Greater implementation of in-hospital physiotherapy, including higher number of modalities, frequency, and amount, was consistently associated with lower hospitalisation-associated disability incidence across all prehospital functional status subgroups in older patients with heart failure, with particular benefit observed for higher modality use and frequency in patients with reduced baseline functional status.
Hospitalisation-associated disability (HAD) occurred in 37.1% of older patients hospitalised with acute heart failure who received in-hospital physiotherapy.
Greater physiotherapy implementation across all measured dimensions was consistently associated with lower HAD incidence across all prehospital functional status subgroups.
Effect modification by prehospital functional status was observed for physiotherapy modality number in patients with prehospital BI 60–80.
Effect modification by prehospital functional status was observed for physiotherapy frequency in patients with prehospital BI <60.
The study was a prospective observational design using a nationwide multicentre registry, limiting causal inference.
The authors concluded that greater in-hospital physiotherapy implementation has potential benefit for preventing HAD, particularly for higher modality use and frequency in patients with reduced baseline functional status.
This research examined whether more intensive physical therapy during hospitalization could help older heart failure patients avoid losing their ability to perform daily activities — a phenomenon called hospitalisation-associated disability (HAD). Using data from nearly 9,500 patients aged 65 and older admitted to 96 hospitals across Japan, the researchers found that over one-third of patients (37.1%) experienced meaningful functional decline during their hospital stay, defined as a notable drop in their ability to perform everyday tasks like eating, bathing, and walking. The study found that patients who received more types of physical therapy exercises, more frequent sessions, and greater overall amounts of therapy were less likely to experience this functional decline, regardless of how physically capable they were before being hospitalized. Importantly, patients who were already somewhat functionally limited before admission appeared to benefit even more from receiving a greater variety of therapy types and more frequent therapy sessions — suggesting that the sickest and most vulnerable patients may stand to gain the most from intensive rehabilitation efforts during hospitalization. This research suggests that optimizing in-hospital physical therapy — both in terms of how often it is delivered and how many different types of exercises are included — may be an important strategy for preserving functional independence in older adults hospitalized with heart failure. The findings are particularly relevant for patients who already have some degree of disability before hospitalization, as these individuals may benefit most from more intensive and varied therapy programs. Because this was an observational study, it cannot definitively prove that more therapy directly causes better outcomes, but the consistency of findings across different patient groups strengthens the case for further investigation.
Hamazaki N, Kato M, Iida Y, Iwata K, Sakurada K, Funami Y, et al.. (2026). Physiotherapy implementation and hospitalisation-associated disability according to prehospital functional status in older patients with heart failure: a secondary analysis of a prospective nationwide multicentre registry.. Age and ageing. https://doi.org/10.1093/ageing/afag283