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  • Hospital-Based Physical Therapy Reduces Readmission Rates for Older Adults With Pneumonia

    Hospital-based physical therapy for older adults isn't just beneficial to recovery from events such as stroke and hip fracture: a new study supports the idea that it can also lead to better outcomes for patients with acute illnesses such as pneumonia—especially when it comes to decreasing the chances of hospital readmission.

    For the study, published in the June issue of Aging and Disease (.pdf), researchers tracked function and 30-day readmission rates for 1,058 adults 65 and older diagnosed with community-acquired pneumonia and admitted to an Ohio hospital between 2007 and 2009. Patients were administered the Katz Activities of Daily Living assessment at admission and after 48 hours in the hospital; patients whose score dropped from 6 (highest independence score possible) to 5 during that 48-hour period were targeted for the study.

    About half of the patients (524) received an average of 30 minutes or more of physical therapy during their stay; the control group received usual care and no physical therapy. Researchers administered the Katz assessment again at discharge, and tracked 30-day readmission rates for all participants. The modalities of physical therapy used were not tracked.

    Although researchers found no significant differences in Katz scores among the patients at the time of discharge, they did see a marked drop in 30-day readmission rates for the physical therapy group, which had an 11.2% readmission rate. The control group's readmission rate was 16.3%.

    Though Katz scores were not tracked after discharge, authors of the study believe that the readmission rates point to better functional outcomes.

    "Our study contributes to the literature by providing evidence that [physical therapy—identified as "PT" throughout the article] reduces progressive functional decline, even in common acute illness (pneumonia)," authors write. "The progression of functional decline during or after hospitalization is subject to 'traction effects' because there are multiple contributing factors that are difficult to disentangle." They describe physical therapy as a "buffer or breaker pedal" for these effects.

    "Additional effects of hospital-based PT might include 'delayed and spillover effects,'" they continue. "Hospital-based [physical therapy] reduces vulnerability to other episodes of acute illnesses, and consequently reduces the early hospital readmission rate."

    Authors believe that hospitals should pay attention to the findings, particularly in light of Medicare's use of 30-day readmission rates as a performance indicator, and warn that other studies that question the benefits of hospital-based physical therapy may be questionable simply because patients didn't receive enough treatment.

    "The little or no functional benefits of hospital-based PT could be explained by premature length of hospital-based PT," authors write. "The length of exposure to hospital-based PT could be too short to present the functional benefits by hospital-based PT. Important next steps will be to determine how to optimize the PT outcomes such as extension to home-based PT after hospital discharge and dose-response relationship between the intensity of PT and functional outcomes."

    A recorded course on the role of physical therapy in reducing hospital readmissions is available through the APTA Learning Center.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • Wow! This is powerful information for PT's in acute care. This is also great evidence based data to share with my DPT students in their Cardiopulmonary course.

      Posted by Judith Mann on 6/10/2015 4:48 PM

    • This is great news on the value of care provided by a physical therapist. However I really wish that in all our publications we stop using phrases like "hospital based physical therapy". Or "(physical therapy-identified as "PT" throughout the article) These are skilled patient specific services provided physical therapists and not a generic thing that is done to patients. It is important that our patients and others understand this so they realize that all physical therapy care is not the same and they should be seeking the best quality services they can find. We need to stop referring to ourselves in these phrases so that others will eventually do the same.

      Posted by Victor Vaughan -> =JP]< on 6/11/2015 8:03 AM

    • My PTA students just finished studying pulmonary rehab. This is great news to share with them!

      Posted by Caroline Peyrone on 6/11/2015 9:18 AM

    • Very interesting study. I would love to see another study done that had follow-up home PT. Am curious as to why they had no 30 day post assessment.

      Posted by Carol Macomber on 6/22/2015 7:45 AM

    • I really appreciate this information for older adults. My grandmother had pneumonia this year, and I wish we would have originally put her into physical therapy so that she could reduce her risk of readmission into the hospital. I think it is so interesting that this points out that physical therapy can be like a "buffer" for the negative side effects of pneumonia. I hope other people are able to see this information in time! Thanks for sharing.

      Posted by June Robinson on 9/2/2015 7:16 PM

    • When my grandma broke her hip, we were all devastated. We have known several older people get failing health and end up dying within months of their incident. However, my grandma was able to go through physical therapy and have a full recovery. Although I feel like it is obvious that people like her and those that were in this PT group are more likely to recover, do we know whether or not their recovery had to do with the type of therapy that they went through?

      Posted by Faylinn on 5/25/2016 9:48 AM

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