30-day Hospital Readmission Rate
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