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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 13, 2022
Accepted:
May 9,
2022
Received in revised form:
May 4,
2022
Received:
February 27,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
