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Influence of inpatient rehabilitation after crisis in patients with myasthenia gravis: A retrospective cohort study using a nationwide administrative database in Japan

  • Hiromichi Otaka
    Affiliations
    Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Neuroscience Medical Franchise, Medical Division, Novartis Pharma K.K., Tokyo, Japan
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  • Shinobu Imai
    Affiliations
    Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan

    Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
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  • Takuaki Tani
    Affiliations
    Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
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  • Kiyohide Fushimi
    Correspondence
    Corresponding author at: Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
    Affiliations
    Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
    Search for articles by this author

      Highlights

      • Most patients with myasthenia gravis received inpatient rehabilitation after a crisis.
      • High-intensity inpatient rehab did not lead to early ADL recovery after a crisis.
      • High-intensity rehab may not help recovery especially in case of worse baseline ADL.

      Abstract

      Background

      Growing evidence indicates that carefully programmed rehabilitation can improve symptoms in patients with myasthenia gravis (MG). However, evidence on rehabilitation to aid in recovery from a myasthenic crisis is lacking. This study aimed to examine the association between inpatient rehabilitation and recovery in the activities of daily living (ADL) after a myasthenic crisis.

      Methods

      We retrospectively identified patients hospitalized due to myasthenic crisis in a nationwide administrative database in Japan. Patients were divided into two groups based on the intensity of rehabilitation after weaning from mechanical ventilation. We evaluated the influence of rehabilitation on recovery in the ADL by comparing the two groups in Kaplan–Meier and Cox proportional hazard model analyses.

      Results

      We extracted the data of 437 cases treated from April 1, 2016 to March 31, 2020. High-intensity rehabilitation was associated with delayed recovery in the ADL on Kaplan–Meier analysis (p = 0.024, log-rank test). A similar result was obtained after adjusting for covariates in the Cox proportional hazard model analysis (hazard ratio: 0.69; 95% confidence interval: 0.48–0.99; p = 0.043).

      Conclusions

      High-intensity rehabilitation performed in current inpatient settings may not contribute to recovery in the ADL after a myasthenic crisis in patients with MG. Despite this study's large sample size, further research is necessary to reach firm conclusions.

      Keywords

      Abbreviations:

      ADL (activities of daily living), sATE (stabilized average treatment effect), BMI (body mass index), CCI (Charlson comorbidity index), CI (confidence interval), DPC (Diagnosis Procedure Combination), HR (hazard ratio), ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision), IPTW (inverse probability of treatment weighting), IQR (interquartile range), IVIg (intravenous immunoglobulin), MG (myasthenia gravis), MICE (multiple imputation by chained equation)
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