Physical Therapy Utilization Research Articles

Fusion versus decompression alone for lumbar degenerative spondylolisthesis and spinal stenosis: a target trial emulation with index trial benchmarking

PurposeThe value of adding fusion to decompression surgery for lumbar degenerative spondylolisthesis and spinal canal stenosis remains debated. Therefore, the comparative effectiveness and selected healthcare resource utilization of patients undergoing decompression with or without fusion surgery at 3 years follow-up was assessed.MethodsUsing observational data from the Lumbar Stenosis Outcome Study and a target trial emulation with index trial benchmarking approach, our study assessed the comparative effectiveness of the two main surgical interventions for lumbar degenerative spondylolisthesis—fusion and decompression alone in patients with lumbar degenerative spondylolisthesis and spinal canal stenosis. The primary outcome-measure was change in health-related quality of life (EuroQol Health Related Quality of Life 5-Dimension 3-Level questionnaire [EQ-5D-3L]); secondary outcome measures were change in back/leg pain intensity (Numeric Rating Scale), change in satisfaction (Spinal Stenosis Measure satisfaction subscale), physical therapy and oral analgesic use (healthcare utilization).Results153 patients underwent decompression alone and 62 had decompression plus fusion. After inverse probability weighting, 137 patients were included in the decompression alone group (mean age, 73.9 [7.5] years; 77 female [56%]) and 36 in the decompression plus fusion group (mean age, 70.1 [6.7] years; 18 female [50%]). Our findings were compatible with no standardized mean differences in EQ-5D-3L summary index change score at 3 years (EQ-5D-3L German: 0.07 [95% confidence interval (CI), − 0.25 to 0.39]; EQ-5D-3L French: 0.18 [95% CI, − 0.14 to 0.50]). No between-group differences in change in back/leg pain intensity or satisfaction were found. Decompression plus fusion was associated with greater physical therapy utilization at 3 years follow-up.ConclusionDecompression alone should be considered the primary option for patients with lumbar degenerative spondylolisthesis and spinal stenosis.

Same-Day Discharge Does Not Increase Resource Utilization Within One Year of Total Joint Arthroplasty

BackgroundWhile the safety of rapid recovery total joint arthroplasty is well established, less is known about its impact on postoperative care utilization patterns. We wished to examine whether same-day discharge—and its associated presumed reduction in hospital-based postoperative care and education—translates to the need for more postoperative support during the 1-year recovery period. MethodsA retrospective review of 1,237 total hip arthroplasty (THA) and 1,710 total knee arthroplasty (TKA) patients who had 0- or 1-day length of stay (LOS) from January 2020 to October 2023 was conducted. The primary outcome was the number of follow-up visits with total joint arthroplasty providers at our institution during the 1-year postoperative period. Secondary outcomes included 30-day emergency department returns, readmissions, 1-year physical therapy utilization, and improvement in Patient-Reported Outcomes Measurement Information System Physical Function scores at 6 to 12 months postoperatively. Bivariate and multivariable analyses were performed to compare outcomes between 0-day and 1-day LOS THA and TKA patients. ResultsIn both the THA and TKA populations, 0-day LOS patients were younger, had a lower average body mass index, were more likely to be White, men, and had an American Society of Anesthesiologists score < 3 than 1-day LOS patients. After controlling for differences between groups, no significant differences in the number of one-year follow-up visits, physical therapy visits, emergency department returns, or readmissions were seen between 0 and 1-day THA or TKA patients. In TKA patients, 1-day LOS was associated with lower improvements in Patient-Reported Outcomes Measurement Information System Physical Function scores. ConclusionsAfter risk adjustment, same-day discharge of THA and TKA patients did not result in increased resource utilization during the one-year postoperative period. In the setting of a coordinated joint arthroplasty program with nurse navigator support, same-day discharge can be safely performed without increasing the need for postoperative care in appropriately selected patients undergoing both THA and TKA.

Abstract P388: Higher Social Vulnerability Was Associated With Less Community-Based Rehabilitation Utilization After Stroke

Background: Timely rehabilitation care significantly improves function and mobility after stroke, but barriers exist in access and utilization. The impact of neighborhood social determinants of health is not fully understood. Our study aims to estimate the association between Social Vulnerability Index (SVI), a measure of a community's need for support, and post-stroke rehabilitation utilization. Methods: This study is an observational, secondary analysis of the COMprehensive Post-Acute Stroke Services study, a pragmatic trial conducted in 41 North Carolina hospitals from 2016-2019. This analysis included 4765 individuals (51.2% female; 74.8% Whites; mean age 69.9) discharged directly home after stroke and linked to administrative claims. Utilization of physical or occupational therapy was obtained from outpatient, carrier file and home health claims. Geocoded participant addresses were linked to 2018 summary SVI percentile ranking and its four sub-domains at the Census tract level. Generalized estimation equations with cluster of Census tract and hospital were used to estimate the association between quintiles of SVIs and incidence proportion of rehabilitation use within 30 days. Covariates included patients’ socio-demographics, clinical characteristics, and comorbidities. Results: The overall proportion of rehabilitation use by 30 days was 38.6%, ranging from 34.6-46.5% across SVI quintiles. In multivariable analysis, quintiles of higher summary SVI were associated with lower rehabilitation use compared with the least vulnerable quintile (RD and 95% CI, Q5 vs Q1: -0.098 [-0.147 to -0.049]; Table). There was a significant decreasing trend across quintiles (P-trend &lt; 0.001). Similar results were observed for SVI sub-domains except for minority status and language. Conclusion: Higher social vulnerability was associated with less post-stroke rehabilitation use. The finding is useful to identify communities for targeted interventions to improve access and utilization to rehabilitation.

Comparison of physical therapy utilization, timing of return-to-sport test completion, and hop test performance by age and between sexes in youth athletes after anterior cruciate ligament reconstruction

ObjectiveTo compare physical therapy (PT) utilization, timing of return-to-sport (RTS) test and hop test performance by age and between sexes in youth after anterior cruciate ligament reconstruction (ACLR). DesignMulticenter retrospective cohort. MethodsA retrospective review of adolescents after primary ACLR was conducted. Participants completed return-to-sport (RTS) tests including single-legged hop testing. PT frequency, average weekly visits, and timing of RTS test were calculated. T-tests assessed the effect of age and sex on average weekly PT visits and multivariable logistic regressions assessed odds of passing hop tests. Results289 participants were included (15.7 ± 1.9 years). There was no difference in average weekly PT visits (p = 0.321) or time to RTS test (p = 0.162) by age. There were significant differences in average weekly PT visits (p = 0.047) and mean time from surgery to RTS test (p = 0.048) between sexes with small effect sizes (d = 0.24 and d = 0.21, respectively). Age and sex had no effect on odds of passing hop tests (OR, 1.29; 95% CI, 0.71–2.35 and OR, 0.79; 95%CI, 0.43–1.45, respectively). ConclusionIn a youth cohort, age and sex may have no clinically important effect on PT visit utilization, timing of RTS test or hop test performance.

Physical Therapy Utilization After Single-level Posterior Lumbar Fusion.

Retrospective cohort study. Characterize physical therapy (PT) utilization following single-level posterior lumbar fusion (PLF). PLF is a common procedure that is increasing in frequency. After such surgeries, PT may be considered to facilitate mobilization and return to activities. However, the usage of such therapy has not been well-characterized in the literature. Patients undergoing single-level PLF were identified from the 2010 to 2021 PearlDiver administrative database. These patients were stratified based on usage of therapy, home versus outpatient therapy, and timing of therapy within the year after surgery. To determine predictors of therapy, patient characteristics were determined and multivariable regressions were performed. A total of 213,240 patients undergoing single-level PLF were identified, of which therapy was done in the year after surgery for 63,231 (29.0%, of which home therapy accounted for 16.5% of therapy visits). Of those who utilized PT, the average number of visits was 10.6±10.6. Home therapy peaked within the first month after surgery and outpatient therapy peaked at month two. Factors associated with any PT following PLF in decreasing odds ratio (OR) were having commercial insurance (OR: 1.68), being from the Northeast (OR: 1.41), age (OR: 1.13 for 70+ of age) female sex (OR: 1.09), and ECI (OR: 1.04 per point) ( P <0.001 for all). Of those who received therapy, factors associated with home PT utilization were being from the Northeast (OR: 2.55), age (OR: 1.91 for 70+ of age), Medicaid insurance (OR: 1.48), female sex (OR: 1.39), and interbody fusion (OR:1.07) ( P <0.001 for all). After single-level PLF, the minority of patients received home or outpatient PT. Of those who did, there was significant variation in the number of visits, with nonmedical factors such as insurance plan and geographic region being strongly associated suggesting room for more consistent practice patterns. Level 3.

Factors Influencing Length of Care in Physical Therapy After Pediatric and Adolescent Concussion.

Social determinants of health including insurance type, income, race, and ethnicity have been shown to influence the utilization of physical therapy and recovery after an orthopedic injury. The influence of social determinants of health on the utilization of physical therapy and recovery from concussion is not well understood. Prospective observational registry study in a specialty concussion program. Patients diagnosed with a concussion using the Postconcussion Symptom Inventory and the visio-vestibular examination (VVE) who were also referred to physical therapy were included. The main outcomes of interest were the number of days from referral to initial physical therapy evaluation and the number of physical therapy visits completed. Information related to patients' age, race, ethnicity, sex, insurance type, and Child Opportunity Index was extracted from the registry. Multivariate and univariate regressions were used to assess the associations of each sociodemographic characteristic with the outcomes. A total of 341 patients diagnosed with concussion between January 2017 and December 2023 met inclusion criteria. The average age was 14.77, and 64% were female. Patients' age, race, ethnicity, insurance type, and Child Opportunity Index were not associated with days to evaluation or length of care in physical therapy. Higher PCSI scores in children under 12years (coefficient: 0.17, 95% CI,0.06-0.29) and female sex (coefficient: 1.2, 95% CI, 0.26-2.1) were associated with a longer course of care in physical therapy. Patients with an abnormal VVE score had on average 2.1 more physical therapy visits than those with a normal VVE score (coefficient: 2.1, 95% CI, 0.73-3.5). Higher PCSI scores in children, female sex, and higher VVE scores in general predicted a longer course of care in physical therapy. Implementation of a clinical care pathway for concussion care using the PCSI and the VVE may be one strategy to help mitigate systemic factors that might otherwise negatively influence access to physical therapy.

Physical Therapy Utilization Prior to Biceps Tenodesis or Tenotomy for Biceps Tendinopathy.

Surgery for the management of individuals with long head of the biceps tendon (LHBT) tendinopathy is common. Little is known about physical therapy (PT) utilization prior to surgery. The purpose of this review was to investigate the use of PT prior to biceps tenodesis and tenotomy surgeries by assessing the number of visits and the types of interventions. A secondary objective was to report on themes of PT interventions. A retrospective observational cohort study design was used to analyze medical records and report on patient visits, procedure codes based on active or passive interventions, and themes of interventions utilized by PT. Patient records (n=308) were screened for eligibility, n=62 (20.1%) patients attended PT prior to surgery. The median number of PT visits was four (IQR=3.5), and 39/62 (63%) patients had four or more visits to PT. Active interventions were used in 54.5% (533/978) of the codes billed; passive interventions were used in 45.5% (445/978) of the codes. There was high utilization of therapeutic exercise [93.4% (498/533) of active procedure codes] including muscle performance/resistance, functional activity, motor control and stretching. Manual therapy [84.3% (375/445) of passive procedure codes] included soft tissue mobilization, non-thrust manipulation (glenohumeral joint and cervical spine) and thrust manipulation (thoracic spine). PT was not commonly utilized prior to undergoing biceps tenodesis and tenotomy surgery. Further research is needed to understand the reasons for low utilization. 3b.

Factors Associated With Higher Utilization of Outpatient Physical Therapy for Patients Who Have Undergone Primary Total Joint Arthroplasty: A Retrospective Cohort Study.

Research has identified predictive factors for inpatient complications and short-term recovery following total knee arthroplasty (TKA) and total hip arthroplasty (THA). Predictors that may influence length of care in outpatient physical therapy (PT) have yet to be examined. Doing so may improve the quality and efficiency of PT care following TKA and THA. The aim of this study was to determine factors associated with a higher utilization of outpatient PT visits for patients who have had primary THA or TKA. A retrospective cohort study was performed using a population of 5147 patients who underwent THA and TKA between January 2017 and October 2022. Demographic and clinical factors were analyzed to determine which factors influenced PT utilization. Our multivariable linear regression model revealed that female sex, need for inpatient PT visits, and TKA as opposed to THA were significantly associated with an increase in outpatient PT visits. Older age, number of telerehabilitation visits, and history of depression were associated with fewer outpatient PT visits while accounting for all other variables. The results of this retrospective analysis may help to identify some potential factors including TKA vs THA, patient age, and a history of depression that can be evaluated prospectively in future studies to determine whether they predict subsequent outpatient PT utilization.

Comparison Of Physical Therapy Utilization And Motion-related Reoperations Between Isolated ACL And Multiligament Knee Injuries

Comparison Of Physical Therapy Utilization And Motion-related Reoperations Between Isolated ACL And Multiligament Knee Injuries

Sociocultural and Economic Disparities in Physical Therapy Utilization among Insured Older Adults with Rheumatoid Arthritis.

To examine influences of sociocultural and economic determinants on physical therapy utilization for older adults with RA. In these annual cross-sectional analyses between 2012-2016, we accessed Medicare enrollment data and fee-for-service claims. The cohort included Medicare beneficiaries with RA based on three diagnosis codes or two codes plus a disease modifying medication claim. We defined race and ethnicity and dual Medicare/Medicaid coverage (proxy for income) using enrollment data. Adults with a Current Procedural Terminology code for physical therapy evaluation were classified as utilizing physical therapy services. Associations between race and ethnicity and dual coverage and physical therapy utilization were estimated with logistic regression analyses. Potential interactions between race and ethnicity status and dual coverage were tested using interaction terms. Of 106,470 adults with RA (75% female; aged 75.8 ± 7.3 years; 83.9% identified as non-Hispanic White, 8.8% as non-Hispanic Black, 7.2% as Hispanic), 9.6-12.5% used physical therapy in a given year. Non-Hispanic Black (aOR: 0.77, 95% CI: 0.73-0.82) and Hispanic (aOR: 0.92, 95% CI: 0.87-0.98) individuals had lower odds of physical therapy utilization than non-Hispanic White individuals. Adults with dual coverage (lower income) had lower odds of utilization than adults with Medicare only (aOR: 0.44, 95% CI: 0.43-0.46). There were no significant interactions between race and ethnicity status and dual coverage on utilization. We found sociocultural and economic disparities in physical therapy utilization in older adults with RA. To address these disparities, we must identify and address the underlying factors that influence the disparities.

Poster 257: Decreased time between injury and surgery and increased injury severity predict motion loss after multi-ligament knee injury, but are only part of the picture

Objectives: Postoperative motion loss is the most common complication following multiple ligament knee injuries (MLKIs). MLKIs are often associated with concomitant musculoskeletal and neurovascular injuries and complex surgical treatment; however, factors that increase the risk of postoperative motion loss remain largely unknown. The purpose of this study was to identify predictors of motion loss following MLKI. We hypothesized that injury classification (Knee Dislocation [KD] grade), and shorter time between injury and surgery would be independent predictors of postoperative motion loss. Methods: This was a multicenter retrospective review of 773 MLKIs that occurred between 2011 and 2015. MLKI was defined as a complete tear of two or more ligaments where at least 1 ligament was repaired or constructed. Individuals with a MLKI defined as a complete tear (grade III tear) of two or more ligaments that underwent surgical repair or reconstruction of at least one ligament were included. Cases with loss of motion were identified from review of follow-up documentation or the need for subsequent manipulation under anesthesia and/or lysis of adhesions. A multivariable logistic regression with forward variable entry (p&lt;0.05) was performed to determine if any of the following variables were predictive of motion loss after MLKI: biological sex, KD grade, number of days between injury and surgery, graft type, use of external fixation, if staged procedures were performed, and associated vascular, nerve or tendon injury. Results: Of the 773 patients identified in the multicenter review, 562 (72.7%) had complete data for inclusion in the current analyses with 65 (11.6%) having postoperative motion loss (Table 1). Of the 562 patients (76.0% male, age=30.7±12.9 y, BMI=29±6.8 kg/m2), the median number of days between injury and surgery was 59 days (IQR=22-192 days). KD I injuries were the most common (59.6%) with 3.6% having KD II, 14.4% KD III-M, 13.9% KD III-L, 5.3% KD IV, and 3.2% KD V injuries. External fixation was used in 8.2% and 6.8% of the patients underwent staged procedures. Multiple graft combinations were used (all allograft = 37.5%, all autograft = 11.4%, combination = 48.9%, all repairs = 2.1%). Associated nerve injuries occurred in 19.8%, tendon injuries in 15.8%, and vascular injuries in 4.1%. Regression analysis identified decreased time between injury and surgery (OR=0.998, 95%CI[0.997-1.00]) and increased injury severity (KDIII OR=2.31, 95%CI[1.19-4.48], KDV OR=5.42, 95%CI[1.84-15.98]) as independent predictors of motion loss after MLKI (p &lt; 0.001, Nagelkerke R2=0.08). Conclusions: While KD grade and time between injury and surgery are predictive of motion loss after MLKI, these variables only explain 8% of the variability in motion loss. This confirms that clinicians should be cognizant that decreased time between injury and surgery and more severe injuries may increase this risk of motion loss; however, postoperative factors not measured in this secondary analysis might more heavily impact motion loss after surgical treatment for MLKI. Future studies are necessary to identify other factors such as pre-operative ROM, the postoperative inflammatory state of the knee, utilization of physical therapy and/or psychosocial factors that might influence motion loss after MLKI reconstruction to better inform postoperative care. [Table: see text]

Comparison of Physical Therapy Utilization and Motion-Related Re-operations Between Isolated Anterior Cruciate Ligament and Multi-Ligament Knee Injuries.

The increased prevalence of postoperative arthrofibrosis after multi-ligament knee injuries (MLKI) compared to isolated anterior cruciate ligament (ACL) injuries has been proposed to be due, in part, to patient factors limiting physical therapy utilization. The purpose of this study was to compare demographic factors, pre- and postoperative physical therapy utilization, and the need for motion-restoring surgery between MLKI and ACL-injured patients. Using the PearlDiver Mariner 151 database, two cohorts matched by age and sex were identified using current procedural terminology (CPT) codes and included those age 16 or greater that underwent isolated ACL (n=3801) vs. MLKI reconstruction (n=3801). The number of pre- and postoperative physical therapy visits was recorded, as was the need for motion-restoring surgery (arthroscopic lysis of adhesions or manipulation under anesthesia). Demographic factors, physical therapy utilization, and the prevalence of motion-restoring surgery were compared between the MLKI and ACL groups using t-tests or chi-square tests, as appropriate. A significantly greater proportion of those with MLKI underwent subsequent motion-restoring surgery (MLKI=412/3081 (13.4%) vs. ACL=84/3081 (2.7%), p<0.001; odds ratio = 5.5 (95% CI: 4.3, 7.0), p<0.0001). Following surgery, less than half of those with MLKI that underwent subsequent motion-restoring surgery attended physical therapy, which was significantly lower than those who did not require motion-restoring surgery (p<0.0001). The prevalence of motion-restoring surgery was significantly greater after MLKI when compared to an isolated ACL injury. While the etiology of arthrofibrosis after MLKI is likely complex, the current results suggest that demographic factors and physical therapy utilization are not solely responsible for the increased risk of arthrofibrosis after MLKI.

Factors influencing physical therapy utilization after shoulder surgery: a retrospective review

Postoperative physical therapy (PT) is a cornerstone to achieve optimal patient outcomes. Access to postoperative PT can be limited by insurance type, coverage, and cost. With copayments (CP) for PT as high as $75 per visit, PT can be costprohibitive for patients. The purpose of this study was to evaluate factors affecting PT utilization among patients that underwent shoulder surgery. A retrospective analysis was performed of 80 shoulder surgery patients with postoperative PT sessions attended at a single institution from 2017 to 2019. Patients were divided based on insurance type: private insurance (PI), and Medicare with or without supplemental insurance (MI), and CP or no copayment. Demographics, CP, total, and postoperative number of PT sessions utilized was collected and analyzed. The cohort had 53 females and an average age of 62. There was no significant difference between PI and MI at baseline other than surgery performed (P= .03), older MI group (69 years vs. 56 years: P < .01), and more females in PI group (76% vs. 55%; P= .05). There was no significant difference in the number of PT sessions between groups. The PI group was more likely to have a CP (P < .01). The CP group more often had PI and significantly more total PT visits (P= .05), while the no copayment group more often had Medicare (P < .01). CP was not independently associated with a change in the number of PT visits or total PT visits. The utilization of PT after shoulder surgery was found to not be influenced by insurance type or CP as determined by the number of PT sessions attended. Further investigations are necessary to better understand the relationship between CP and different insurance types and develop effective strategies to increase access to PT for postoperative shoulder patients.

Association of Housing Status With Types of Operations and Postoperative Health Care Utilization.

To analyze the association between housing status and the nature of surgical care provided, health care utilization, and operational outcomes. Unhoused patients have worse outcomes and higher health care utilization across multiple clinical domains. However, little has been published describing the burden of surgical disease in unhoused patients. We conducted a retrospective cohort study of 111,267 operations from 2013 to 2022 with housing status documented at a single, tertiary care institution. We conducted unadjusted bivariate and multivariate analyses adjusting for sociodemographic and clinical characteristics. A total of 998 operations (0.8%) were performed for unhoused patients, with a higher proportion of emergent operations than housed patients (56% vs 22%). In unadjusted analysis, unhoused patients had longer length of stay (18.7 vs 8.7 days), higher readmissions (9.5% vs 7.5%), higher in-hospital (2.9% vs 1.8%) and 1-year mortality (10.1% vs 8.2%), more in-hospital reoperations (34.6% vs 15.9%), and higher utilization of social work, physical therapy, and occupational therapy services. After adjusting for age, sex, comorbidities, insurance status, and indication for operation, as well as stratifying by emergent versus elective operation, these differences went away for emergent operations. In this retrospective cohort analysis, unhoused patients more commonly underwent emergent operations than their housed counterparts and had more complex hospitalizations on an unadjusted basis that largely disappeared after adjustment for patient and operative characteristics. These findings suggest issues with upstream access to surgical care that, when unaddressed, may predispose this vulnerable population to more complex hospitalizations and worse longer term outcomes.

"Beyond waking and walking. Intensive rehabilitation in patients requiring extended durations of advanced mechanical circulatory support: A case series".

Physical therapy (PT) utilization in patients requiring mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) has been reported; however, little is known about intensive rehabilitation and associated outcomes in patients requiring extended complex MCS and/or ECMO support. Authors sought to explore safety, feasibility and outcomes associated with active rehabilitation in patients requiring prolonged advanced MCS/ECMO support. Single-center retrospective series evaluated functional, clinical, and longitudinal outcomes of sample of eight critically ill, adult (≥18 years of age) patients who underwent a intensive rehabilitation while receiving prolonged MCS/ECMO through advanced configurations including: venovenous (VV-ECMO), venoarterial (VA-ECMO), oxygenator with right ventricular assist device (Oxy-RVAD) and right ventricular assist device (RVAD). 406 sessions were conducted; 246 during provision of advanced MCS/ECMO support. Incidence of major adverse events-accidental decannulation, migration of cannulas, circuit failure, hemorrhage, major flow limitations, and major hemodynamic instability-was 1.2 events per 100 sessions. None of reported major adverse events impeded longitudinal ability to participate in PT. Increased time to PT initiation was associated with a statistically significant increase in intensive care unit (ICU) length-of-stay (β1 1.93, CI 0.55–3.30) and reduced ambulatory distance during last session on MCS/ECMO (β1 -47.64, CI - 93.93, −1.66). All patients survived to hospital discharge and 12 months from sentinel hospitalization. Amongst those patients discharged to an inpatient rehabilitation center ( n = 4), all were discharged home within 3 months. Findings support the safety and feasibility of active rehabilitational PT in patients requiring extended durations of advanced MCS/ECMO support. Moreover, it highlights potentially associated benefits of this degree of intensive rehabilitation for these unique patients. Further investigation is needed to identify associations with longitudinal clinical outcomes, as well as predictors of success in this population.

Postoperative Physical Therapy Following Balloon Kyphoplasty for Management of Vertebral Burst Fracture: A Case Report

BACKGROUND: There is paucity in the literature regarding physical therapy (PT) utilization for postoperative management following balloon kyphoplasty (BKP). CASE PRESENTATION: A 74-year-old female with osteoporosis and multiple sclerosis presented with a vertebral burst fracture following a fall. The patient was successfully treated with transforaminal epidural for radiculopathy but underwent a BKP due to worsening low back pain. The patient was referred to PT and began 6 weeks after BKP due to residual low back pain and limitations in functional mobility. OUTCOME AND FOLLOW-UP: Significant improvements in Oswestry Disability Index, Patient-Specific Functional Scale, numeric pain-rating scale, and 5 times sit-to-stand were demonstrated following 16 weeks of postoperative PT without adverse events. DISCUSSION: Physical therapy following BKP may reduce pain and fall risk while improving quality of life without adverse events in patients with vertebral burst fracture on an individual basis. JOSPT Cases 2023;3(1):81–95. Epub: 14 December 2022. doi:10.2519/josptcases.2022.11399

Racial/Ethnic Disparities in Physical Therapy Utilization After Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is a common orthopaedic procedure, after which many patients benefit from physical therapy (PT). However, such services may not be uniformly accessible and used. To that end, disparities in access to care such as PT after interventions may be a factor for those of varying race/ethnicities. TKAs were abstracted from the 2014 to 2016 Standard Analytic Files PearlDiver data set-a large national health administrative data set containing information on more than 60 million Medicare patients. Occurrences of home or outpatient PT within 90 days after TKA were identified. Patient demographic factors were extracted, including age, sex, Elixhauser Comorbidity Index, estimated average household income of patient based on zip code (low average household income [<75k/year] or high average household income [>75k/year]), and patient race/ethnicity (White, Hispanic, Asian, Native American, Black, or Other). Predictive factors for PT utilization were determined and compared with univariate and multivariate analyses. Of 23,953 TKA patients identified, PT within 90 days after TKA was used by 18,837 (78.8%). Patients self-identified as White (21,824 [91.1%]), Black (1,250 [5.2%]), Hispanic (268 [1.1%]), Asian (241 [1.0%]), Native American (90 [0.4%]), or "Other" (280 [1.2%]) and were of low household income (19,957 [83.3%]) or high household income (3,994 [16.7%]). When controlling for age, sex, and ECI, PT was less likely to be received by those of low household income (relative to high household income OR 0.79) or by those of defined race/ethnicity (relative to White or Black OR 0.81, Native American OR 0.58, Asian OR 0.50, or Hispanic OR 0.44) ( P < 0.05 for each). In a large Medicare data set, disparities in utilization of PT after TKA were identified based on patient's estimated household income and race/ethnicity. Identification of such factors may help facilitate the expansion of care to meet the needs of all groups adequately. Level III.

Factors associated with utilization of physical therapy services during pregnancy and after childbirth

ObjectiveTo explore demographic and clinical factors associated with utilization of antepartum/postpartum physical therapy. MethodsThis is a secondary analysis of a cross-sectional survey of 298 women who were receiving or had received obstetric care at a medical center in southern Taiwan. Data were collected between May 2021 and May 2022 using an online questionnaire, which included demographic, medical, and obstetric details, the symptom severity questionnaires, management strategies, and experience and perception about physical therapy. Descriptive statistics, independent t-test, chi-square analysis and multivariate logistic regression model were used to analyze data. ResultsAmong 298 respondents, 190 (63.8%) were pregnant and 108 (36.2%) were postpartum. Thirteen percent of pregnant participants and 27% of postpartum participants had received physical therapy during and/or after childbirth. Multivariate analyses showed that being postpartum, having an associate degree and below, and experiencing depressive symptoms were significantly associated with an increased utilization of physical therapy (postpartum: OR = 3.039, 95% CI = 1.530, 6.035; associate degree and below: OR = 2.521, 95% CI = 1.007, 6.316; depressive symptoms: OR = 3.606, 95% CI = 1.067, 12.185). The odds of utilizing physical therapy decreased with age (OR = 0.935, 95% CI = 0.874, 1.000). ConclusionsIndividual factors, such as age, education level, pregnancy status, and experience of depressive symptoms, have a significant association with utilization of antepartum/postpartum physical therapy and should be considered when developing obstetric care pathways to optimize clinical and healthcare utilization outcomes.

The association between implementation of multidisciplinary rounds and clinical outcomes.

Multidisciplinary rounds (MDR) consisting of social workers, dietitians, pharmacists, physical therapists, nurses, and physicians have been implemented at many healthcare institutions to address the complex components of inpatient care. However, little is known on the association of MDR on clinical outcomes across cardiovascular pathologies. This study aimed to investigate the impact of MDR on cardiovascular patients. Hospital admissions to inpatient cardiology were evaluated prior to (November 2017 to November 2018) and after implementation of MDR (December 2018 to August 2020) at a metropolitan academic medical center. The following outcomes were evaluated: clinical complications (incidence of stroke, gastrointestinal bleed, myocardial infarction, or systemic infection during hospitalization), Length of Stay (LOS), 30-day readmissions and all-cause in-hospital mortality. Secondary outcomes included utilization of physical therapy and dietary services. Admissions were evaluated prior to (N = 1054) and after (N = 1659) MDR implementation. All-cause in-hospital mortality after MDR implementation decreased significantly from 2.8 to 1.6% (P = 0.03). Although the number of complications and LOS decreased, these differences were not statistically significant. No significant change was observed in 30-day readmissions. Significant increase in the utilization of physical therapy (34.2 to 53.5%; P < 0.01) and dietary services (7.2 to 19.3%; P < 0.01) were observed. Multidisciplinary rounds implementation was associated with significantly decreased mortality and positively impacted resource utilization with increased consultations for ancillary services. MDR is a high impact intervention that utilizes existing resources to improve mortality and should be implemented especially for cardiovascular patients. Further investigation into the benefit of MDR across different patient populations and care settings is warranted.

Physical Therapy Utilization Within 90 Days of Total Ankle Arthroplasty

Category: Ankle; Arthroscopy; Other Introduction/Purpose: Physical therapy (PT) following total ankle arthroplasty (TAA) is often considered, but guidelines for its use are not standardized. While there may be patient factors that dictate recommendations, establishing a baseline of utilization practices may set the stage for establishing generalizable recommendations. Methods: This retrospective cohort study employed data from the 2010 to 2019 M91Ortho PearlDiver administrative dataset. Those undergoing TAA were identified based on coding, and patient factors were extracted, including: age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients' surgery was performed (midwest, northeast, south, west), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of PT utilization in the 90-days following TAA were identified as occurring at home or in an outpatient setting. Univariate and multivariate logistic regression analyses allowed the identification of predictive factors for PT utilization. Results: Of 6,563 TAA patients identified, 2788 (42.5%) utilized postoperative PT services. Most services were done as an outpatient (63.4%), compared to at home (6.1%). Weekly utilization of PT was greatest in the first week following surgery (17.7% of those who utilized PT) and thereafter followed a roughly bell-shaped curve of utilization with the greatest incidence at seven weeks following surgery (14.9% of those who utilized PT). Multivariate analysis identified multiple predictors of PT utilization following TAA, including: older age (odds ratio [OR] 1.23 per decade increase, p &lt; 0.0001), higher ECI (OR 1.03 per 2-point increase, p = 0.0383), having surgery performed in the midwest, northeast, or western US (relative to the South OR 1.43, p &lt; 0.0001; 1.20, p = 0.0109; and 1.32, p &lt; 0.0001, respectively), and having commercial or Medicaid insurance coverage (relative to Medicare OR 1.96, p &lt; 0.0001 and 1.62, p = 0.0006, respectively). Conclusion: Of 6,563 TAA patients, 42.5% utilized PT within 90 days of surgery. PT utilization was highest in the first- and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAA, algorithms for PT usage may be better defined and consistently employed.