title: Effect of early rehabilitation by physical therapists on in-hospital mortality after aspiration pneumonia in the elderly.
abstract: OBJECTIVE
  To clarify the effect of early rehabilitation by physical therapists on in-hospital mortality among elderly patients with aspiration pneumonia.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  A total of 1161 acute-care hospitals across Japan.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.affiliation: 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.
authors.forename: Ryo
authors.initials: R
authors.lastname: Momosaki
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D026741:Physical Therapy Modalities; D011015:Pneumonia, Aspiration / Q000401:mortality* / Q000534:rehabilitation*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Hospital mortality; Pneumonia, aspiration; Rehabilitation