Five Functional Classes Identified Among Patients Hospitalized for Pneumonia Characterized by Activity Limitations With Mobility and Self-Care Tasks

Abstract

Objective: Latent class analysis was used to identify functional classes among patients hospitalized for pneumonia. Then, we determined predictors of class membership and examined variation in distal outcomes among the functional classes.

Design: An observational, cross-sectional study design was used with retrospectively collected data between 2014 and 2018.

Setting: The study setting was a single health system including 5 acute care hospitals.

Participants: A total of 969 individuals hospitalized with the primary diagnosis of pneumonia and receipt of an occupational and/or physical therapy evaluation were included in the study.

Interventions: Not applicable.

Main outcomes: The following 5 distal outcomes were examined: (1) occupational therapy treatment use, (2) physical therapy treatment use, (3) discharge to home with no services, (4) discharge to home with home health, and (5) institutional discharge.

Results: Five functional classes were identified and labeled as follows: Globally impaired, Independent with low-level self-care, Independent low-level mobility, Independent self-care, and Independent. Probability of occupational therapy treatment use (χ²[4]=50.26, P<.001) and physical therapy treatment use (χ²[4]=50.86, P<.001) varied significantly across classes. The Independent with low-level self-care class had the greatest probability of occupational therapy treatment use and physical therapy treatment use. Probability of discharging to home without services (yes/no; χ²[4]=88.861, P<.001), home with home health (yes/no; χ²[4]=15.895, P=.003), and an institution (yes/no; χ²[4]=102.013, P<.001) varied significantly across the 5 classes. The Independent class had the greatest probability of discharging to home without services.

Conclusions: Five functional classes were identified among individuals hospitalized for pneumonia. Functional classes could be used by the multidisciplinary team in the hospital as a framework to organize the heterogeneity of functional deficits after pneumonia, improve efficiency of care processes, and help deliver targeted rehabilitation treatment.

Keywords: Acute care; Daily activities; Function; Mobility; Pneumonia; Rehabilitation; Self-care.

Fig 1

Latent class model with predictors of class membership and distal outcomes. NOTE. x₁-x₁₂ signify the AM-PAC items used to identify the functional subgroups, which are: (1) turning over in bed; (2) sitting down on/standing up from a chair with arms; (3) moving from lying on back to sitting on the side of the bed; (4) moving to and from a bed to a chair; and (5) walking in the hospital room; and (6) climbing 3-5 steps with a railing; (7) upper body dressing; (8) lower body dressing; (9) bathing; (10) toileting; (11) grooming; and (12) eating.

Fig 2

Profile plot illustrating conditional item probabilities for each of the 5 latent classes. No shading indicates mobility tasks. Shading indicated self-care tasks.

Fig 3

Estimated probability of receiving OT and PT treatment use and discharge location across the 5 latent classes. Estimates adjusted for sex, age, significant other status, minority status, insurance type, comorbidity burden, and length of stay.