Number Of Physical Therapy Sessions Research Articles

Key Factors Driving Physiotherapy Use in Patients with Nonspecific Low Back Pain: Retrospective Clinical Data Analysis

Background/objectives: Understanding the factors that influence physiotherapy (PT) service use among patients with nonspecific lower back pain (LBP) is necessary to optimize treatment strategies, healthcare resource allocation, and the planning of value-based initiatives. We report factors that influence the number of PT visits per episode of care (defined as a referral from a physician) for an LBP population in Saudi Arabia, and compare them with patients experiencing their first and recurrent episodes of LBP. Methods: LBP patients were retrospectively enrolled from a clinical dataset derived from an outpatient PT clinic in Saudi Arabia. The primary outcome variable was the number of PT visits performed per episode of care. Multiple linear regression analysis was performed to examine the relationships between the numbers of PT visits per episode of care and independent variables. Results: The number of PT sessions per week (β 0.34, p < 0.001), compliance with PT sessions (β 0.31, p < 0.001), and pre-pain scores (β 0.29, p < 0.001) explained 41.8% (adjusted R2 0.32) of the variance in the total number of PT visits per episode of care (p < 0.001). Conclusions: Factors that might improve value-based care for LBP patients are reported. The more PT sessions per week, compliance with these sessions, and higher baseline pain scores predict a higher number of PT visits per episode of care among these patients. While reported for a Saudi Arabian population, there is no reason to believe that these findings do not apply internationally.

Does Insurance Provide Adequate Coverage for Physical Therapy Visits for Common Orthopedic Diagnoses? A Survey Study.

This study aimed to analyze the association between physical therapists' recommended number of visits for a full recovery from common orthopedic injuries/surgeries and the extent of insurance coverage for these visits. A prospective observational study was conducted with board-certified physical therapists. A qualitative questionnaire was used to gather physical therapists' demographics and the recommended number of physical therapy visits to achieve a full recovery after 11 common orthopedic diagnoses. Physical therapists also were asked to report whether they believe that insurance provides an adequate number of visits overall. In addition to the qualitative survey, insurance coverage details of major Alabama companies were obtained for comparison. Descriptive statistics of the participating therapists were analyzed for sex, age, degree/training, and years of experience. Kruskal-Wallis statistics were used to analyze variance between the aforementioned groupings when compared with the reported average number of sessions. The survey (N = 251) collected data on the average number of physical therapy sessions that are necessary for a complete recovery as recommended by physical therapists for 11 common orthopedic diagnoses. From this survey, the average number of necessary visits ranged from 11.3 visits (ankle sprains) to 37.3 visits (anterior cruciate ligament reconstruction), with the overall average number of visits being 23.8. Only 24% of physical therapists believed that insurance companies provided enough coverage. Insurance coverage varied but often required additional procedures to allocate the adequate number of visits for the studied orthopedic pathologies. The majority of practicing physical therapists in Alabama perceive insufficient insurance coverage for physical therapy visits for most orthopedic diagnoses. This study has implications for healthcare decision making and patient-centered rehabilitation goals. Physicians and physical therapists can use this information to optimize treatment decisions and rehabilitation goals. Patients will benefit from improved physical and economic well-being. This study has the potential to drive further research and influence national insurance policies to better serve patients' needs.

The Impact of Outpatient Physical Therapy on Patient-Reported Outcomes After Lumbar Fusion: Perspective from A Bundled Care Dataset

As value-based care grows in popularity across the United States, more payers have turned toward bundled payment models for surgical procedures. Though episode costs in spine are highly variable, physical therapy (PT) has been identified as a driver of 90-day cost. The goal of this study is to assess the impact of postoperative PT on patient-reported outcomes and cost after lumbar fusion surgery using bundled insurance data. Bundled payment information of lumbar fusion episodes-of-care (EOC) from 2019 to 2021 was reviewed at a single, urban, tertiary care center. EOC comprised a 210-day period surrounding the date of the procedure, beginning 30 days preoperatively and ending 180 days postoperatively. Patients were grouped into physical therapy (PT) and no physical therapy (no PT) groups based on the presence of PT claims. Bivariate analysis of surgical outcomes revealed similar overall complication rates (P= 0.413), 30-day readmissions (P= 0.366), and 90-day readmissions (P= 0.774). Patients who did not participate in postoperative PT had significantly better preoperative physical component score (PCS) (P= 0.003), 6-month postoperative PCS (P= 0.001), and 6-month ΔPCS (P= 0.026) compared with patients who participated in postoperative PT. At 1-year follow-up, patients who did not participate in PT had less leg pain (P= 0.041) than those who did participate in PT. Our study finds that PT after lumbar fusion is not associated with significant improvement in Oswestry Disability Index, PCS, mental component score, or visual analog scale pain scores. Additionally, the number of PT sessions a patient attends has no correlation with improvement in these outcomes.

Prolonged Physiotherapy after Anterior Cruciate Ligament Reconstruction Does Not Improve Muscular Strength and Function.

Background: After the rupture of the anterior cruciate ligament (ACL), surgery is proposed in the case of knee instability or for athletes who want to return to a pivotal and/or contact sport. The current trend is to extend physiotherapy sessions until a patient's return to sport. We aimed to assess the interest in prolonging the physiotherapy sessions up to 4 postoperative months to restore muscle knee strength and function. Methods: From a historical cohort, 470 patients (24.3 ± 8.7 years) were included; 312 (66%) were males. They all had undergone a primary ACL reconstruction with a hamstring procedure. The number of physiotherapy sessions was established at 4 postoperative months. The main study parameters to assess the benefit of prolonged physiotherapy were the isokinetic limb symmetry index (LSI) for the quadriceps and the hamstrings as well as the Lysholm score. Results: At 4 postoperative months, 148 patients (31.4%) still had physiotherapy sessions. This group had performed 49 ± 14 physiotherapy sessions at the time of evaluation compared to 33 ± 9 sessions performed by the group that stopped physiotherapy at 3 months post-ACL reconstruction. The isokinetic knee LSI and the Lysholm score were not different between the two groups. Continued physiotherapy sessions were associated with female gender, previous high sport level, meniscal repair, lateral tenodesis and outpatient rehabilitation at the beginning of the rehabilitation management, while knee pain complications were not associated. Conclusions: No significant correlation was found between the number of physiotherapy sessions and the knee strength LSI or the Lysholm score. Prolonging patient physiotherapy sessions after 3 months post-ACL reconstruction seems ineffective in improving knee strength recovery and function.

Optimal Duration of Physical Therapy Following Total Knee Arthroplasty.

The purpose of this study was to identify patient characteristics associated with engagement and completion of physical therapy (PT) following total knee arthroplasty (TKA) and examine the relationship between number of PT sessions attended and outcomes during the first 12weeks after surgery. Patients underwent unilateral primary TKA by a single surgeon and were advised to complete 17 PT sessions over 6weeks at a hospital-affiliated facility. Analyses examined predictors of PT engagement (attendance of ≥2 sessions) and completion (attendance of 17 ± 1 sessions) within 6weeks and associations between number of PT sessions attended and changes in range of motion (ROM) and Knee Injury and Osteoarthritis Outcome Score (KOOS) values. Patients living <40km were more likely to be engaged in PT than those living ≥40km from the clinic (P < .0001). Among patients who completed PT within 6weeks, 95.0%, 85.1%, and 56.4% achieved flexion of, respectively, ≥90°, ≥100°, and ≥110°. Among engaged patients, the active flexion thresholds of ≥90°, ≥100°, and ≥110° were achieved by, respectively, 94.4%, 82.5%, and 58.1% by 6weeks and by 96.7%, 92.1%, and 84.2% by 12weeks. Improvement in KOOS Symptoms (P = .029), Function in daily living (P = .030) and quality of life (P = .031) linearly decreased as number of PT sessions increased. These results raise the question of whether patients who meet satisfactory outcomes before completing 6weeks of prescribed PT and those who attend more PT sessions than prescribed may be over-utilizing healthcare resources without additional benefit.

Força muscular em pacientes hospitalizados por COVID-19

Abstract Introduction Complications arising from hospitalization due to COVID-19 have great impact on the physical health of individuals. One of the consequences that deserves attention is muscle weakness, which can be influenced by several factors, generating consequences that may need rehabilitation. Objective To relate the degree of peripheral and respiratory muscle strength to sociodemographic, clinical, and hospitalization variables close to discharge after hospitalization due to COVID-19. Methods This cross-sectional study analyzed data for 52 patients hospitalized for COVID-19 who were interviewed close to discharge to determine sociodemographic and clinical profiles and underwent muscle strength testing. Peripheral muscle strength was evaluated using the Medical Research Council scale, and respiratory strength was determined according to maximum inspiratory and expiratory pressure measured with a vacuometer. Hospitalization data were collected from patient medical records. Results Peripheral strength was reduced in 53.9% of the sample, and the related variables (p &lt; 0.05) were age, weight, cancer, high blood pressure, physical therapy, and number of physiotherapy sessions. Inspiratory force was reduced by 50% of individuals and expiratory force in 60% individuals, and these reductions were related (p &lt; 0.05) to sex, high blood pressure, age, and weight. Conclusion Close to COVID-19 hospital discharge, over 50% of patients exhibited peripheral and respiratory muscle weakness, associated with advanced age, hypertension, and low weight. Those with peripheral weakness received more physiotherapy and had more oncological diseases, while respiratory weakness was more common in men. This underscores the importance of preventive measures and post-hospitalization rehabili-tation programs, including physiotherapy, for muscle strength recovery.

Sarcopenia, malnutrition and cognition affect physiotherapy frequency during geriatric rehabilitation: RESORT cohort

Physiotherapy (PT) is important to optimize functional recovery in geriatric rehabilitation. The dose of PT received by inpatients during geriatric rehabilitation and the determinants of dose are unknown. Describe PT dose in terms of total number of sessions, frequency, duration and type of sessions, and inpatient characteristics determining the frequency of PT in geriatric rehabilitation. The observational, longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort consists of geriatric inpatients undergoing rehabilitation including PT (Melbourne, Australia). Ordinal regression was used to assess the determinants of PT frequency (total number of sessions divided by length of stay in weeks). Malnutrition, frailty and sarcopenia were diagnosed according to the Global Leadership Initiative on Malnutrition criteria, Clinical Frailty Scale and revised definition of the European Working Group on Sarcopenia in Older People respectively. Of the 1890 participants, 1799, median (quartile 1; quartile 3) age 83.4 (77.6; 88.4) years, 56% females received PT and were admitted for at least 5 days. Median total number of PT sessions was 15 (8; 24); median frequency was 5.2 sessions per week (3.0; 7.7); and duration was 27 (22; 34) minutes per session. Higher disease burden, cognitive impairment, delirium, higher anxiety and depression scores, malnutrition, frailty and sarcopenia were associated with a lower PT frequency. Older age, female sex, musculoskeletal reason for admission, greater independence in (instrumental) activities of daily living and handgrip strength were associated with a higher PT frequency. PT frequency varied widely with a median of 1 session per working day. PT frequency was lowest in participants with poorest health characteristics.

WARP: RESULTS OF THE WYCOMBE ARTHROPLASTY RAPID-RECOVERY PATHWAY

The development and implementation of Enhanced Recovery After Surgery (ERAS) protocols are of particular interest in elective orthopaedics due to clinical benefits and cost effectiveness. The Wycombe Arthroplasty Rapid-Recovery Pathway (WARP) was designed to streamline hip and knee joint arthroplasty to reduce time spent in hospital whilst optimising outcomes in an NHS District General Hospital.966 patients were admitted to Wycombe General Hospital for primary elective joint replacement (60 UKR, 446 THR, 460 TKR) during the period 1st September 2020 to 31st September 2022. The WARP pathway was used for 357 (37%) patients (32 UKR, 155 THR, 170 TKR) and the standard “non-WARP” pathway was used for 609 (63%) patients (28 UKR 291 THR, 290 TKR). Data was collected on length of stay, time of mobilisation, number of physiotherapy sessions, and inpatient morbidity.Average length of stay following UKR was 0.75 days for WARP vs 2.96 for non-WARP patients, following THR was 2.17 days for WARP vs 4.17 for non-WARP patients, following TKR was 3.4 days for WARP vs 3.92 for non-WARP patients. Day-0 mobilisation after UKR was achieved in 97% of WARP vs 12% of non-WARP patients, after THR in 43% of WARP vs 14% of non-WARP patients, after TKR in 33% of WARP vs 11% of non-WARP patients. Same-day discharge was achieved in the WARP cohort in 63% of UKR, 10% of THR, 2% of TKR patients. There were no same-day discharges in the non-WARP cohort. Complications delaying mobilisation (pain, nausea/vomiting, dizziness/low BP) were identified in 8.4% of WARP vs 25% of non-WARP patients.Our cohort study shows that the initiation of WARP Rapid Recovery pathway for joint arthroplasty decreased the average length of stay after UKR by 2.21 days, after THR by 2 days, after TKR by 0.52 days. Time to first mobilisation was decreased significantly by increased rates of same-day mobilisation and reduced rates of postoperative anaesthetic-related complications.

Effectiveness of a telerehabilitation tablet app in combination with face-to-face physiotherapy for people with wrist, hand or finger injuries: A pragmatic multicentre clinical trial.

To evaluate whether, in patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app reduces the consumption of face-to-face resources and improves clinical recovery, compared to a conventional home exercise program prescribed on paper. Pragmatic, multicentre, parallel, two-group, controlled clinical trial with blinded assessor. Eighty-one patients with traumatic bone and/or soft tissue injuries of the hand, wrist and/or fingers recruited in four hospitals of the Andalusian Public Health System. The experimental group received a home exercise program using a touchscreen tablet application and the control group received a home exercise program on paper. Both groups received the same treatment of face-to-face physiotherapy. Number of physiotherapy sessions. Secondary outcomes were the duration of physiotherapy and clinical variables such as functional ability, grip strength, pain and manual dexterity. The experimental group required fewer physiotherapy sessions (MD -11,5 sessions; 95% CI -21.4 to -1.4), showed a shorter duration of physiotherapy (MD -3.8 weeks, 95% CI -7 to -1) and had better recovery of grip strength, pain and dexterity compared to the control group. In patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app in combination with face-to-face physiotherapy reduces the consumption of face-to-face resources and improves clinical recovery, compared to conventional home exercise program prescribed on paper.

Fisioterapia temprana, funcionalidad y complicaciones postoperatorias en adultos con cirugía abdominal de urgencia

IntroductionGiven that the relevancy of early physiotherapy (PT) in persons undergoing emergency abdominal surgery is unknown, this study aimed to determine the effectiveness of early versus late physiotherapy in improving functional levels and reducing postoperative complications (PC) in adults undergoing this procedure. MethodologyLongitudinal retrospective study which included a sample of 132 patients admitted for emergency abdominal surgery. Functionality was evaluated using the Barthel index and the cumulated ambulation score (CAS). In addition, the type of PT (early vs. late) and the date of its onset were recorded, the PC during the hospital stay and the length of stay were recorded. ResultsPatients that received early PT exhibited less severe postoperative complications (p=0.012). Moreover, this group had a shorter length of stay (median=10 vs. 17 days; p=0.0001). In addition, in terms of functionality, decreases were observed during hospitalization compared with baseline levels (Barthel index and CAS), whereas a partial increase was observed at discharge, without differences between the patients that received early PT or not. Nevertheless, the early PT group required a lower number of PT sessions (p=0.04). ConclusionIn this study, a less severe postoperative complications rate, shorter length of stay, and lower necessity of PT sessions were observed in adults undergoing emergency abdominal surgery that received early PT versus late PT. This suggests that early PT in this context would optimize health care resources, improving the postoperative process in these patients.

The Effect of a New Payment System on Physiotherapeutic Management of Patients With Low Back Pain in Primary Care

ObjectiveTo evaluate differences regarding the number of treatment sessions, costs, and outcomes (including relapses) between a regular payment-per-session system and the recently introduced product payment system in The Netherlands. DesignProspective cohort study. SettingDutch physical therapy practices in primary care over a 2-year period. Participants16,103 patients with low back pain (LBP). InterventionThe new product payment system is compared with the regular payment-per-session system. Main Outcome MeasuresPain, disability, recovery, number of physical therapy sessions, therapy duration, costs (per episode), and LBP relapse. ResultsAt baseline, we found greater pain and disability scores associated with an increased risk profile in both payment systems. With regard to the payment systems, we found greater costs (€283.8 vs €210.8) and a greater percentage of relapse (4.5% vs 2.8%) for the product payment system compared with the payment-per-session system. Comparing the 2 payment systems within each risk strata, we found no significant differences, except for a decrease in pain in the medium-risk stratum. Concerning the therapy characteristics, we found that in the payment-per-session group, the therapy took 6 days longer for low-risk patients (median 27 vs 21 days) and 7 days shorter for high-risk patients (median 42 vs 49 days) compared with the product payment group. Moreover, the mean number of sessions in the payment-per-session group was greater for low-risk patients (5.4 vs 4.8 sessions) and lower for high-risk patients (7.7 vs 8.1 sessions) compared with the payment-per-session group. Finally, the costs were significantly greater in all strata of the product payment group compared with the payment-per-session group. ConclusionsThe 2 payment systems are largely comparable regarding patient outcomes, therapy duration, and treatment sessions. Both the average cost per patient per LBP episode and the number of relapses in the product payment system are statistically significantly greater than in the payment-per-session system.

Investigation of health literacy by gender in individuals receiving physiotherapy and rehabilitation services

Purpose: Health literacy is important for the science of physiotherapy, which includes treatment methods based on understanding and practice. To increase the health literacy level of patients, individual characteristics should be considered. The aim of this study is to investigate the health literacy level of individuals who received physiotherapy and rehabilitation services and identify the role of gender on the health literacy level.Methods: The health literacy levels of patients who received physiotherapy and rehabilitation services due to an orthopedic injury or musculoskeletal problem were examined. Health literacy was evaluated with the Turkey Health Literacy Questionnaire (THLQ). Age, body mass index, disease duration, number of physiotherapy sessions, physiotherapy history and education level were questioned. Whether the data obtained differed according to gender was analysed with appropriate statistical methods.Results: Average health literacy overall score found as 34.02±8.56. The mean health literacy score of females was found to be significantly better than that of males (p&amp;lt;0.01). No difference was found between genders in terms of excellent health literacy status (p=0.008).Conclusion: The health literacy level of patients who received physiotherapy and rehabilitation services was found to be sufficient. The health literacy level of females was found to be higher than males. Since our study reveals the health literacy level of patients receiving physiotherapy, it is also expected to contribute to future studies on public health.with the Turkey Health Literacy Questionnaire (THLQ). Age, body mass index, disease duration,number of physiotherapy sessions, physiotherapy history and education level were questioned.Whether the data obtained differed according to gender was analysed with appropriate statisticalmethods.Results: Average health literacy overall score found as 34.02±8.56. The mean health literacy score offemales was found to be significantly better than that of males (p&amp;lt;0.01). No difference was foundbetween genders in terms of excellent health literacy status (p=0.008).Conclusion: The health literacy level of patients who received physiotherapy and rehabilitationservices was found to be sufficient. The health literacy level of females was found to be higher thanmales. Since our study reveals the health literacy level of patients receiving physiotherapy, it is alsoexpected to contribute to future studies on public health.

Paper 23: The Impact of Graft Choice on Return to Sport Testing After Adolescent ACL Reconstruction

Objectives:The number of anterior cruciate ligament (ACL) injuries and reconstructions observed in the adolescent population continues to rise. While the use of quadriceps tendon autograft has increased in popularity in this population, there remains no consensus on the ideal graft for pediatric ACL reconstruction. The objective of this study was to compare three commonly used ACL graft types with respect to i) performance on return to sport assessments and ii) timing to clearance for return to sports in an adolescent population.Methods:All patients, less than or equal to 19 years of age, who underwent reconstruction for ACL tears between 2016 and 2020 at a large, urban, academic institution were identified. Graft choice was made in a shared decision-making model with patient, parents, and surgeon. Patient demographics, laterality, graft type, time from surgery to clearance, number of physical therapy (PT) visits, and presence of concomitant meniscus injuries were collected from the electronic medical record. At a minimum of 6 months postoperatively, patients completed a formal return to sport test (RTS) including isometric strength assessments, Y- balance testing, and hop testing. Treatment cohorts based on graft type were compared with respect to RTS performance and timing to clearance. Associations between patient demographics and return to sport timing and performance were also assessed. Clearance for return to sport was determined by the treating surgeon with limb symmetry index of 90% on RTS as the goal for clearance.Results:A total of 110 adolescents, 44 female (40%), with a mean age of 16.3 years (SD, 1.7; range, 10-19) met our inclusion criteria (Table 1). Average time to first RTS assessment was 280 days (9.3 months) and average time to clearance was 371 days (12.2 months) after surgery. ACL grafts included 58 (52.7%) hamstring autografts, 26 (23.6%) bone-patellar tendon-bone (BPTB) autografts, 21 (19.1%) bone quadriceps (BQT) autografts, and 5 (4.6%) iliotibial band (ITB) autografts. ITB patients were younger on average (12.5 years old) than those receiving hamstring, BPTB or BQT grafts. There were no significant differences between groups with respect to laterality, number of physical therapy visits, or rate of concurrent meniscus surgery.Patients receiving BQT grafts were more likely to be cleared within 1 year of surgery compared to hamstring graft patients (82.4% vs. 39.6%, p=0.002) and had similar rates of clearance within 1 year compared to BPTB patients (82.4% vs. 65.2%, p=0.230). Patients with BQT and BPTB grafts both demonstrated significantly better hamstring strength symmetry compared to hamstring graft patients (5.8% strength deficit compared to healthy side vs. 1.3% vs. 29.3%, p<0.001) (Table 2). There were no differences in quadriceps strength or hop test asymmetry between graft types. Multivariate regression with age, gender, and number of PT sessions included as covariates demonstrated that hamstring graft choice was associated with decreased odds of clearance at 1 year.Conclusions:In this study of 110 adolescent ACL reconstruction patients who underwent return to sport evaluations, we found no significant difference between BPTB and BQT autografts with respect to RTS performance and time to clearance. Hamstring autograft was associated with significantly worse hamstring strength asymmetry and significantly lower rates of clearance within 1 year. Concurrent meniscus surgery, age, gender, and number of PT sessions completed prior to RTS evaluation were not significantly associated with timing of clearance or performance on the RTS assessment.Table 1.Patient Demographics and Surgical CharacteristicsTable 2.Patient Demographics and Performance by 3 Common Graft Types

Relationship between time of referral for physiotherapy and length of stay after stroke in a Nigerian tertiary hospital: a retrospective study

BackgroundDespite the known benefits of physiotherapy, the relationship between its time of referral and the length of stay (LOS) of stroke patients in developing countries has been understudied. This relationship was investigated in this study as we determined the relationships between LOS and time of referral and LOS and the number of physiotherapy sessions received.MethodsMedical records of stroke patients admitted at Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife between January 2007 and December 2016 were retrieved. Descriptive statistics were used to summarize the data, independent samples t test, and one-way analysis of variance were used to determine differences, and Pearson correlation was used to determine relationships.ResultsA total of 585 medical records were retrieved. With an inpatient mortality rate of 40.7%, only 243 case records were included in the study. The mean LOS was 17 ± 13 days, and 63.4% received inpatient physiotherapy. Patients who were referred for physiotherapy (p = 0.019) and those who utilized physiotherapy (p = 0.001) had higher LOS. Also, there were significant correlations between LOS and the time of referral for physiotherapy (r = 0.575, p = 0.001) and LOS and the number of physiotherapy sessions received (r = 0.293, p = 0.001).ConclusionsStroke patients who utilized physiotherapy had longer LOS. The longer the time of referral and the higher the number of physiotherapy sessions, the longer the LOS. Early referral and commencement of physiotherapy optimize physiotherapy utilization, which may reduce the LOS of stroke patients.

IS PHYSICAL THERAPY SESSION DURATION EFFECTIVE ON FUNCTIONALITY IN REHABILITATION OF BELL’S PALSY (IDIOPATHIC FACIAL PARALYSIS)?

Abstract&#x0D; Purpose: The aim of the study is to evaluate the effect of the changing number of physical therapy sessions on the functionality level of the in patients with Bell Palsy.&#x0D; Method: In this retrospective study, the data of patients who were diagnosed with Bell's Palsy (BP) and applied a physical therapy program consisting of electrotherapy, infrared and mimic exercises were examined. The data of 21 patients who were rehabilitated with the diagnosis of BP and received 15 sessions of treatment and 21 patients who received 30 sessions of treatment were analyzed. Age, gender and comorbidities of the patients were recorded. Functionality of the patients was evaluated with Facial Disability Index (FDI), House Brackmann System (HBS) and Sunny Brook Grading System (SBGS) before and after treatment.&#x0D; Results: In all intragroup clinical and functionality evaluations of the patients, significant improvement was observed in both groups both after 15 sessions and after 30 sessions (p

Physical therapy utilization, costs, and return-to-work status following lumbar spine surgery: A retrospective analysis of workers compensation claims in Australia

BackgroundNo study to our knowledge has explored physical therapy utilization following lumbar spine surgery in a workers’ compensation setting. ObjectivesDescribe physical therapy utilization and costs, and return-to-work status in patients following lumbar spine surgery under a workers’ compensation claim. MethodsUsing data from the New South Wales (NSW) State Insurance Regulatory Authority (Australia), we audited physical therapy billing codes for patients who received lumbar spine surgery from 2010 to 2017. We summarised, by fusion versus decompression, the number of physical therapy sessions patients received up to 12 months post-operatively, total cost of physical therapy and time to initiation of physical therapy. Number of physical therapy sessions and physical therapy utilization at 12 months were summarised by return-to-work status at 12 months. ResultsWe included 3524 patients (1220 had fusion; 2304 decompression). On average, patients received 22 ± 22 physical therapy sessions to 12 months post-operatively (mean cost=AU$1902, US$1217); 24% were receiving physical therapy at 12 months. Most had 9–24 (31%) or 25–50 sessions (25%); 11% had > 50 sessions, whereas 11% had no physical therapy. Patients who had fusion (compared to decompression) had more physical therapy and incurred higher physical therapy costs. Time post-surgery to initiate physical therapy increased from 2010 to 2017. Patients with > 50 sessions and still having physical therapy by 12 months were least likely to be working. ConclusionsFor most patients, physical therapy utilization following lumbar spine surgery aligns with the best available evidence. However, some patients may be receiving too much physical therapy or initiating physical therapy too early.

Functional outcomes of cancer patients in an acute inpatient setting at King Fahad Medical City.

[Purpose] Cancer survivors have functional impairments that adversely affect patients’ quality of life (QoL). Acute rehabilitation helps to reduce disability and improves QoL in cancer survivors. This study investigated the potential improvement in mobility levels and QoL of cancer patients during acute inpatient physical therapy (PT) from admission to discharge. [Participants and Methods] This was a cross-sectional study conducted at King Fahad Medical City, Riyadh. Acute inpatient cancer survivors (n=99) were assessed at their admission and discharge. The primary outcome measure was the AM-PAC “6-Clicks” Basic Mobility, Functional Assessment of Cancer Therapy-General (FACT-G7) and the Karnofsky Performance Scale (KPS). [Results] Overall, 82.8% of cancer patients were discharged home. There were significant improvements in all the three outcome measures for all the patients from admission to discharge. Patients who were discharged home exhibited significantly better improvement in all the scales. Factors that predicted discharge mobility and quality of life were discharge destination, number of PT sessions, and baseline admission scores. [Conclusion] The study found that acute inpatient cancer rehabilitation helps to improve mobility and QoL. Rehabilitation programs available in Saudi Arabia are limited, and it is important to integrate the cancer rehabilitation model into the oncology services.

Physical therapy modalities in the rehabilitation of cats (Felis catus) with neurological and orthopedic conditions

ABSTRACT: This retrospective study described the therapeutic modalities used for the rehabilitation of cats with neurological and orthopedic diseases and provided data regarding the number of sessions, frequency, and treatment duration; the study also evaluated the modality acceptance by this species. Twenty cats were selected, 11 with neurological diseases and nine with orthopedic conditions. Acute spinal cord trauma and femoral fracture were the most frequently observed neurological (72.7%) and orthopedic (44.4%) conditions, respectively. Manual therapies comprised of passive stretching (PS), passive range of motion (PROM), and bicycle movement (BM) exercises were included in all the protocols.Therapeutic modality acceptance was positive for physical agents, thermotherapy, and hydrotherapy (100%);in manual therapies, it was positive in 40% and partially positive in 60% of cats; in kinesiotherapy, it was positive for all the assisted active exercises and negative for the active exercises. The number of physical therapy sessions significantly influenced the positive acceptance of PS (P &lt; 0.05). The PS, PROM, and BM exercises were the most commonly used modalities; the number of physiotherapy sessions and duration of treatment were higher in cats with neurological diseases, and acceptance was positive in most therapeutic modalities.

Patients' perception of physical therapy after shoulder surgery.

BackgroundFormal physical therapy (PT) traditionally has been a critical part of postoperative recovery, but recently, because of cost containment, coverage of PT has become limited. Alternatives to formal PT have been proposed, including telerehabilitation, internet-based PT (IBPT), and home-based physician-guided PT. The purpose of this study was to understand patient perceptions of PT, the benefits, perception of improvements, access to PT, and alternative forms of PT after shoulder surgery.MethodsEighty patients who underwent orthopedic shoulder surgery were anonymously surveyed at one institution. Demographics, PT access, number of PT sessions, insurance, copayment, patients’ perceptions of improvement, and their opinion about IBPT were collected. Answers were designed using Likert-scale or open-ended questions. Descriptive statistics were used to report survey data. Analyses were performed based on demographic variables using independent t-test, chi-square tests, and analysis of variance.ResultsPatients attended an average of 16.3 ± 13.8 PT sessions, with 65% ± 32.2 attributing average improvement to their sessions. Average copay was $18 ± 20.8 per session, which 56.1% agreed was reasonable. Almost all patients (94.8%) agreed their therapist took time to educate them. Half (52.5%) disagreed that successful PT could be achieved by IBPT, and 68.6% of patients responded they would not consider using IBPT even after a few in-person sessions.ConclusionPatients have a positive perception of their therapist, cost, number of sessions, and utility of PT to impact improvements after orthopedic shoulder surgery. For IBPT to be a viable alternative, it should involve close engagement of a physical therapist given patients’ perceptions of PT.

Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study.

BackgroundBalance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life.ObjectiveTo determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou.MethodThis cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests.ResultsA total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04–0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03–67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03–0.93; p = 0.02) were significantly associated with balance impairments.ConclusionOur results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments.Clinical implications[AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.