Clinical question: Does increased frequency of physical therapy (PT) for hospitalized pneumonia patients affect their discharge to home versus to a post-acute care facility?
Background: Each year, one million older adults in the U.S. are hospitalized for pneumonia, with a third eventually discharged to post-acute care facilities. Prior research indicates that early PT has been linked to shorter length of stay (LOS), and frequent PT has been linked to reduced readmission rates. However, the impact of in-hospital PT visit frequency on discharge disposition is not well established.
Study design: Observational cohort study
Setting: 595 hospitals across the U.S.
Synopsis: The study analyzed 18,886 hospitalized patients, focusing on those receiving PT on the first and fifth days within a five-day window. Exclusion criteria included transfer to or from another acute hospital, intensive care unit stay, and long-term care residents.
Patients had higher home-discharge rates if receiving PT on all five days (+6.1%; 95% confidence interval [CI], 3.5% to 8.6%) or four out of five days (+3.6%; 95% CI, 1.1% to 6.0%) compared to those receiving PT on two out of five days. Lower in-hospital mortality rates were observed in patients receiving PT on all five days and four out of five days (-1.3% and -1.0%, respectively) compared to patients receiving PT on two out of five days. However, no significant association was found between PT frequency and mortality after adjusting for hospital and patient characteristics.
Of note, more-frequent-PT patients were older and more likely to be non-Hispanic and white, with fewer severe illness indicators. The study’s limitations, including its observational nature, exclusion of patients receiving no days or one day of PT, and lack of comprehensive clinical data should be noted.
Bottom line: Increased frequency of PT visits for hospitalized pneumonia patients is associated with a higher likelihood of discharge to home.
Citation: Young DL, Johnson JK, et al. Association between physical therapy frequency and post-acute care for a national cohort of patients hospitalized with pneumonia. J Hosp Med. 2023;18(9):803-11.
Dr. Siau
Dr. Siau is a hospitalist in the division of hospital medicine at the Mount Sinai Health System and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York.