Delivery of Physical Therapy in the Acute Care Setting: A Population-Based Study

Freburger, Janet K.; Shank, Kendra Heatwole; Knauer, Stefanie R.; Montmeny, Richard M.

doi:10.2522/ptj.20100337

Cited by 24 publications

(23 citation statements)

References 50 publications

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“…Yet, U.S. hospitals do not prioritize functional recovery by providing comprehensive rehabilitation services in acute settings. 3–5 Physical and Occupational Therapists have a vital role in the interdisciplinary team that assists patients in their transition from acute to post-acute to community settings, and rehabilitation services delivered during acute stays play an important role in improving function in patients with stroke. 6…”

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confidence: 99%

Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

Kumar

Resnik

Karmarkar

et al. 2019

Archives of Physical Medicine and Rehabilitation

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Objective: To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke. Design: Secondary analysis of inpatient Medicare claims data using Standard Analytical File. Setting: Acute Hospitals across the U.S. Participants: From nationwide data, 88,826 Medicare fee-for-service beneficiaries aged 66 or older hospitalized for ischemic stroke between January-November, 2010. Interventions: Hospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high. Main Outcome Measures: All-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics. Results: In fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission; low PT: 30 minutes (OR= 0.90; 95% CI; 0.83–0.96), medium PT: >30 to ≤75 minutes (OR=0.89; 95% CI; 0.82–0.95) and high PT: >75 minutes (OR=0.86; 95%CI; 0.80–0.93). Conclusion: Hospital-based physical therapy services was associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.

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confidence: 99%

Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

Kumar

Resnik

Karmarkar

et al. 2019

Archives of Physical Medicine and Rehabilitation

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“…In this study, 28.2% (134 of 475) of the total patient admissions received a doctor's order for physical therapy. Although this referral rate is similar to the 22.4% of patient admissions (all diagnoses) to acute-care hospitals in North Carolina that received physical therapy, 37 it seems low given the prevalence of impairments in PLWHA. [8][9][10] In a sample of persons living with HIV in British Columbia, 8 91.5% reported at least 1 impairment, 80.6% reported at least 1 activity limitation, and 93.2% reported at least some level of participation restriction.…”

Section: Discussionmentioning

confidence: 69%

“…Longer length of stay was also found to be associated with receipt of physical therapy in patients with stroke and joint replacement in acute-care hospitals in North Carolina. 37…”

Section: Discussionmentioning

confidence: 99%

The Acute Care Physical Therapy HIV/AIDS Patient Population

Kinirons

2013

J Int Assoc Provid AIDS Care

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This study was based on an analysis of an existing database compiled from 475 medical records of people living with HIV/AIDS admitted to an acute-care hospital in New York City in 2004. The characteristics of patients with HIV infection that received physical therapy were determined. Differences between patients with HIV infection that did and did not receive physical therapy, as well as predictors of receipt of physical therapy, were identified. The physical therapy subgroup (n = 69) had a mean age of 48.3 years, consisted of more men than women, and was predominately black, with public health insurance. Admissions were commonly due to non-AIDS-defining illness as the primary diagnoses, accompanied by several comorbidities. Admissions often presented with functional deficits, incurred a prolonged length of stay, and required assistance at discharge. Differences existed between the physical therapy subgroup and the non-physical therapy subgroup (n = 406). Predictors of receipt of physical therapy were functional status on admission and length of stay.

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“…In an effort to mirror current clinical conditions, no attempt is made to interfere with the care received from the doctor or independently sought by the participants in this group. While there is debate about what constitutes usual medical care at later stage post TKR, the definition of usual medical care was informed from extensive discussions with patients, physicians, rehabilitation clinicians, and a literature review which all indicate that at two months post TKR the majority of patients no longer undergo rehab despite suboptimal improvement [ 24 – 29 ]. Because the study only recruits subjects who had a TKR at least two months ago, it is unlikely that they are still undergoing rehabilitation.…”

Section: Methodsmentioning

confidence: 99%

A randomized trial to compare exercise treatment methods for patients after total knee replacement: protocol paper

Piva

Moore

Schneider

et al. 2015

BMC Musculoskelet Disord

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BackgroundAlthough the outcome of total knee replacement (TKR) is favorable, surgery alone fails to resolve the functional limitations and physical inactivity that existed prior to surgery. Exercise is likely the only intervention capable of improving these persistent limitations, but exercises have to be performed with intensity sufficient to promote significant changes, at levels that cannot be tolerated until later stages post TKR. The current evidence is limited regarding the effectiveness of exercise at a later stage post TKR. To that end, this study aims to compare the outcomes of physical function and physical activity between 3 treatment groups: clinic-based individual outpatient rehabilitative exercise during 12 weeks, community-based group exercise classes during 12 weeks, and usual medical care (wait-listed control group). The secondary aim is to identify baseline predictors of functional recovery for the exercise groups.Methods/DesignThis protocol paper describes a comparative effectiveness study, designed as a 3-group single-blind randomized clinical trial. Two hundred and forty older adults who underwent TKR at least 2 months prior will be randomized into one of the three treatment approaches. Data will be collected at baseline, 3 months, and 6 months. The wait-listed control group will be randomized to one of the 2 exercise groups after 6 months of study participation, and will complete a 9-month follow-up. Primary outcome is physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index Physical Function Subscale (WOMAC-PF). Physical function is also measured by performance-based tests. Secondary outcomes include performance-based tests and physical activity assessed by a patient-reported survey and accelerometry-based physical activity monitors. Exploratory outcomes include adherence, co-interventions, attrition, and adverse events including number of falls. Linear mixed models will be fitted to compare the changes in outcome across groups. Logistic regression will identify patient characteristics that predict functional recovery in the exercise groups. Instrumental variable methods will be used to estimate the efficacy of the interventions in the presence of non-compliance.DiscussionResults will inform recommendations on exercise programs to improve physical function and activity for patients at the later stage post TKR and help tailor interventions according with patients’ characteristics.Trial registrationClinicalTrials.gov Identifier NCT02237911.

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Delivery of Physical Therapy in the Acute Care Setting: A Population-Based Study

Abstract: The use and intensity of physical therapy for stroke and joint replacement in acute care hospitals in North Carolina vary by clinical and nonclinical factors. Reasons behind the association of hospital characteristics and physical therapy use need further investigation.

Cited by 24 publications

References 50 publications

Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

The Acute Care Physical Therapy HIV/AIDS Patient Population

A randomized trial to compare exercise treatment methods for patients after total knee replacement: protocol paper

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