Key result
More in-hospital physiotherapy is linked to less functional decline in older acute HF patients.
Why the study?
Hospitalisation-associated disability is common in older patients with heart failure and the optimal physiotherapy approach for preventing it remains uncertain.
Does greater implementation of in-hospital physiotherapy reduce the incidence of hospitalisation-associated disability in older patients admitted with acute heart failure?
Observational (n=9,448)
Yes
Does greater implementation of in-hospital physiotherapy reduce the incidence of hospitalisation-associated disability in older patients admitted with acute heart failure?
Greater implementation of in-hospital physiotherapy is associated with reduced hospitalisation-associated disability in older adults with acute heart failure, particularly among those with lower baseline functional status.
May guide physiotherapy tailoring by baseline function in older HF inpatients; hypothesis-generating pending RCTs.
BACKGROUND: Hospitalisation-associated disability (HAD) is common in older patients with heart failure (HF) and associated with adverse outcomes. However, the optimal physiotherapy approach for preventing HAD remains uncertain. OBJECTIVE: To examine the association between physiotherapy implementation and HAD incidence according to baseline functional status in older patients with HF from the nationwide multicentre registry. DESIGN: Prospective observational study. SETTING: Nationwide registry conducted across 96 sites in Japan. SUBJECTS: Patients aged ≥65 years who were admitted with acute HF and received in-hospital physiotherapy. METHODS: Physiotherapy information included the number of modalities (basic out-of-bed activity, gait exercise, low-intensity muscle training, aerobic exercise and resistance training), frequency/week and amount/week. HAD was defined as a ≥5-point decrease in the Barthel Index (BI) score at discharge compared with the prehospital level. Associations between physiotherapy implementation and HAD were analysed using logistic regression analyses stratified by prehospital BI levels (≥85, 60-80 and <60). RESULTS: Among 9448 patients with HF (median age 83 years), HAD occurred in 3503 patients (37.1%). Greater physiotherapy implementation, including higher number of modalities, frequency and amount, was consistently associated with lower HAD incidence across prehospital BI subgroups. Evidence of effect modification was observed for modality in those with BI 60-80 (P for interaction = .048) and for frequency in those with BI <60 (P = .045), compared with patients with prehospital BI ≥85. CONCLUSIONS: This large registry revealed the potential benefit of greater implementation of in-hospital physiotherapy for preventing HAD, particularly for higher modality use and frequency in patients with reduced baseline functional status.
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Hamazaki et al. (2026) conducted an observational in Acute heart failure (n=9,448). Physiotherapy implementation vs. Lower levels of physiotherapy implementation was evaluated on Hospitalisation-associated disability (HAD) defined as a ≥5-point decrease in the Barthel Index score at discharge compared with prehospital level. Greater in-hospital physiotherapy implementation was associated with a lower incidence of hospitalisation-associated disability, which occurred in 37.1% of older patients with acute heart failure.
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