Physical Therapy Utilization Research Articles

Depression and Anxiety among Patients with Atraumatic Lateral Epicondylitis and Ulnar-Sided Wrist Pain

Background Ulnar-sided wrist pain (UWP) and lateral epicondylitis (LE) are common disorders that can be difficult to treat. Depression and anxiety have been shown to modify patient symptoms, disability and pain. Questions/Purposes The purpose of our study was to quantify the prevalence of depression and anxiety among patients with LE or UWP. A secondary aim was to determine if these patients report higher levels of pain upon presentation and if they are more likely to require occupational therapy. Patients and Methods A retrospective chart review was conducted, and patients included those with LE or UWP, atraumatic in origin, ages 18 and over, and ongoing use of noninvasive treatment of LE or UWP. Results Our final analysis included 97 patients of which 57 had LE, 34 had UWP, and 6 had both. The prevalence of a mood disorder was 34.0%. Anxiety and/or depression was more prevalent in patients with LE compared to UWP. The most common medication was alprazolam. Pain scores averaged 1.2 points higher in subjects with a history of a mental health disorder. After adjusting for age and sex, there was no significant association between prevalence of depression and/or anxiety and utilization of physical or occupational therapy. Conclusions Patients with either LE, UWP or both along with depression and/or anxiety may be less likely to improve with traditional treatments. Future investigations are warranted focusing on the value of a multidisciplinary team consisting of a hand surgeon, behavioral therapist, or psychologist to optimize treatment response. Level of Evidence This is a Level IV, case series study.

Arthroscopy for Management of Femoroacetabular Impingement Syndrome in the Military Health System: A 10-Year Epidemiological Overview of Cases with 2-year Follow-up

With the rapid rise in arthroscopy rates for the management of Femoroacetabular Impingement (FAI) Syndrome, it is important to understand current surgical rates and the impact of these surgeries within the Military Health System (MHS). The purpose of this study was to provide an epidemiological descriptive summary of hip arthroscopy for FAI Syndrome in the MHS and describe perioperative healthcare utilization variables. Eligible beneficiaries ages 18-50, undergoing hip arthroscopy with 2-year follow-up after surgery were included. Healthcare utilization data were abstracted from the MHS Data Repository (MDR) from June 2003 to July 2015, and included all visits, costs, procedures, and prescriptions taking place in both military and civilian hospitals worldwide. 1870 patients were included (mean age 32.2 years; 55.5% male). 51.7% of the procedures took place in military versus 48.3% in civilian hospitals. Mean hip-related healthcare costs in the 2-year following surgery were $15,434 per patient. Patients had a median of 3 opioid prescriptions and 72% had a comorbidity present after surgery. Generally, rates of surgery grew annually from 66 cases in 2004 to 422 cases in 2013. Overall complication rates were comparable to other published reports. Procedures in both military and civilian hospitals had the same rates of femoroplasty and labral repairs, however acetabuloplasty procedures occurred at a higher rate in military (18.9%) vs civilian (14.7%) hospitals. Only 58.8% of patients had physical therapy in the year prior to surgery, while 82.7% had it after surgery. Additionally, 50% of patients had received opioid prescriptions in the 1 year prior to surgery, while 38.9% had 3 or greater opioid prescriptions beyond the initial perioperative fill within the 2-year follow-up. Rates of arthroscopy have grown in the MHS over the last decade. Complication rates are similar to those reported in other populations and settings. Utilization of physical therapy was much more likely after surgery than prior to it. Opioid use was high prior to surgery and many individuals continued to receive opioid prescriptions beyond the initial perioperative period.

Increased Utilization of Ambulatory Occupational Therapy and Physical Therapy After Medicaid Expansion

ObjectiveTo determine if Medicaid expansion in 2014 improved utilization of ambulatory physical therapy and occupational therapy. DesignSecondary data, pre-post analysis study using a difference in differences approach. The study compared utilization rates and likelihood of an ambulatory therapy visit for Medicaid ambulatory therapy patients in the pre-expansion (2012-2013) period and postexpansion (2014-2015) period. A descriptive analysis of utilization and logistic regression with a difference in differences approach of the odds of a therapy visit was conducted. SettingNot applicable. ParticipantsThe 2012-2015 public use data files of the Medical Expenditure Panel Survey- Household Component. Main Outcome MeasuresDescriptive results and the odds ratio of an ambulatory therapy visit were determined. ResultsAbout 788,233 more Medicaid beneficiaries had an ambulatory therapy visit after Medicaid expansion. By subpopulation, the increases in utilization were greatest for beneficiaries from low-income households and beneficiaries living in the west census region. Policy change increased the odds of a therapy visit for a Medicaid beneficiary by 27%. ConclusionsUtilization of ambulatory therapy by Medicaid beneficiaries increased after Medicaid expansion.

Service Utilization and Costs of Patients at a Cash-Based Physical Therapy Clinic.

Cash-based physical therapy, a model in which the clinicians do not accept insurance payments and accept only direct payment, is quickly becoming an enticing option for clinicians who own their own practice. The purpose of this study was to describe service utilization for a single cash-based physical therapy clinic. Forty-eight charts of patients who had been discharged between 2013 and 2016 were randomly selected. The data were deidentified prior to the researchers gaining access. Chronic diagnoses were predominately prevalent (n = 28). The lumbo/pelvic region of diagnoses (39.6%) and knee/leg region of diagnoses (29.2%) encompassed the majority of the diagnoses. The mean physical therapy utilization for the cohort per episode of care was 8.0 ± 8.1 visits per episode of care, total cost of $780.19 ± 530.30 per episode of care, and $97.52 per visit. This study is the first to present data regarding costs, utilization, and patient demographics for a cash-based physical therapy clinic.

Utilization of physical therapy, speech therapy and occupational therapy by children and adolescents in Germany.Results of the cross-sectional KiGGS Wave 2 study and trends.

Allied health services such as physical therapy, speech therapy and occupational therapy contribute to the early treatment of health disorders in children and adolescents and promote a healthy development. This article describes the utilization of these allied health services by children and adolescents in Germany and analyses its association with demographic and social factors. The analyses are based on the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) including 15,023 participants. Trends are calculated in comparison with the KiGGS baseline study (2003-2006). Within one year, 9.6% of children and adolescents in Germany use physical therapy, 6.1% speech therapy and 4.0% occupational therapy. Speech therapy and occupational therapy are used more frequently by boys than by girls. The utilization of speech therapy is highest among 3- to 6-year-olds with 15.0%. Occupational therapy (8.3%) is most frequently used by 7- to 10-year-olds and physical therapy (16.9%) by 14- to 17-year-olds. Social differences are evident mainly in the higher utilization of occupational therapy and speech therapy and a lower utilization of physical therapy by socially disadvantaged children and adolescents. Over the last ten years, the utilization of speech therapy and physical therapy in children and adolescents has increased significantly.

Home-Health-Care Physical Therapy Improves Early Functional Recovery of Medicare Beneficiaries After Total Knee Arthroplasty.

Home-health-care utilization after total knee arthroplasty (TKA) is increasing. Recent publications have suggested that supervised rehabilitation is not needed to optimize functional recovery after TKA; however, few studies have evaluated patients in home-health-care settings. The objectives of this study were to (1) determine whether physical therapy (PT) utilization is associated with functional improvements for patients in home-health-care settings after TKA and (2) determine which factors are related to utilization of PT. This study was an analysis of Medicare home-health-care claims data for patients treated with a TKA in 2012 who received home-health-care services for postoperative rehabilitation. Multivariable linear regression models were used to evaluate relationships between PT utilization and recovery in activities of daily living (ADLs). Negative binomial regression models were used to determine factors associated with PT utilization. Records from 5,967 Medicare beneficiaries were evaluated. Low home-health-care PT utilization (≤5 visits) was associated with less improvement in ADLs compared with 6 to 9 visits, 10 to 13 visits, or ≥14 visits. Compared with low home-health-care utilization, utilization of 6 to 9 visits was associated with a 25% greater improvement in ADLs over the home-health-care episode (p < 0.0001); 10 to 13 visits, with a 40% greater improvement (p < 0.0001); and ≥14 visits, with a 50% greater improvement (p < 0.0001). The findings remained robust following adjustments for medical complexity, baseline functional status, and home-health-care episode duration. After adjustment, lower PT utilization was observed for patients receiving home health care from rural agencies (10.7% fewer visits, 95% confidence interval [CI] = 7.9% to 13.7%), those with depressive symptoms (4.8% fewer visits, 95% CI = 1.3% to 8.3%), and those with any baseline dyspnea (5.3% fewer visits, 95% CI = 3.1% to 7.5%). Low home-health-care PT utilization was significantly associated with worse recovery in ADLs after TKA for Medicare beneficiaries, after controlling for medical complexity, baseline function, and home-health-care episode duration. Patients who are served by rural agencies or who have higher medical complexity receive fewer PT visits after TKA and may need closer monitoring to ensure optimal functional recovery. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Physical Therapy Services for People With Intellectual and Developmental Disabilities: The Role of Medicaid Home- and Community-Based Service Waivers.

Care and support for people with intellectual and developmental disabilities (IDD) in natural community contexts are increasing. Many people with IDD use physical therapy services to support their community participation. Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are the largest providers of long-term services and supports for people with IDD. However, little is known about physical therapy provision under this program. The aim of this study was to compare the operational definitions of physical therapy service under the HCBS 1915(c) waiver system and to describe projected physical therapy service utilization, spending, and reimbursement for people with IDD across states. This was a cross-sectional, descriptive study. This study analyzed fiscal year 2015 HCBS IDD waivers from across the nation (N=111), focusing on physical therapy utilization (total projected spending, total participants, reimbursement rates, and average annual service provision per participant). Service definitions were also analyzed to determine trends across waivers. Fifty-one waivers (45.9%) provided 61 different types of physical therapy services in fiscal year 2015. States utilized waivers to provide long-term remedial care rather than the acute short-term physical therapy. HCBS waiver physical therapy services were often provided in participants' homes and communities to expand physical therapy access and secure the benefits of providing physical therapy services in natural environments. Although most states have adopted similar definitions of physical therapy service, procedures and services vary. Medicaid HCBS waivers are state projections made to the federal government rather than actual utilization data. Physical therapy service definitions, projected service utilization, spending, and reimbursement for people with IDD who use Medicaid HCBS waivers vary greatly between states. Physical therapy may be utilized less than expected given the reported benefits for people with IDD.

Geographic Variability in Discharge Setting and Outpatient Postacute Physical Therapy After Total Knee Arthroplasty: A Retrospective Cohort Study.

Despite the frequency of total knee arthroplasty (TKA) in the Medicare population, little is known about the use of postacute physical therapy among those discharged to home. The objectives of this study were to explore factors associated with geographic variability in discharge disposition and outpatient physical therapy utilization for Medicare patients after TKA discharged to home/self-care. The design of the study was a retrospective cohort study. Medicare patients with TKA discharged alive from July 1, 2010, to June 30, 2011, with discharge disposition to home/self-care (HSC), home health agency (HHA), inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF) were selected. Geography was measured with Census region. Outpatient physical therapy utilization was calculated from Medicare Part B claims. Odds ratios for discharge disposition and adjusted means for physical therapy utilization variables by Census region were calculated, accounting for county-clustered data and adjusting for demographics, clinical, and environmental characteristics. There was significant variation with discharge destination by Census region among 18,278 patients. With discharge disposition analysis, the patients from the West region who were discharged home were the referent group. The patients from the South and Northeast regions had higher odds for discharge to HHAs (adjusted odds ratio [95% CI=1.80 [1.48-2.19] and 2.20 [1.70-2.84]), SNFs (1.34 [1.08-1.66] and 4.42 [3.38-5.79]), and IRFs (2.36 [1.80-3.09] and 8.83 [6.41-12.18]). For those discharged to HSC, 40.4% received outpatient physical therapy within 4 weeks. Significant differences were found with time to first physical therapy visit (Midwest <South <[West=Northeast]) and length of therapy episode, but not with the number of therapy visits by geographic region. Geographic region was associated with discharge setting, postacute physical therapy, and outpatient therapy utilization in Medicare beneficiaries after TKA. Differences in outcomes of outpatient therapy should be assessed to better describe the impact of geographic variation in care.

Interventional Approaches to Low Back Pain.

Chronic low back pain (LBP) places a tremendous economic burden on society due to both direct and indirect costs. Health care costs for adults with chronic LBP have steadily increased over the past 20 years, coinciding with a large increase in the utilization of spinal injections, surgical interventions, opioid medications, and physical therapy. The treatment of LBP is best approached by a multimodal and even multidisciplinary approach with a combination of physical rehabilitation, pharmacologic management, psychological intervention, spinal injections, and surgical intervention with a goal of improving the functional status of the patient. In this review, we discuss the interventional management of LBP secondary to herniated nucleus pulposus, spinal stenosis, facet mediated pain, sacroiliitis, and discogenic pain.

The Utilization of Formal Physical Therapy After Shoulder Arthroplasty.

It is widely believed that structured rehabilitation programs by professional therapists help guide patients through the various recovery periods after shoulder arthroplasty, speeding up their recovery and improving their final functional gains. However, to our knowledge, there are no studies providing information about the current state of physical rehabilitation use after shoulder arthroplasty. To describe the variation in physical rehabilitation utilization after total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), and to identify differences in utilization based on type of insurance (private versus public), sex, age, and region of the country. This epidemiological retrospective database study utilized a commercially available database, PearlDiver, with longitudinal patient tracking linking all patients' Current Procedural Terminology and International Classification of Diseases-Ninth Revision codes to their specific records to analyze patterns of physical rehabilitation usage after TSA and RSA in the United States. Two main patient populations were analyzed within the PearlDiver database, the Humana private insurance population and the Medicare insurance population. The period analyzed was 2010 to 2015. There was significantly higher utilization of physical rehabilitation in the Humana population when compared to the Medicare population (P<.001, Cramer's V = 0.270). In the Humana population, 36% of patients had 5 or fewer physical rehabilitation visits in the 6 months following their operation, while in the Medicare population, 56% of patients had 5 or fewer physical rehabilitation visits in the same period. Those with TSA had a higher utilization rate than those with RSA in the Humana (P<.001, V = 0.104; TSA, 31% had 5 or fewer physical rehabilitation visits; RSA, 40% had 5 or fewer physical rehabilitation visits within 6 months) and Medicare populations (P<.001, V = 0.135; TSA, 51% had 5 or fewer physical rehabilitation visits; RSA, 61% had 5 or fewer physical rehabilitation visits within 6 months). Postoperative utilization of physical rehabilitation after anatomic TSA and RSA is markedly higher in privately insured patients than in patients with Medicare, regardless of age, sex, diagnosis, or region of country. These findings have important implications, from the individual patient's experience and outcomes to system-wide resource utilization. Economic and decision analyses, level 4. J Orthop Sports Phys Ther 2018;48(11):856-863. Epub 8 May 2018. doi:10.2519/jospt.2018.8176.

Sociodemographic and Clinical Correlates of Physical Therapy Utilization in Adults With Symptomatic Knee Osteoarthritis.

Physical therapy is essential for conservative management of symptomatic knee osteoarthritis (OA). However, physical therapy utilization data are limited for knee OA. The purpose of this study is to identify correlates of physical therapy utilization among adults with symptomatic knee OA. The design consisted of secondary analysis using baseline data from a randomized controlled trial of 350 adults with physician-diagnosed symptomatic knee OA. Patients completed baseline surveys regarding demographics, pain, function, medical history, and prior physical therapy utilization for symptomatic knee OA. Multivariable logistic regression identified correlates of physical therapy utilization, with models adjusted for body mass index and age. Interactions of race and sex with all other characteristics were evaluated. One hundred and eighty-one patients (52%) reported prior physical therapy utilization. Factors independently associated with increased odds of physical therapy utilization were female sex (odds ratio [OR] = 3.06, 95% CI = 1.58-5.93), bachelor degree or higher degree (OR = 2.44, 95% CI = 1.15-5.16), prior knee injury (OR = 1.86, 95% CI = 1.08-3.19), and duration of knee OA symptoms (OR = 2.16, 95% CI = 1.09-4.29 for >5-10 years; OR = 2.11, 95% CI = 1.10-4.04 for >10 years). Whites who had received a joint injection were >3 times as likely to have utilized physical therapy (OR = 3.69, 95% CI = 1.94-7.01); this relationship did not exist for non-whites who had received joint injections. A sample enrolled in an exercise study may limit generalizability. Self-report of physical therapy may misclassify utilization. It cannot be determined whether lack of utilization resulted from lack of referral or from patients choosing not to attend physical therapy. Physical therapy is underutilized to manage symptomatic knee OA. Women and those with a bachelor degree or higher degree, prior knee injury, and longer duration of knee OA symptoms were more likely to have used therapy previously. Differences by race in the link between joint injection and physical therapy utilization may reflect a reduced likelihood of referral and decreased use of health interventions for symptomatic knee OA among non-whites, or both.

Physical Therapy Utilization and Patients Characteristics among Home Health Care Beneficiaries with Cerebrovascular Accidents in Saudi Arabia

Background: Home Health Care (HHC) services for stroke survivors in Saudi Arabia has just recently developed and were not studied in the literature, which requires efforts in enhancing the service utilization for better care delivered to HHC patients. Objectives: The purpose of our study is to explore stroke patients’ characteristics and associated factors, and the service utilization especially PT visits among patients receiving HHC services in Aseer region, Saudi Arabia. Materials and method: A total of 71 stroke patients were admitted to the HHC program and were included for our analysis. They received HHC services and undergone various health services including Physical Therapy, Nursing, and Medical Doctor Visits. We selected factors of interests in our correlation analysis. These selected factors that have an impact on PT outcomes for patients receiving HHC were the following: Age above 65, Urinary Incontinence, Impaired functional mobility, and cognitive impairment. Results: The majority of our patients were 65 years of age and above (n= 64, 90.1%). Regarding the involvement of the selected factors, 71.1% of our patients had Urinary Incontinence, 63.4% were cognitively impaired, and 95.8% of our patients had impairment in functional mobility. In terms of the activities of daily living, 80.3% (n= 57) of patients were depend others for their activities, 9.9% (n=7) were independent, and 8.4 % of patients (n = 6) needs the assistive device for their activities. Conclusion: HHC service beneficiaries are primarily males, aged greater than 65 years and dependent on others for their functional activities among Saudi Arabia stroke patients. Functional mobility impairment presents in almost every stroke HHC service beneficiaries which has low positive with urinary incontinence and negligible correlation with cognitive impairment. Only less than 20% of beneficiaries are prior non-hospitalized and requires more physiotherapy visits than priory hospitalized one which is lowest amongst other health care (i.e.) physician and nursing care.

Fall risks factors among home-based health care patients in the Aseer province: Observational study

Purpose: To describe the prevalence of fall risks factors using the Missouri Alliance for Home Care’s fall risk assessment tool (MAHC-10) on home-based health care (HHC) patients in the Aseer region, southern Saudi Arabia. Also, to highlight the process of care, and physical therapy utilization among home health care beneficiaries. Method: 242 patients’ information were retrieved and reviewed. Patients in our study received various healthcare services including physical therapy, nursing and physicians’ visits between October and December 2017. We used the MAHC-10, which was designed for assessing multifactorial fall risks among home-based health care patients. Results: 43% of patients were male, and 57% were female. Males received care within an average of 8 d of a referral date, whereas female patients received care within an average of 15 d. Majority of patients are functionally dependent (78%) of patients. Nursing visits were the highest number of professionals that provided HHC visits for both patients’ risk groups. The impairment of functional mobility had the highest fall risk factor among patients receiving HHC services, and fall history factor was the lowest prevalent fall risk factor among patients. Conclusion: Health care utilization is very important, and it should start early enough to decrease the risk of fall especially physical therapy visits. The level of functional mobility was also a most prevalent factor across all home health care patients in our study, and it is an essential element for predicting the likelihood of a fall in the older adult Aseer population.

Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study

BackgroundWith the growth of reverse shoulder arthroplasty (RSA), it is becoming increasingly necessary to establish the most cost-effective methods for the procedure. The surgical approach is one factor that may influence the cost and outcome of RSA. The purpose of this study was to compare the clinical results of a subscapularis- and deltoid-sparing (SSCS) approach to a traditional deltopectoral (TDP) approach for RSA. The hypothesis was that the SSCS approach would be associated with decreased length of stay (LOS), equal complication rate, and better short-term outcomes compared to the TDP approach.MethodsA prospective evaluation was performed on patients undergoing RSA over a 2-year period. A deltopectoral incision was used followed by either an SSCS approach or a traditional tenotomy of the subscapularis (TDP). LOS, adverse events, physical therapy utilization, and patient satisfaction were collected in the 12 months following RSA.ResultsLOS was shorter with the SSCS approach compared to the TDP approach (from 8.2 ± 6.4 days to 15.2 ± 11.9 days; P = 0.04). At 3 months postoperative, the single assessment numeric evaluation score (80 ± 11% vs 70 ± 6%; P = 0.04) and active elevation (130 ± 22° vs 109 ± 24°; P = 0.01) were higher in the SSCS group. The SSCS approach resulted in a net cost savings of $5900 per patient. Postoperative physical therapy, pain levels, and patient satisfaction were comparable in both groups. No immediate intraoperative complications were noted.ConclusionUsing a SSCS approach is an option for patients requiring RSA. Overall LOS is minimized compared to a TDP approach with subscapularis tenotomy. The SSCS approach may provide substantial healthcare cost savings, without increasing complication rate or decreasing patient satisfaction.

Hospitalization and rehospitalization in Parkinson disease patients: Data from the National Parkinson Foundation Centers of Excellence.

BackgroundPatients with Parkinson disease (PD) are at high risk of hospital encounters with increasing morbidity and mortality. This study aimed to determine the rate of hospital encounters in a cohort followed over 5 years and to identify associated factors.MethodsWe queried the data from the International Multicenter National Parkinson Foundation Quality Improvement study. Multivariate logistic regression with backward selection was performed to identify factors associated with hospital encounter prior to baseline visit. Kaplan-Meier estimates were obtained and Cox regression performed on time to hospital encounter after the baseline visit.ResultsOf the 7,507 PD patients (mean age 66.5±9.9 years and disease duration 8.9±6.4 years at baseline visit), 1919 (25.6%) had a history of a hospital encounter prior to their baseline visit. Significant factors associated with a history of a hospital encounter prior to baseline included race (white race: OR 0.49), utilization of physical therapy (OR 1.47), history of deep brain stimulation (OR 1.87), number of comorbidities (OR 1.30), caregiver strain (OR 1.17 per standard deviation), and the standardized Timed Up and Go Test (OR 1.21). Patients with a history of hospitalization prior to the baseline were more likely to have a re-hospitalization (HR1.67, P<0.0001) compared to those without a prior hospitalization. In addition, the time to hospital encounter from baseline was significantly associated with age and number of medications. In patients with a history of hospitalization prior to the baseline visit, time to a second hospital encounter was significantly associated with caregiver strain and number of comorbidities.ConclusionHospitalization and re-hospitalization were common in this cohort of people with PD. Our results suggest addressing caregiver burden, simplifying medications, and emphasizing primary and multidisciplinary care for comorbidities are potential avenues to explore for reducing hospitalization rates.

How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

Relationship Between Physical Therapy, Occupational Therapy, Palliative Care Consultations, and Hospital Length of Stay

Purpose: Physical therapy (PT) and occupational therapy (OT) treatment utilization in palliative care (PC) is not well documented. This study analyzed which hospitalized patients have received an order for a PC consultation and also received an order for PT or OT during that admission and described the patients most likely to have these services ordered. Methods: Palliative care orders were examined retrospectively for presence or absence of PT/OT orders in the context of primary PC diagnoses, age, and length of stay (LOS). Results: Of the 824 unique patients, 681 patients (83%) received at least 1 order for PT while 615 patients (75%) received at least 1 order for OT. Palliative care patients who received orders for PT and OT (9.7 days) and PT and/or OT (9.3 days) had a longer LOS (P &lt; .0001) compared with those who did not receive either PT or OT (5.0 days). Conclusions: A large percentage of patients who received PC consultations also received PT and/or OT orders, and most of the time therapy was ordered before PC. On the basis of these findings, ordering providers may be consulting PT/OT to assist with discharge planning for medically complex patients with a longer anticipated LOS.

Individual and Regional Determinants for Physical Therapy Utilization in Germany: Multilevel Analysis of National Survey Data

Physical therapy is included in many clinical guidelines and is a commonly used health service. However, access to its benefits should not strongly depend on social or demographic factors. The present study used the Andersen model to explain to what extent physical therapy utilization in Germany depends on factors beyond medical need. The German Health Interview and Examination Survey for Adults (DEGS, 2008-2011; target population, 18-79 years) is part of the German health-monitoring system. Two-stage stratified cluster sampling resulted in a sample of 8152 participants. Data were matched with district-related information on social structures and service supply. Following Andersen's Behavioral Model of Health Services Use, this study identified predisposing, enabling, and need factors for physical therapy utilization using multilevel logistic regression analyses. Physical therapy was used by 23.4% (95% CI: 22.0-24.8) of the German population within one year, with a higher proportion of females (26.8%; 95% CI: 25.1-28.6) than males (19.9%; 95% CI: 18.1-21.8) and an increase with age. Beyond medical need, physical therapy utilization depended on higher education, migrant background, nonsmoking (predisposing), social support, higher income, private health insurance, and gatekeeping service contact (enabling). Variation among districts partly reflected regional supply. Because the present study was cross-sectional, its findings provide representative information on physical therapy use but do not establish final causal links or identify whether utilization or supply in certain districts or population groups is adequate. Whether certain regions are under- or overserved and whether further regulations are needed is of political interest. Physicians and therapists should develop strategies to improve both adherence of hard-to-reach groups and supply in low-supply regions.

Physical and occupational therapy utilization in a pediatric intensive care unit

PurposeTo characterize the use of physical therapy (PT) and occupational therapy (OT) consultation in our pediatric intensive care unit (PICU). Materials and methodsWe studied children aged 1week–18years admitted to a tertiary care PICU for ≥3days. Patient characteristics, details of PT and OT sessions and adverse events were collected. A multivariable logistic regression was performed to determine factors associated with receipt of PT and OT consultation with propensity analysis followed by a regression for factors associated with outcome. ResultsOf 138 children studied, 40 (29%) received PT and OT consultation. Services were initiated 6.9±10.0 (mean±standard deviation) days after PICU admission. Range of motion (83%) was the most common therapy provided and 28% of patients were ambulated. Sixty-four of 297 (21.5%) sessions were deferred and 7 (2.4%) sessions were terminated early due to physiologic instability with no serious adverse events. Children who received PT and OT were older, more likely to require neuromuscular blocking agents, and had lower pre-PICU POPC scores (all p<0.05). ConclusionsData are needed to inform on the efficacy of rehabilitative therapies initiated in the ICU to improve outcome for critically ill children.

Risk Factors for Revision or Contralateral ACL Reconstruction

Objectives:Physical therapy (PT) is routinely prescribed after anterior cruciate ligament (ACL) reconstruction, and is considered a significant contributor to the cost of ACL care. With the upcoming implementation of alternative reimbursement models, data about the true cost and value of ACL rehabilitation are necessary to guide its utilization. The purpose of this study is to evaluate the effects of age, gender, and physical therapy (PT) utilization on second ACL reconstruction rates and to assess the value of post-operative PT.Methods:Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 2007 and 2014 were identified using the PearlDiver database. Demographic data including age and sex were obtained for this cohort. Physical therapy utilization was determined by the percentage of patients with at least one post-operative PT-related code at 2, 4, 6, 12 and 24 weeks after surgery. Patients with a subsequent ACL injury (ipsilateral or contralateral) requiring reconstruction within 24 months of the index procedure were identified. The effects of age, sex and PT utilization on the risk of subsequent ACL surgery were calculated using contingency analysis (chi-square test). Risk ratios (RR) with 95% confidence intervals were calculated for each predictor.Results:A total of 11,272 patients undergoing ACL reconstruction were identified between 2007 and 2014. PT utilization steadily increased at each time point, and 89.8% of patients had at least one PT visit in the 6 months following ACL reconstruction. A total of 513 patients had subsequent ACL surgery, for a composite subsequent ACL surgery rate of 4.6%. Age under 19 years carried a higher risk of subsequent ACL surgery (8.3% vs. 3.8%, RR = 2.21, 95% CI 1.88 - 2.61, p < 0.0001). Women had a slightly higher rate of subsequent ACL surgery than men (5.1% vs. 4.2%, RR = 1.22, 95% CI 1.03 - 1.44, p = 0.02). Participation in any PT significantly decreased the risk of subsequent ACL surgery (3.9% vs. 10.6%, RR = 0.36, 95% CI = 0.30 - 0.44, p < 0.0001). Subsequent surgery rates were not affected by the number of PT visits if less than 30 visits were utilized. However, patients utilizing greater than 30 visits had a higher risk of subsequent ACL surgery (16.5% vs. 2.3%, RR = 7.15, 95% CI = 5.68 - 9.01, p < 0.0001). The total cost associated with ACL reconstruction within 24 months was $19,191 per patient. The weighted per-person average reimbursement (PPAR) for PT was $1,879, or 9.8% of the total cost of care.Conclusion:Physical therapy utilization is currently high after ACL reconstruction (89.8%). Participation in PT reduces the incidence of subsequent ACL surgery (ipsilateral or contralateral) nearly three-fold (3.9% vs. 10.6%), at a cost of only $1,879 per patient (< 10% of total cost of care). PT after ACL reconstruction therefore offers significant value, particularly in young (< 19 years) athletes who have a higher risk of subsequent injury. However, excessive PT use after ACLR (> 30 visits) may be an indicator of patients with a sustained risk of re-injury.