Utilization and potential disparities in access to physical therapy for spine pain in the long-term care population

Abstract

ObjectiveTo determine the frequency of physical therapy (PT) services and potential disparities in receiving PT amongst Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings. DesignSecondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017 – 2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date. To identify potential disparities in access to PT services, we performed multivariable logistic regression to determine resident demographic, clinical, and community factors associated with receiving PT. SettingN/A ParticipantsMedicare fee-for-service LTC residents ages ≥65. InterventionsN/A Main Outcome MeasureReceiving PT services. ResultsOf the 999,495 LTC residents with a history of spine pain, 49.6% received PT. Only 12.1% of PT episodes specifically treated spine pain. The odds of receiving PT were higher for residents with pain in multiple spine regions or neuropathic pain (OR 1.27, 95%CI 1.26-1.29) and for residents with inpatient admissions (OR 1.76, 95%CI 1.75-1.78). Odds of receiving PT were lower for residents from minoritized racial and ethnic groups, and for residents with dementia (OR 0.89, 95% CI 0.88-0.90), depression (OR 0.95, 95% 0.94, 0.96), or who lived in urban or more socioeconomically deprived areas. ConclusionsWhile nearly half of LTC residents with histories of spine pain received PT services, most PT was not for spine pain. There are potential disparities in access to PT for LTC residents from minoritized groups living in urban and more deprived areas. Further work should examine PT outcomes and remove barriers to PT for LTC residents with histories of spine pain.