Effect of early versus delayed mobilization by physical therapists on oral intake in patients with sarcopenic dysphagia after pneumonia

  • Narimi Miyauchi
  • Mikako Nakamura
  • Ikuyo Nakamura
  • Ryo MomosakiEmail author
Research Paper

Key Summary Points


To test the hypothesis that early mobilization by physical therapists enhances oral intake after pneumonia in sarcopenic dysphagia.


The study demonstrated that early mobilization by a physical therapist is associated with improved total oral intake in patients with sarcopenic dysphagia after pneumonia.


Early mobilization is possibly a practicable alternative for improving the quality of geriatric medical practice in managing pneumonia patients with sarcopenic dysphagia.


Background and purpose

Older pneumonia patients with sarcopenic dysphagia have difficulty with oral intake. Physical rehabilitation might be beneficial in the treatment of sarcopenic dysphagia. This study aimed to test the hypothesis that early mobilization by physical therapists enhances oral intake after pneumonia in sarcopenic dysphagia.


This retrospective observational study used data on consecutive pneumonia patients with sarcopenic dysphagia aged over 65 years hospitalized in the acute care ward from May 2017 to October 2017. We compared characteristics and outcomes between the early mobilization group and the delayed mobilization group. The outcomes were total oral intake and functional oral intake scale score at discharge.


Applying the exclusion criteria, 125 patients were eligible. Patients with early mobilization were 33.6% of all pneumonia patients. There were no significant differences in baseline characteristics between both groups. Total oral intake rates at discharge were higher in the early mobilization group compared with the delayed mobilization group (75.6% vs 51.8%; p = 0.012). Functional oral intake scale scores were higher in the early mobilization group than the delayed mobilization group (p = 0.001). On multiple logistic regression analysis, early mobilization was significantly associated with total oral intake at discharge (odds ratio, 3.06; p = 0.01). Multiple linear regression analysis revealed that early mobilization was a significant factor affecting functional oral intake scale score at discharge (coefficient, 0.25; p = 0.01).


Our cohort analysis demonstrated that early mobilization by a physical therapist is associated with improved total oral intake in patients with sarcopenic dysphagia after pneumonia.


Dysphagia Early mobilization Physical therapy Pneumonia Sarcopenia 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Spilios D, Soultana P, Konstantinos K, Filippos Z (2018) Sarcopenic dysphagia. A narrative review. JFSF 8:1–7CrossRefGoogle Scholar
  2. 2.
    Mori T, Fujishima I, Wakabayashi H et al (2017) Development, reliability, and validity of a diagnostic algorithm for sarcopenic dysphagia. JCSM Clin Rep 2:e00017Google Scholar
  3. 3.
    Wakabayashi H (2014) Presbyphagia and sarcopenic dysphagia: association between aging, sarcopenia, and deglutition disorders. J Frailty Aging 3:97–103Google Scholar
  4. 4.
    Wakabayashi H, Uwano R (2016) Rehabilitation nutrition for possible sarcopenic dysphagia after lung cancer surgery: a case report. Am J Phys Med Rehabil 95:e84–e89CrossRefGoogle Scholar
  5. 5.
    Kohno S, Imamura Y, Shindo Y et al (2013) Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP). Respir Investig 51:103–126CrossRefGoogle Scholar
  6. 6.
    Fox MT, Sidani S, Persaud M et al (2013) Acute care for elders components of acute geriatric unit care: systematic descriptive review. J Am Geriatr Soc 61:939–946CrossRefGoogle Scholar
  7. 7.
    Abizanda P, León M, Domínguez-Martín L et al (2011) Effects of a short-erm occupational therapy intervention in an acute geriatric unit: a randomized clinical trial. Maturitas 69:273–278CrossRefGoogle Scholar
  8. 8.
    Matsui H, Hashimoto H, Horiguchi H, Yasunaga H, Matsuda S (2010) An exploration of the association between very early rehabilitation and outcome for the patients with acute ischaemic stroke in Japan: a nationwide retrospective cohort survey. BMC Health Serv Res 10:213CrossRefGoogle Scholar
  9. 9.
    Hodgson CL, Berney S, Harrold M, Saxena M, Bellomo R (2013) Clinical review: early patient mobilization in the ICU. Crit Care 17:207CrossRefGoogle Scholar
  10. 10.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65Google Scholar
  11. 11.
    Shindo Y, Sato S, Maruyama E et al (2008) Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia. Respirology 13:731–735CrossRefGoogle Scholar
  12. 12.
    Murayama H, Nishinaga M, Sugawara I et al (2012) Interactions of household composition and required care level with functional and cognitive status among disabled Japanese elderly living in a suburban apartment complex. Geriatr Gerontol Int 12:538–546CrossRefGoogle Scholar
  13. 13.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  14. 14.
    Crary MA, Mann GD, Groher ME (2005) Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 86:1516–1520CrossRefGoogle Scholar
  15. 15.
    Detsky AS, McLaughlin JR, Baker JP et al (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13CrossRefGoogle Scholar
  16. 16.
    Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399–424CrossRefGoogle Scholar
  17. 17.
    Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191CrossRefGoogle Scholar
  18. 18.
    Momosaki R, Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Abo M (2016) Predictive factors for oral intake after aspiration pneumonia in older adults. Geriatr Gerontol Int 16:556–560CrossRefGoogle Scholar
  19. 19.
    Yagi M, Yasunaga H, Matsui H et al (2016) Effect of early rehabilitation on activities of daily living in patients with aspiration pneumonia. Geriatr Gerontol Int 16:1181–1187CrossRefGoogle Scholar
  20. 20.
    Momosaki R, Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Abo M (2015) Effect of early rehabilitation by physical therapists on in-hospital mortality after aspiration pneumonia in the elderly. Arch Phys Med Rehabil 96:205–209CrossRefGoogle Scholar
  21. 21.
    Kim SJ, Lee JH, Han B et al (2015) Effects of hospital-based physical therapy on hospital discharge outcomes among hospitalized older adults with community-acquired pneumonia and declining physical function. Aging Dis 6:174–179CrossRefGoogle Scholar
  22. 22.
    Koyama T, Maeda K, Anzai H, Koganei Y, Shamoto H, Wakabayashi H (2015) Early Commencement of oral intake and physical function are associated with early hospital discharge with oral intake in hospitalized elderly individuals with pneumonia. J Am Geriatr Soc 63:2183–2185CrossRefGoogle Scholar
  23. 23.
    Brummel NE, Girard TD (2013) Preventing delirium in the intensive care unit. Crit Care Clin 29:51–65CrossRefGoogle Scholar
  24. 24.
    Li Min, Wang Zheng, Han Wei-Jia, Shi-Yin Lu, Fang Ya-Zhen (2015) Effect of feeding management on aspiration pneumonia in elderly patients with dysphagia. Chin Nurs Res 2:40–44CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Department of RehabilitationTeikyo University School of Medicine University Hospital, MizonokuchiKawasakiJapan
  2. 2.Department of Rehabilitation MedicineThe Jikei University School of MedicineMinato-kuJapan

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