Article 10: Influence of Outcome Expectations on Surgeon Referral to Physical Therapy: Results of a National Survey of Orthopaedic Trauma Association Members

Abstract

Objective: To explore the influence of physician outcome expectations on referral to physical therapy (PT) for patients with traumatic lower-extremity injury. Design: Cross-sectional survey. Setting: Clinical practice. Participants: 274 members of the Orthopaedic Trauma Association. Interventions: Not applicable. Main Outcome Measure: Referral to PT based on 5 case vignettes. Results: Surgeons reported that 58% of their patients would have a positive outcome from PT and 24% a negative outcome. The highest PT expectations were for the appropriate use of assistive device(s) (81%) and improved range of motion and strength (76%). The lowest outcome expectations were for improvements in pain (36%), coping with the emotional aspects of disability (44%), and improvements in workplace limitations (51%). Physicians also reported that 27% of their patients referred to PT would have no improvement beyond what would naturally occur and 28% would receive inappropriate medical information. Multivariate analyses found positive physician outcome expectations to have the largest effect on referral to PT (odds ratio=3.3, P<.001). Conclusions: Results suggest that orthopedic trauma surgeons refer to PT based mostly on expectations for physical and motor outcomes, and that low referral rates may be attributed to a preference for surgeon-directed home-based rehabilitation. Future research should consider the effect of PT on various dimensions of pain and psychosocial aspects of recovery, and exploring the differences between supervised PT and physician-directed home exercise programs.