Association of Disability Duration With Physical Therapy Services Provided After Meniscal Surgery in a Workers' Compensation Population

Abstract

Webster BS, Verma S, Willetts J, Hopcia K, Wasiak R. Association of disability duration with physical therapy services provided after meniscal surgery in a workers' compensation population. Objective To examine the association between physical therapy (PT) amount and type (eg, active exercise and passive modalities) received postmeniscectomy with subsequent days of work disability. Design Historical prospective study. Setting Workers' compensation administrative claims data source. Participants Patients (N=3888) with a new knee injury filed between January 1, 2001, and December 31, 2003, who underwent meniscectomy within 6 months postinjury. Interventions PT services received within 42 days postmeniscectomy. Patients were divided into 9 groups based on PT service amount and type received during the exposure period (no PT, only low active, only high active, only low passive, only high passive, low active/low passive, high active/low passive, low active/high passive, high active/high passive). Main Outcome Measure Number of disability days post–exposure period and truncated at the end of the 1.5-year outcome period based on lost-time payments. Results During the exposure period, 32.5% received no PT services, 15.3% had only active, 1.5% had only passive, and 50.8% had a combination of both. After controlling for covariates (including severity indicators and physical job demands), receipt of any passive services was associated significantly with a greater number of disability days, and no significant differences were found for those who received only active PT compared with those receiving no PT. Severity indicators, including opioid use pre- and postsurgery, more disability before surgery, and greater surgery severity, were associated with more disability days, whereas physical job demands were not. Conclusions Our results suggest that passive PT services provided postmeniscectomy may be counterproductive to work resumption. In addition, disability duration was shorter or no different for those who received no PT services than for those who received any type of PT services. With better control of confounders in future studies, a beneficial effect of active PT might be found. For the development of rehabilitation guidelines, randomized controlled trials are needed to better understand the effectiveness of active and passive PT services postmeniscectomy.