Am Fam Physician. 2004;69(9):2198-2199
A significant number of cases of community-acquired pneumonia (CAP) occur in the United States each year. About 15 percent of these patients require hospitalization, which substantially increases health care expenditures. Multiple efforts have been made to improve the efficiency of treating these patients. Most efforts have focused on improvement of triage decisions, identification of low-risk patients for outpatient care, reduction in delivery time of antibiotics, more judicious use of antibiotics, and early transition from intravenous to oral antibiotics. Early mobilization has been effective in improving outcomes in patients who have had total knee replacement and patients who have had acute myocardial infarction. Although the mechanism is unknown, this simple maneuver might be beneficial in the treatment of patients with CAP. Mundy and colleagues conducted a group randomized trial at multiple sites to assess the impact of early mobilization in hospitalized adult patients with CAP.
Participants were randomized to receive usual care for pneumonia or early mobilization along with usual care. Early mobilization was defined as being out of bed or ambulating for at least 20 minutes within the first 24 hours following admission. After the first 24 hours, progressive mobilization occurred each subsequent day until discharge in the early-mobilization group. Sitting up for meals or using a commode was not considered adequate for early mobilization. The authors gathered information, including demographics and standard-of-care data. During the hospitalization, all patients were interviewed by trained professionals to assess functional health status and pneumonia-specific information. The main outcomes were length of hospital stay, mortality rate, number of chest radiographs, emergency department visits after discharge, and readmissions at 30 and 90 days after admission.
The authors enrolled 227 patients in the early-mobilization group and 231 patients in the usual-care group. The groups did not differ significantly with regard to age, sex, disease severity, door-to-drug delivery time, and intravenous-to-oral switchover time. The hospital length of stay was significantly less in the early-mobilization group than in the usual-care group, with an adjusted absolute difference of 1.1 days. The mortality rates, number of follow-up chest radiographs, emergency department visits, readmission rates, and number of adverse events were not significantly different between the two groups. However, the cost of hospitalization between the groups was significantly different, with a savings of approximately $1,000 per patient in the early-mobilization group.
The authors conclude that early mobilization of patients admitted with CAP reduces overall hospital length of stay and use of institutional resources. These reductions occur without increasing the risk of adverse outcomes.
editor’s note: One of the changes that has occurred in medicine is the concept of early mobilization. In the past, patients with any major medical illness were placed on prolonged bed rest. It was believed that this would allow the body to recuperate after the insult of the major medical illness. Published evidence demonstrated that prolonged bed rest not only failed to improve outcomes but, in reality, made things worse. Results of the study by Mundy and colleagues demonstrate that the same can be said for patients with pneumonia. Early mobilization during hospitalization improves outcomes. This study demonstrates that an action once thought to make sense actually did more harm than good.—K.E.M.