Early mobilisation of patients with community-acquired pneumonia reduce length of hospitalisation-a pilot study.
Dorte Melgaard, Ulrik Baandrup, Martin Bøgsted and 2 others
PMID 30034100WHAT IT FOUND
Early mobilisation within 24 hours did not significantly shorten hospital stay: mean 5.0 days versus 6.5 days.
Shorter stays were significant only in patients with a CURB65 score of 2 or COPD.
Key findings
01The early mobilisation group had an estimated mean length of stay of 5.0 days, compared with 6.5 days in the control group; the reported average reduction was 1.5 days (P=0.077).
02Significant shorter stays were reported in the CURB65 score 2 subgroup (5.0 versus 8.1 days; P=0.041) and the COPD subgroup (4.3 versus 6.4 days; P=0.028).
03No significant differences were seen in in-hospital mortality (4.1% versus 7.2%; P=0.351), 30-day mortality (4.3% versus 3.3%; P=0.738), or 30-day rehospitalisation (20.4% versus 14.4%; P=0.274).
STILL TO COME
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What it does not show
Small pilot study with a historical, non-randomised control group, so unmeasured changes in care could influence length of stay. The main length-of-stay result was not significant (P=0.077), so the study does not show an overall reduction in hospital stay. Patients with very severe pneumonia, palliative care, dementia, transfers, or weekend admissions were excluded, so results may not apply to those groups. Only 80 of 97 intervention patients were mobilised within 24 hours, so not all received the intended early mobilisation. Pre-admission functional level was not available for the control group, and CURB65 data were missing for some patients. Fewer patients in the intervention group had COPD by coincidence, and nurses also began focusing on early mobilisation, so the effect of the physiotherapy programme alone cannot be separated. The significant CURB65 score 2 and COPD results are subgroup findings after a non-significant primary outcome and should not be treated as proven effects.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not conclude that early mobilisation reduces hospital stay in all patients with community-acquired pneumonia. The overall length-of-stay difference was not significant, and the significant findings were subgroup analyses. Nurses also began focusing on mobilisation, so the effect of the physiotherapy programme alone cannot be separated.