Physical Therapy Consultation Research Articles

Early intervention for children with/at risk of developmental coordination disorder: a scoping review.

To summarize current evidence for early identification and motor-based intervention for children aged 5 years and younger of age with/at risk of developmental coordination disorder (DCD). Using scoping review methodology, we independently screened over 11 000 articles and selected those that met inclusion criteria. Of the 103 included articles, 78 articles were related to early identification and are summarized in a companion article. Twenty-two articles focused on early intervention, with an additional three articles covering both early identification and intervention. Most intervention studies were at a low level of evidence, but provide encouraging evidence that early intervention is beneficial for young children with/at risk of DCD. Direct intervention can be provided to whole classes, small groups, or individuals according to a tiers of service delivery model. Educating and building the capacity of parents and early childhood educators are also key elements of early intervention. Evidence for early intervention for children with/at risk of DCD is emerging with promising results. Further studies are needed to determine best practice for early intervention and whether intervening early can prevent the negative developmental trajectory and secondary psychosocial consequences associated with DCD.

Assessment of the Impact of Training on the Stabilometric Platform Using the Biofeedback Method on Improving Balance and Functional Efficiency of Patients After a Stroke

Introduction: Postural balance disorders are one of the most common motor symptoms in patients after stroke, which affect the limitation of patients mobility and their ability to perform everyday activities. Balance disorders require comprehensive neurorehabilitation. Aim: The aim of the study was to assess the effect of exercises on the stabilometric platform using the biofeedback method on improving balance and functional performance in patients after stroke. Material and Methods: The study involved 75 patients after ischemic stroke aged from 35-80 years. Two groups were created: a study and control group. The study group consisted of patients in whom a comprehensive rehabilitation program was implemented, consisting of physical therapy, kinesitherapy, speech therapy and psychological consultation, complemented by the use of modern neurorehabilitation solutions, including a platform for balance training. The control group included patients in whom a comprehensive therapy program was implemented, but without training on a stabilometric platform. Functional assessment of patients was performed using selected scales and tests: Barthel Scale, Tinetti Test and Berg Balance Scale. Results: Patients after stroke, in whom a comprehensive physiotherapy program was implemented using the training on the Tecnobody stabilometric platform, obtained a statistically significant improvement in all parameters describing the ability to maintain balance. Also in the Tinetti Test in the gait evaluation section, Berg Balance Scale and Barthel Scale the improvement was statistically significant. Conclusions: The program used on the stabilometric platform had a significantly better impact on improving ability to maintain balance and everyday functioning of patients after stroke.

Understanding the supportive care needs of early-phase cancer clinical trial (CT) participants.

26 Background: Early phase CTs investigate novel therapeutic approaches for patients with cancer, but little is known about the use of supportive care services among participants in early phase CTs. Methods: We conducted a retrospective chart review of consecutive patients enrolled in Phase 1 CTs from 2017-2019, capturing sociodemographics, clinical data, and use of supportive care services from the electronic health record. We calculated the Royal Marsden Hospital (RMH) prognostic score using data at the time of CT trial enrollment based on patients’ lactate dehydrogenase, albumin, and number of sites of metastasis. The RMH score ranges from 0-3, with scores of 2+ indicating a poor prognosis. We explored differences in patient characteristics, supportive care use, and clinical outcomes based on the RMH prognosis score. Results: Among 426 patients treated on Phase 1 CTs during the study period, the median age was 63.0 years (range 20.5-85.2 years), and most were female (56.1%), white race (85.1%), and had metastatic cancer (97.7%). The most common cancer types were gastrointestinal (22.1%), lung (20.0%), and breast (10.6%) cancer. Under half (31.6%) had an RMH score indicating a poor prognosis. Patients with a poor prognosis score had a worse performance status (ECOG ≥1: 80.2% v 58.3%, p < .001) and more prior treatment (3+ prior lines: 49.5% v 35.0%, p = .001) compared to those without a poor prognosis score. Those with a poor prognosis score were more likely to receive palliative care before or during CT participation (40.5% v 27.1%, p = .011). We observed no significant differences in the rates of nutrition (69.1% v 64.0%), social work (62.2% v 63.8%), or physical therapy (64.5% v 61.7%) consults between those with and without a poor prognosis score. We found that those with an RMH score indicating a poor prognosis had a shorter time on trial (median: 49 vs 87 days, p < .001) and worse survival (median: 139 v 379 days, p < .001). Conclusions: Early phase CT participants represent an advanced cancer population with unique supportive care needs, and we identified a group with a particularly poor prognosis for whom earlier intervention with supportive care services may be needed. Our findings highlight the need to prospectively examine these characteristics along with patient-reported outcomes to better understand the distinct supportive care needs of this population and guide the development of targeted interventions.

Can an Emergency Department–Initiated Intervention Prevent Subsequent Falls and Health Care Use in Older Adults? A Randomized Controlled Trial

We determine whether an emergency department (ED)-initiated fall-prevention intervention can reduce subsequent fall-related and all-cause ED visits and hospitalizations in older adults. The Geriatric Acute and Post-acute Fall Prevention intervention was a randomized controlled trial conducted from January 2018 to October 2019. Participants at 2 urban academic EDs were randomly assigned (1:1) to an intervention or usual care arm. Intervention participants received a brief, tailored, structured, pharmacy and physical therapy consultation in the ED, with automated communication of the recommendations to their primary care physicians. Of 284 study-eligible participants, 110 noninstitutionalized older adults (≥65 years) with a recent fall consented to participate; median age was 81 years, 67% were women, 94% were white, and 16.3% had cognitive impairment. Compared with usual care participants (n=55), intervention participants (n=55) were half as likely to experience a subsequent ED visit (adjusted incidence rate ratio 0.47 [95% CI 0.29 to 0.74]) and one third as likely to have fall-related ED visits (adjusted incidence rate ratio 0.34 [95% CI 0.15 to 0.76]) within 6 months. Intervention participants experienced half the rate of all hospitalizations (adjusted incidence rate ratio 0.57 [95% CI 0.31 to 1.04]), but confidence intervals were wide. There was no difference in fall-related hospitalizations between groups (adjusted incidence rate ratio 0.99 [95% CI 0.31 to 3.27]). Self-reported adherence to pharmacy and physical therapy recommendations was moderate; 73% of pharmacy recommendations were adhered to and 68% of physical therapy recommendations were followed. Geriatric Acute and Post-acute Fall Prevention, a postfall, in-ED, multidisciplinary intervention with pharmacists and physical therapists, reduced 6-month ED encounters in 2 urban EDs. The intervention could provide a model of care to other health care systems aiming to reduce costly and burdensome fall-related events in older adults.

Telerehabilitation for people with breast cancer through the COVID-19 pandemic in Chile.

Adapting face-to-face physical therapy consultations in cancer care to a model of telerehabilitation has been necessary, given the imminent spread of the COVID-19 pandemic. In this respect, the current model of telerehabilitation for people with breast cancer can be described as a method of continuing physical therapy treatment, in a public hospital with limited resources.

Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti.

IntroductionIn many low-income countries, Emergency Medicine is underdeveloped and faces many operational challenges including emergency department (ED) overcrowding and prolonged patient length of stays (LOS). In high-resource settings, protocolized ED observation unit (EDOU) care reduces LOS while preserving care quality. EDOUs are untested in low-income countries. We evaluate the effect protocolized EDOU care for ischemic stroke on the quality and efficiency of care in Haiti.MethodsWe performed a prospective cohort study of protocolized observation care for ischemic stroke at a Haitian academic hospital between January 2014 and September 2015. We compared patients cared for in the EDOU using the ischemic stroke protocol (study group) to eligible patients cared for before protocol implementation (baseline group), as well as to eligible patients treated after protocol introduction but managed without the EDOU protocol (contemporary reference group). We analysed three quality of care measures: aspirin administration, physical therapy consultation, and swallow evaluation. We also analysed ED and hospital LOS as measures of efficiency.ResultsPatients receiving protocolized EDOU care achieved higher care quality compared to the baseline group, with higher rates of aspirin administration (91% v. 17%, p < 0.001), physical therapy consultation (50% v. 9.6%, p < 0.001), and swallow evaluation (36% v. 3.7%, p < 0.001). We observed similar improvements in the study group compared to the contemporary reference group. Most patients (92%) were managed entirely in the ED or EDOU. LOS for non-admitted patients was longer in the study group than the baseline group (28 v. 19 h, p = 0.023).ConclusionProtocolized EDOU care for patients with ischemic stroke in Haiti improved performance on key quality measures but increased LOS, likely due to more interventions. Future studies should examine the aspects of EDOU care are most effective at promoting higher care quality, and if similar results are achievable in patients with other conditions.

Health professionals donating work hours: an initiative for improving access to healthcare in Brazil: case study and initial results

BackgroundEven with a universal public health system, the Brazilian population faces inequalities on access to healthcare. Long queues for medical appointments, caused by lack of professionals, space and equipment, are...

The utility of emergency department physical therapy and case management consultation in reducing hospital admissions.

BackgroundA significant number of patients who present to the emergency department (ED) following a fall or with other injuries require evaluation by a physical therapist. Traditionally, once emergent conditions are excluded in the ED, these patients are admitted to the hospital for evaluation by a physical therapist to determine whether they should be transferred to a sub‐acute rehabilitation facility, discharged, require services at home, or require further inpatient care. Case management is typically used in conjunction with a physical therapist to determine eligibility for recommended services and to aid in placement.ObjectiveTo evaluate the benefit of using ED‐based physical therapist and case management services in lieu of routine hospital admission.MethodsRetrospective, observational study of consecutive patients presenting to an urban, tertiary care academic medical center ED between December 1, 2017, and November 30, 2018, who had a physical therapist consult placed in the ED. We additionally evaluated which of these patients were placed into ED observation for physical therapist consultation, how many required case management, and ED disposition: discharged home from the ED or ED observation with or without services, placed in a rehabilitation facility, or admitted to the hospital.ResultsDuring the 12‐month study period, 1296 patients (2.4% of the total seen in the ED) were assessed by a physical therapist. The mean age was 75.5 ± 15.2 and 832 (64.2%) were female. Case management was involved in 91.8% of these cases. The final patient disposition was as follows: admission 24.3% (95% CI = 22.1–26.7%), home discharge with or without services 47.8% (95% CI = 45.1–50.5%), rehabilitation (rehab) setting 27.9% (95% CI = 25.6%–30.4). The median (interquartile range) time in observation was 13.1 (6.0–20.3), 9.9 (1.8–15.8), and 18.4 (14.1–24.8) hours for patients admitted, discharged home, or sent to rehabilitation (P < 0.001). Among the 979 patients discharged home or sent to rehabilitation, 17 (1.7%) returned to the ED within 72 hours and were ultimately admitted.ConclusionGiven that the standard of care would otherwise be an admission to the hospital for 1 day or more for all patients requiring physical therapist consultation, an ED‐based physical therapy and case management system serves as a viable method to substantially decrease hospital admissions and potentially reduce resource use, length of hospital stay, and cost both to patients and the health care system.

Shared decision-making in physical therapy: a cross-sectional observational study

Background The objectives of this study were to evaluate physical therapists’ shared-decision-making behaviour in a rehabilitation centre and a private practice, to determine agreement between patients’ preferred levels of involvement in shared-decision-making and therapists’ assumptions of patients’ preferences, and to examine predictors of shared-decision-making behaviour. Methods Thirty initial physical therapy consultations were audio-recorded. Shared-decision-making behaviour was observed using the observing patient involvement (OPTION) instrument. A pre-defined threshold of ≥35/100 points was considered to represent good shared-decision-making behaviour. The Control Preferences Scale was used to measure patients’ preferred levels of involvement in shared-decision-making and therapists’ assumptions. Shared-decision-making behaviour was analysed using descriptive statistics. Predictors of shared-decision-making behaviour were analysed by multiple regression. Results Shared-decision-making OPTION ratings were a median of 50.5/100 (25th, 75th percentiles 44.0, 66.0). Agreement between patients and physical therapists regarding shared-decision-making was poor (weighted kappa −0.26 (95% confidence interval −0.51 to −0.01). Therapy settings, education and the interaction of education and work experience predicted shared-decision-making behaviour (b = 15.76, p < 0.001; b = 8.05, p < 0.05; b = −0.33, p < 0.05). Conclusion Shared-decision-making behaviour was good, and predicted by therapy setting, education and the interaction of education with work experience. Because of the limited number of institutions and therapists with MSc or PhD qualifications in this study, further research is required into the relationship between education and communication skills.

The Effects of Early Mobilization on Patients Requiring Extended Mechanical Ventilation Across Multiple ICUs.

Objectives:1) To successfully implement early mobilization of individuals with prolonged mechanical ventilation in multiple ICUs at a tertiary care hospital and 2) to reduce length of stay and improve quality of care to individuals in the ICUs.Design:Comparative effectiveness cohort study based on a quality improvement project.Setting:Five ICUs at a tertiary care hospital.Patients:A total of 541 mechanically ventilated patients over a 2-year period (2014–2015): 280 and 261, respectively. Age ranged from 19 to 94 years (mean, 63.84; sd, 14.96).Interventions:A hospital-based initiative spurred development of a multidisciplinary team, tasked with establishing early mobilization in ICUs.Measurements and Main Results:Early mobilization in the ICUs was evaluated by the number of physical therapy consults, length of stay, individual treatment sessions utilizing functional outcomes, and follow-up visits. Implementation of an early mobilization protocol across all ICUs led to a significant increase in the number of physical therapy consults, a significant decrease in ICU and overall lengths of stay, significantly shorter days to implement physical therapy, and a significantly higher physical therapy follow-up rate.Conclusions:Mobilizing individuals in an intensive care setting decreases length of stay and hospital costs. With an interdisciplinary team to plan, implement, and evaluate stages of the program, a successful early mobilization program can be implemented across all ICUs simultaneously and affect change in patients who will require prolonged mechanical ventilation.

Deep vein thrombosis after “Tennis Leg” injury: A clinical case

Abstract Background “Tennis leg” is a common lesion in sports with quick accelerations and stops, consisting of an injury to the fascia joining the soleus muscle with the medial gastrocnemius. In these cases, a differential diagnosis must be performed, considering possible complications such as a deep vein thrombosis (DVT) of the veins of the deep musculature of the lower leg. The aim of this clinical case is to alert professionals regarding possible complications of these injuries and to train professionals to detect a possible vascular problem. Case Description A 42 year old male who attends a physical therapy consultation 24 hours after suffering a “muscle pull” in the gastrocnemius. After a medical diagnosis of tennis leg he received appropriate standard regulated physical therapy treatment procedures. A follow-up ultrasound exam was performed eight days after the injury and at 14 days after a worsening of symptoms, at which point a vascular alteration was detected which was diagnosed and treated as DVT. Results The patient came for consultation and we observed a vascular alteration and therefore we referred the person to the emergency room, where he was diagnosed with DVT. Discussion DVT is a possible complication of gastrocnemius injuries. The present case describes a clinical presentation of DVT after 14 days evolution. It is essential to evaluate and reevaluate the clinical condition of the patient with all the diagnostic tools possible to detect possible red flags. Conclusion Ultrasound is an essential tool for the detection of possible complications after a musculoskeletal injury.

Effect of ultrasound-guided percutaneous neuromodulation applied to the femoral nerve on pain and range of motion in patients with anterior knee pain: A case study

Abstract Introduction Anterior knee pain (AKP) is one of the most frequent reasons for physical therapy consultations, remaining a difficult treatment challenge for professionals. The aim of this study was to evaluate the effects of an intervention using ultrasound-guided percutaneous neuromodulation (US-guided PNM) applied to the femoral nerve on pain and knee flexion range of motion (ROM), in patients with unilateral chronic anterior knee pain. Methods Eight patients received a single intervention of NMP-e on the femoral nerve of the symptomatic knee. The level of pain and ROM were measured before, immediately after and 24 hours after the intervention. Results A decrease in pain and an increase of ROM were observed after the intervention and at 24 hours. For pain values, a medium effect size was observed (ES = 0.63 ± 0.43) after the intervention, and a large effect size (ES = 1.73 ± 0.44) was found at 24h. Concerning ROM, the effect size was large at both moments (ES = − 1.30 ± 1.14; −1.76 ± 0.80, respectively). Conclusion A single intervention of US-guided PNM on the femoral nerve produces a decrease of pain and increases the ROM, which is greater 24h after the stimulation. Level of Evidence Level II-3.

Evaluación de la actividad clínica y asistencial de una unidad de fisioterapia de Atención Primaria

La inclusión de la fisioterapia en este primer nivel asistencial de rehabilitación se ha llevado ya también a las áreas de Atención Primaria. En este trabajo se presenta un estudio descriptivo retrospectivo en la Unidad de Fisioterapia de Atención Primaria (UFAP) Soria Urbana (SU), para conocer la actividad asistencial desarrollada a lo largo de un año. Fundamentalmente, el estudio está centrado en los aspectos de actividad asistencial y características de la población atendida. El estudio ha permitido conocer características generales de los pacientes atendidos, sus patologías más prevalentes y el servicio sanitario ofrecido. En general podemos decir que se han conseguido los objetivos planteados en el pacto específico de las UFAP, en referencia a la demora y/o listas de espera, consultas de fisioterapia, sesiones realizadas y resultados clínicos con un alto porcentaje de finalización de tratamientos con el objetivo terapéutico cumplido. Todo ello permitirá mejorar la calidad asistencial fisioterapéutica extrahospitalaria.

‘Rehab’ vs Hospice, Let's Seriously Talk; Can Jack Weight-Bear, Will Jill Walk? The Impact and Benefit of Sponsored Physical Therapy Consults for Hospice Enrollees (TH323A)

•Discuss with hospice referred hospitalized patients and families the potential for low level, closely monitored physical therapy during hospice enrollment, often a safer, more rational venture for sick, debilitated patients than traditional Medicare-funded inpatient rehabilitation.•Create a hospice plan of care for enrolled inpatients that, if clinical improvement is exhibited, encompasses the possibility of provided physical therapy, reducing the likelihood of revocation to pursue Medicare-funded inpatient rehabilitation.•Discuss with hospice inpatients (and their families) facing live discharge the best next care vehicle (home, assisted living, or skilled nursing facility) utilizing experience gleaned from a physical therapy consultation during the inpatient stay. Medicare covered inpatient rehabilitation (“rehab”) is a common, and often appealingly expeditious, hospital discharge plan for older patients, despite the fact that many of these people have little capacity to participate in (or gain benefit from) this enterprise. In the past, “rehab” vs hospice enrollment was the frequent choice facing patients and families. For the past three years our hospice organization has encouraged our clinicians to utilize the physical therapy division of our visiting nurse sister service to reduce the dichotomy of these two alternatives. This study evaluates the impact of this offering. Analyze the impact of the hospice physical therapy intervention on both hospice enrollment, and hospice revocation statistics. A 5-year retrospective analysis of hospice enrollment statistics from the hospitals within our service area, and a study of hospice revocation statistics for live discharge patients from our inpatient care centers. For the two years prior to this intervention, the median percentage of hospice-referred hospitalized patients who chose inpatient “rehab” rather than hospice enrollment upon discharge was 26.4% per month. Post intervention this statistic fell to 15.1% per month (a 42.8% decrease). In the three years since implementation of this clinical intervention, the median percentage of hospice inpatients who, because of clinical stabilization and the advent of a live discharge hospice plan of care, chose to revoke the Medicare hospice benefit and instead pursue inpatient “rehab” has fallen consistently from 21.5 % in 2014 to 9.8% in 2018 (a decrease of 54.4%). In addition, the physical therapy consults have aided in establishing the correct care mindset (i.e. home with family, assisted living or skilled nursing) for the hospice patients discharged from the inpatient care center. The addition of sponsored physical therapy consultations and sessions for specific hospice patients has aided both enrollment, and live discharge planning from our inpatient care centers.

Practical Guidance for Non-Specialist Physical Therapists Managing People with Hemophilia and Musculoskeletal Complications

People with hemophilia (PWH) have impaired blood coagulation and hemostasis. Bleeding into joints and muscles is the main manifestation of the disorder, causing severe joint damage and muscle complications. Lifelong, regular physical therapy is therefore important for PWH, in order to support recovery from bleeds and reduce recurrences. Ideally, these individuals should be in the care of a hemophilia treatment center (HTC), where a physical therapist (PT) should be a regular part of the comprehensive team. However, not all PWH have convenient access to an HTC, and they may be referred to local non-specialist PTs, who may have only limited experience with the condition, for day-to-day physical therapy treatment. This article, written by four experienced hemophilia PTs, introduces key aspects of the pathology of the hemophilic joint in adult PWH with musculoskeletal complications or established joint disease (or those with inhibitors) that are relevant to PTs. The characteristic differences between the joints of PWH and those of people with similar pathologies are clarified. Practical advice on how the physical therapy consultation can be adjusted for PWH is given, and the importance of communicating with the HTC emphasized. The aim of this narrative review is to raise awareness of hemophilia and joint disease for non-specialist PTs, and serve as helpful background information for PTs who encounter PWH with musculoskeletal complications or established joint disease in their clinics.

Ultrasound-Guided percutaneous neuromodulation in non-radiating low back pain

Abstract Background Low back pain is very common, affecting 15–20% of the population each year, and representing of the main causes of physical therapy consultations. Multiple treatments have been defined for chronic low back pain, however, the findings are still controversial, and therefore new and improved solutions are necessary for the population who suffers from low back pain. Aims To evaluate the effectiveness of ultrasound-guided percutaneous neuromodulation (US-guided PNM) in patients with non-radiating low back pain. Material and Methods An experimental study was performed in patients with non-radiating low back pain, between the months of march and may of 2018 at the F&amp;S-Narón Physical Therapy clinic, in A Coruña. Functionality was evaluated via the Oswestry questionnaire and pain was evaluated using the visual analog scale (VAS). US-guided NMP was applied to stimulate the medial branch of a L2 posterior ramus and the iliohypogastric and ilioinguinal nerves, following the protocol described by Valera &amp; Minaya, which consists of the application of a PES type current at 10Hz and 240 microseconds, during 15 seconds and for 6 applications. In total, 3 sessions were applied (sequence 1:7:7), once a week after the first week of initiating treatment. Results Initially, 12 patients participated in the study, aged between 32 and 59 years. The mean age was 41.4 years. Two of the patients abandoned the study due to personal reasons, unrelated to the research. The final sample consisted of 10 subjects, 50% of each sex. 80% of patients improved after the application of the treatment protocol. An important decrease in activity limitations was observed, from 14 to 4.35 points out of 100 according to the Oswestry questionnaire, and a decrease of 6.8 to 2.15 points out of 10 was observed on the VAS scale, which was statistically significant according to the Wilcoxon test (p &lt; 0,05). Conclusions The ultrasound-guided percutaneous neuromodulation technique used was effective, obtaining positive results in relation to pain and functionality. Clinical studies are necessary with a greater sample size to confirm these findings.

Length of Stay Beyond Medical Readiness in Neurosurgical Patients: A Prospective Analysis.

In an era of growing healthcare costs, there is increased pressure on medical care providers to discharge patients once they are medically fit. However, it is not uncommon for patients to stay beyond medical readiness (BMR). To analyze the frequency with which patients remain in the hospital BMR. A prospective cohort analysis utilizing a database maintained between 2014 and 2015 included 718 adults admitted to the neurosurgical service. The attending for admitted patients was asked on a daily basis as to whether the patient was medically cleared for discharge. Standard statistical analyses were performed. Of the 718 patients, 105 (14.6%) remained in the hospital BMR. Of the patients who presented with a spinal pathology, 17.8% had a length of stay (LOS)-BMR compared to 13.9% who presented with cerebrovascular pathologies and 14.8% who presented with a brain tumor. The average LOS-BMR was 1.8 d. Only 7.7% of patients who were discharged home had an LOS-BMR compared to 30.7% of patients who were discharged to a skilled nursing facility or rehabilitation center (P<.001). In logistic regression, a physical therapy consultation and discharge to a specialized nursing facility were both associated with a longer LOS (average 2.4 d longer, P<.001, and 6.2 d longer, P=.028, respectively). However, neither was associated with an LOS-BMR. LOS-BMR is an important process engineering concept within neurosurgery that represents a potential area for improvement to maximize limited healthcare resources. A sizeable portion of neurosurgical patients remained in the hospital BMR.

Is Post-discharge Rehabilitation Timing Associated with 90-Day Readmission in Primary Total Joint Arthroplasty?

Physical therapy (PT) is an accepted standard of care after total joint arthroplasty (TJA) and essential to maximizing joint functionality and minimizing complications that lead to readmission. However, evidence-based guidelines about appropriate post-discharge rehabilitative care are not well-defined in the orthopedic literature. We sought to determine the average timing for receiving PT rehabilitation and to evaluate the association between PT rehabilitation timing and unplanned readmission within 90days of a TJA patient being discharged home from acute care. This retrospective study examined 11,545 joint procedures using claims data for the years 2008 to 2013. Outcomes were assessed using a population-averaged approach to regression models. The average time for initiating PT was 4days for knee arthroplasty and 6days for hip arthroplasty in patients discharged home from acute care. Most patients (89%) began PT consultation or supervised exercises during the first week after discharge. The type of joint surgery considerably modified the effect of rehabilitation timing on the likelihood of readmission. Later initiation of rehabilitation was associated with a higher probability of 90-day readmission in both knee and hip arthroplasty, with the effect of rehabilitation timing being more pronounced in hip rather than knee arthroplasty 2weeks post-discharge from acute care. Timing for initiating PT may be an important modifiable factor that can affect readmission in patients discharged home from acute care after TJA. Further exploration of the role of PT timing along with other factors such as dosage and frequency among such patients is needed.

Utilization of Intensive Care Unit Nutrition Consultation Is Associated With Reduced Mortality.

The aim of this project was to investigate the prevalence of nutrition consultation (NC) in U.S. intensive care units (ICUs) and to examine its association with patient outcomes. Data from the Healthcare Cost and Utilization Project's state inpatient databases was utilized from 2010 - 2014. A multilevel logistic regression model was used to evaluate the relationship between NC and clinical outcomes. Institutional ICU NC rates varied significantly (mean: 14%, range: 0.1%-73%). Significant variation among underlying disease processes was identified, with burn patients having the highest consult rate (P < 0.001, mean: 6%, range: 2%-25%). ICU patients who received NC had significantly lower in-hospital mortality (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.48-0.74, P < 0.001), as did the subset with malnutrition (OR 0.72, 95% CI 0.53-0.99, P = 0.047) and the subset with concomitant physical therapy consultation (OR 0.53, 95% CI 0.38-0.74, P < 0.001). NC was associated with significantly lower rates of intubation, pulmonary failure, pneumonia, and gastrointestinal bleeding (P < 0.05). Furthermore, patients who received NC were more likely to receive enteral or parenteral nutrition (ENPN) (OR 1.8, 95% CI 1.4-2.3, P < 0.001). Patients who received follow-up NC were even more likely to receive ENPN (OR 3.0, 95% CI 2.1-4.2, P < 0.001). Rates of NC were low in critically ill patients. This study suggests that increased utilization of NC in critically ill patients may be associated with improved clinical outcomes.

Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort

BackgroundPatients seek care from physical therapists for neck pain but it is unclear what the association of the timing of physical therapy (PT) consultation is on 1-year healthcare utilization and costs. The purpose of this study was to compare the 1-year healthcare utilization and costs between three PT timing groups: patients who consulted a physical therapist (PT) for neck pain within 14 days (early PT consultation), between 15 and 90 days (delayed PT consultation) or between 91 and 364 days (late PT consultation).MethodsA retrospective cohort of 308 patients (69.2% female, ages 48.7[±14.5] years) were categorized into PT timing groups. Descriptive statistics were calculated for each group. In adjusted regression models, 1-year healthcare utilization of injections, imaging, opioids and costs were compared between groups.ResultsCompared to early PT consultation, the odds of receiving an opioid prescription (aOR = 2.79, 95%CI: 1.35–5.79), spinal injection (aOR = 4.36, 95%CI:2.26–8.45), undergoing an MRI (aOR = 4.68, 95%CI:2.25–9.74), X-ray (aOR = 2.97, 95%CI:1.61–5.47) or CT scan (aOR = 3.36, 95%CI: 1.14–9.97) were increased in patients in the late PT consultation group. Similar increases in risk were found in the delayed group (except CT and Opioids). Compared to the early PT consultation group, mean costs were $2172 ($557, $3786) higher in the late PT contact group and $1063 (95%CI: $ 138 - $1988) higher in the delayed PT consultation group.DiscussionThere was an association with the timing of physical therapy consultation on healthcare utilization and costs, where later consultation was associated with increases costs and healthcare utilization. This study examined the association of timing of physical therapy consultation on costs and healthcare utilization, but not the association of increased access to physical therapy consultation. Therefore, the findings warrant further investigation to explore the effects of increased access to physical therapy consultation on healthcare utilization and costs in a prospective study.