Earlier Physical Therapy Input is Associated with a Reduced Length of Hospital Stay and Reduced Care Needs on Discharge in Frail Older Inpatients: An Observational Study

$\textbf{Background and Purpose}$: Pressures on hospital bed occupancy in the English National Health Service (NHS) have focused attention on enhanced service delivery models and methods by which physical therapists might contribute to effective cost savings, while retaining a patient-centered approach. Earlier access to physical therapy may lead to better outcomes in frail older inpatients, but this has not been well studied in acute NHS hospitals. Our aim was to retrospectively study the associations between early physical therapy input and length of hospital stay (LOS), functional outcomes and care needs on discharge. $\textbf{Methods}$: This was a retrospective observational study in a large tertiary university NHS hospital in the United Kingdom. We analyzed all admission episodes of people admitted to the Department of Medicine for the Elderly wards over 3 months in 2016. Patients were categorized into 2 groups: those examined by a physical therapist within 24 hours of admission and those examined after 24 hours of admission. The outcome variables were: LOS (days), functional measures on discharge (Elderly Mobility Scale and walking speed over 6 meters), and the requirement of formal care on discharge. Characterization variables on admission were: age, gender, existence of a formal care package, pre-admission abode, the Clinical Frailty Scale, Charlson Comorbidity Index, the Emergency Department Modified Early Warning Score, C-reactive protein level on admission, and the 4-item version of the Abbreviated Mental Test. The association between the delay to physical therapy input and LOS before discharge home was evaluated using a Cox proportional hazards regression model. $\textbf{Results and Discussion}$: There were 1022 hospital episodes over the study period. We excluded 19 who were discharged without being examined by a physical therapist. Of the remaining 1003, 584 (58.2%) were examined within 24 hours of admission (early assessment), and 419 (41.8%) after 24 hours of admission (late assessment). The median (interquartile range: IQR) LOS of the early assessment group was 6.7 (3.1–13.7) versus 10.0 (4.2-20.1) days in the late assessment group, P < 0.001. The early assessment group was less likely to require formal care on discharge: n=110 (20.3%) versus n=105 (27.0%), P = 0.016. No other statistically significant differences were seen between the 2 groups. In the unadjusted Cox proportional hazards model, the hazard ratio for early assessment compared to late assessment was 1.29 (95% confidence interval: 1.12-1.48, P < 0.001). Early assessment was associated with a 29% higher probability of discharge to usual residence within the first 21 days after admission, compared to late assessment. Adjustment for possible confounding variables increased the hazard ratio: 1.34 (1.16 – 1.55) P < 0.001. $\textbf{Conclusions}$: Early physical therapy input was associated with a shorter LOS and lower odds of needing care on discharge. This may be due to the beneficial effect of early physical therapy in preventing hospital-related deconditioning in frail older adults. However, causality cannot be inferred and further research is needed to investigate causal mechanisms

Earlier Physical Therapy Input is Associated with a Reduced Length of Hospital Stay and Reduced Care Needs on Discharge in Frail Older Inpatients: An Observational Study

$\textbf{Background and Purpose}$: Pressures on hospital bed occupancy in the English National Health Service (NHS) have focused attention on enhanced service delivery models and methods by which physical therapists might contribute to effective cost savings, while retaining a patient-centered approach. Earlier access to physical therapy may lead to better outcomes in frail older inpatients, but this has not been well studied in acute NHS hospitals. Our aim was to retrospectively study the associations between early physical therapy input and length of hospital stay (LOS), functional outcomes and care needs on discharge. $\textbf{Methods}$: This was a retrospective observational study in a large tertiary university NHS hospital in the United Kingdom. We analyzed all admission episodes of people admitted to the Department of Medicine for the Elderly wards over 3 months in 2016. Patients were categorized into 2 groups: those examined by a physical therapist within 24 hours of admission and those examined after 24 hours of admission. The outcome variables were: LOS (days), functional measures on discharge (Elderly Mobility Scale and walking speed over 6 meters), and the requirement of formal care on discharge. Characterization variables on admission were: age, gender, existence of a formal care package, pre-admission abode, the Clinical Frailty Scale, Charlson Comorbidity Index, the Emergency Department Modified Early Warning Score, C-reactive protein level on admission, and the 4-item version of the Abbreviated Mental Test. The association between the delay to physical therapy input and LOS before discharge home was evaluated using a Cox proportional hazards regression model. $\textbf{Results and Discussion}$: There were 1022 hospital episodes over the study period. We excluded 19 who were discharged without being examined by a physical therapist. Of the remaining 1003, 584 (58.2%) were examined within 24 hours of admission (early assessment), and 419 (41.8%) after 24 hours of admission (late assessment). The median (interquartile range: IQR) LOS of the early assessment group was 6.7 (3.1–13.7) versus 10.0 (4.2-20.1) days in the late assessment group, P < 0.001. The early assessment group was less likely to require formal care on discharge: n=110 (20.3%) versus n=105 (27.0%), P = 0.016. No other statistically significant differences were seen between the 2 groups. In the unadjusted Cox proportional hazards model, the hazard ratio for early assessment compared to late assessment was 1.29 (95% confidence interval: 1.12-1.48, P < 0.001). Early assessment was associated with a 29% higher probability of discharge to usual residence within the first 21 days after admission, compared to late assessment. Adjustment for possible confounding variables increased the hazard ratio: 1.34 (1.16 – 1.55) P < 0.001. $\textbf{Conclusions}$: Early physical therapy input was associated with a shorter LOS and lower odds of needing care on discharge. This may be due to the beneficial effect of early physical therapy in preventing hospital-related deconditioning in frail older adults. However, causality cannot be inferred and further research is needed to investigate causal mechanisms

Physical exercise to prevent multifactorial diseases: A warning written in our genes?

The human genome has about forty thousand genes and has been subject to strong selective pressure in various periods and different geographical areas. Various evidence sustains the hypothesis that the widespread nature of multifactor diseases is partly due to modified life-styles (reduced physical activity, over-eating) and partly to genetic inheritance selected over thousands of years for life-styles that persisted almost up to the start of the twentieth century. Physical activity could therefore be a natural remedy for recovering part of the imbalance caused by modern life-styles in bodies "born to run" and fed parsimoniously. In order to prescribe it as a cure, more research is necessary into the effects of physical activity on the body at molecular level and into individual predispositions to be used in targeted prevention programmes

Gene expression and mRNA editing of serotonin receptor 2C in brains of HPRT gene knock-out mice, an animal model of Lesch-Nyhan disease

Lesch-Nyhan disease (LND), a genetic disorder associated with motor and psychiatric disturbance and self-injurious behaviour (SIB) is caused by a complete deficiency of hypoxanthine-guanine phosphoribosyltransferase (HPRT). The connection between enzyme deficiency and neurological involvement is still unclear. Evidence exists for a role of basal ganglia dysfunction with decreased dopamine and excess serotonin striatal content. In this study, we investigate the role of serotonin receptor 2C (HTR2C) in the brains of HPRT gene knock-out mice, a model of LND. HTR2C expression is analyzed by real-time polymerase chain reaction (PCR) using SYBR-green detection methods. The percentage of edited HTR2C mRNA was determined by direct sequencing of amplification products of the region containing the editing sites. We found a 55% increase in the expression of HTR2C gene but no significant difference in mRNA editing levels between knock-out and control mice. The above alteration found in HPRT-deficient mice is similar to those found in other animal models used to study aggressive and self-injurious behaviour

Feasibility and effect of supplementing a modified OTAGO intervention with multisensory balance exercises in older people who fall:a pilot randomized controlled trial

Objective: To investigate the feasibility and comparative effect of supplementing a modified OTAGO falls rehabilitation programme with multisensory balance exercises and informed sample size calculation for a definitive trial. Design: Single-blinded randomized controlled trial with pre/postcomparisons using a per-protocol analysis. Setting: Secondary care-based falls clinic, London, UK. Subjects: Community-dwelling older people (n = 21) experiencing ≥2 non-syncopal falls during previous 12 months. Intervention: Modified OTAGO exercise classes supplemented with supervised home-based rehabilitation consisting of multisensory balance or stretching exercises. Group classes and home sessions each occurred twice-weekly for eight weeks. Measurements: A computerised randomization was used for group allocation. A rater, blinded to intervention, performed the assessment including the Functional Gait Assessment (primary outcome), Physiological Profile Assessment, and questionnaires relating to symptoms, balance confidence, and psychological state (secondary outcomes). Results: Significant within-group improvements were noted for the Functional Gait (p < 0.01, r = -0.63) and Physiological Profile Assessments (p < 0.05, r = -0.63) in the OTAGO+multisensory rehabilitation group only and for balance confidence scores in the OTAGO+stretching group (p < 0.01, r = -0.63). Between-group differences were noted for the Functional Gait (p < 0.01, r = -0.71) and Physiological Profile (p < 0.05, r = -0.54) assessments with the OTAGO+multisensory group showing significantly greater improvement. The drop-out rate was similar for both groups (~30%). No serious adverse events were reported