OBJECTIVE. Alzheimer's disease (AD) results in a loss of independence in activities of daily living (ADLs), which in turn affects the quality of life of affected people and places a burden on caretakers. Limited research has examined the influence of physical training (aerobic, balance, and strength training) on ADL performance of people with AD.METHOD. Six randomized controlled trials (total of 446 participants) fit the inclusion criteria. For each study, we calculated effect sizes for primary and secondary outcomes.RESULTS. Average effect size (95% confidence interval) for exercise on the primary outcome (ADL performance) was 0.80 (p < .001). Exercise had a moderate impact on the secondary outcome of physical function (effect size 5 0.53, p 5 .004). CONCLUSION. Occupational therapy intervention that includes aerobic and strengthening exercises mayhelp improve independence in ADLs and improve physical performance in people with AD. Additional research is needed to identify specific components of intervention and optimal dosage to develop clinical guidelines.

Key Points Question Is the amount of physical and occupational therapy received by patients with pneumonia associated with 30-day hospital readmission or death? Findings In this cohort study of 30 746 patients with pneumonia or influenza-related conditions discharged from 12 acute care hospitals in western Pennsylvania, there was a significant inverse association between the amount of therapy received and the risk of 30-day hospital readmission or death. Meaning In this study, the amount of therapy received by patients with pneumonia or influenza-related conditions in the acute care setting was associated with decreases in the risk of 30-day hospital readmission or death.

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Background Readmissions in patients with congestive heart failure are common and often preventable. Limited data suggest that patients discharged to a less intensive postacute care setting than recommended are likely to readmit. We examined whether postacute setting discordance (discharge to a less intensive postacute setting than recommended by a physical and occupational therapist) was associated with hospital readmission in patients with congestive heart failure. We also assessed sociodemographic and clinical predictors of setting discordance. Methods and Results Retrospective analysis of administrative claims and electronic health record data was conducted on 25 500 adults with a discharge diagnosis of congestive heart failure from 12 acute care hospitals in Western Pennsylvania. Generalized linear mixed models were estimated to examine the association between postacute setting discordance and 30‐day hospital readmission and to identify predictors of setting discordance. The 30‐day readmission and postacute setting discordance rates were high (23.7%, 20.6%). While controlling for demographic and clinical covariates, patients in discordant postacute settings were more likely to be readmitted within 30 days (adjusted odds ratio [OR], 1.12; 95% CI, 1.04–1.20). The effect was also seen in the subgroup of patients with low mobility scores (adjusted OR, 1.20; 95% CI, 1.08–1.33). Factors associated with setting discordance were lower‐income, higher comorbidity burden, therapist recommendation disagreement, and midrange mobility limitations. Conclusions Postacute setting discordance was associated with an increased readmission risk in patients hospitalized with congestive heart failure. Maximizing concordance between therapist recommended and actual postacute discharge setting may decrease readmissions. Understanding factors associated with post‐acute setting discordance can inform strategies to improve the quality of the discharge process.

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