Academic journal article Journal of Allied Health

Use of Physical Therapy in Patients Hospitalized with a Diagnosis of Generalized Weakness: A Retrospective Study

Academic journal article Journal of Allied Health

Use of Physical Therapy in Patients Hospitalized with a Diagnosis of Generalized Weakness: A Retrospective Study

Article excerpt

In a retrospective analysis of data from a national database, we observed and compared the presence of complications, lengths of stay, inflation-adjusted charges, and discharge statuses of two groups of patients hospitalized with a primary diagnosis of generalized weakness who did or did not receive physical therapy (PT) services. From a sample of patients (n = 38,991 cumulative from 1988 through 2003) from the Nationwide Inpatient Sample (NIS), 2.3% of patients admitted to the hospital with generalized weakness received PT intervention. Patients hospitalized with a primary diagnosis of generalized weakness who received PT services were sicker, had more selected secondary complications, and were demographically and socioeconomically dissimilar from patients who did not receive PT services. Quantitative analyses indicate that PT patients had longer inpatient hospital stays, more nonroutine discharges, and higher inflation-adjusted charges. The results are consistent with the interpretation that outcomes such as those examined here (nonroutine discharge, length of stay, and charges at discharge) are related to referral patterns in which only the most serious comorbidities qualify patients for referral for PT intervention services. J Allied Health 2008; 37:162-168.

GENERALIZED WEAKNESS is a common condition of patients presenting to primary care providers.1 The condition may be associated with muscle, tendon, or fascia, but it is typically diagnosed in conditions in which muscle weakness is the primary disorder. In infrequent situations where patients with generalized weakness demonstrate considerable functional deficits and self-care challenges, particularly if changes occur rapidly, hospitalization may be required.2 Primary causes or conditions associated with generalized weakness include stroke,3 influenza,4 selected medications,5,6 asthenia/cachexia,7 dehydration and electrolyte disorders,6 infections,8,9 and neuromuscular disorders.2,10-13 In nearly all cases of hospitalization, generalized weakness is a secondary diagnosis. Patients hospitalized with generalized weakness as a primary diagnosis typically are undergoing differential diagnosis and further workup,1 have succumbed to weakness associated with neglect or malnutrition,6 or have experienced significant debilitating muscle wasting or sarcopenia.7,14-18

Physical therapists frequently treat hospitalized patients and community-dwelling individuals for weakness and utilize interventions such as resistive strength training, neuromuscular retraining, and endurance exercises.19 These individuals benefit from resistive exercises and may experience increases in muscle mass and muscle strength and preservation of bone density.14-18 Regularly performed strengthening exercises allay muscle protein wasting and can retard the effects of sarcopenia.20 Improvements are often gained using basic equipment such as resistive elastic bands, weights, and the patient's own body weight during strengthening exercises.15

Despite the fact that strength gains have been demonstrated in patients experiencing weakness using common physical therapy (PT) interventions, we are unaware of any studies that outline the role of PT specifically for patients with a primary diagnosis of generalized weakness in a hospitalized setting. Prior studies have focused solely on treatments of selected conditions, have addressed patients who were not generalizable to hospitalized environments,14-18 or have included patients with near-terminal medical disorders such as lung, kidney, or liver failure as a primary diagnosis.21 We are also unaware of any evidence outlining complications or direct cost benefits such as length of stay, reduction of hospital charges, or improved discharge status for patients admitted with generalized weakness seen by physical therapists. At present, studies reflective of complications during hospitalization (in absence of reference of PT) for disorders associated with weakness involve problems such as infections,22,23 respiratory distress,22,24-26 deep vein thromboses,24,26 aspiration,22 and metabolic dysfunctions. …

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