L-913. Adjunctive Manual Treatment for Older Adults Hospitalized with Community-Acquired Pneumonia
Session: Slide Session: New Issues with Community-Acquired Pneumonia
Sunday, October 26, 2008: 12:00 AM
Room: Room 151B
Background: Community acquired pneumonia (CAP) is a major health care issue with significant morbidity, mortality and cost. The Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) assessed the impact of adjunctive osteopathic manual treatment (OMT) in patients ≥50 years old hospitalized with pneumonia.
Methods: MOPSE is a registered, randomized, controlled, blinded clinical trial. Seven community hospitals in 5 states participated. Subjects (N=406) ≥50 years old were randomized into a conventional care (CC), light touch (LT) plus CC, or OMT plus CC group. Standardized adjunctive OMT and LT treatments lasting 15 minutes were initiated within 24 hours of admission and administered twice daily. Treatment endpoints were hospital discharge, intubation or death. Results: Subgroup analysis examined subjects with CAP (N=306, 144 male, 162 female), 171 in the 50 - 74 years age group and 135 in the group >75 years. There were no differences between the groups on Pneumonia Severity Index. Per-protocol analysis for 50 - 74 age group (N= 141) showed a reduction in the length of hospitalization (LOH) in the OMT group compared to the LT and CC groups (median (95% CI) 2.9 days (2.7.-3.4) vs 3.5 (2.9-4.5) & 3.9 (3.2-4.5); P=.02). There was no difference in LOH in those >75 (N=112, P=.21). In the intention-to-treat (ITT) analysis, there was no difference in LOH for either age group. In the ITT analysis, mortality was decreased in the OMT and LT groups compared to CC in the >75 age group only (0% & 0% vs 9%; P= .04).
Conclusions: There was a significant reduction in LOH for the OMT group of 1 day compared to the CC group and 0.6 days compared to the LT group by per-protocol analysis of CAP patients aged 50-74. This could reduce the cost of inpatient management of CAP. ITT analysis showed a significant decrease in mortality in both the OMT and LT groups in the >75 age group. With the small sample size, conclusions are limited, but considering the prevalence of CAP, adjunctive OMT merits further study.
Brian Degenhardt, DO1, Donald Noll, DO2, Francis Blais, DO3, Jane Johnson, MA3, Kari Hortos, DO3, Kendi Hensel, DO3 and Thomas Morley, DO3, (1)A.T. Still Research Institute, Kirksville, MO, (2)A.T. Still Research Institute, Blacksburg, VA, (3)A.T. Still Research Institute