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

Abstract

BackgroundGrowing 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. MethodsWe 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. ResultsWe 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). ConclusionsHigh-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.