TY - JOUR
T1 - Use and Perceived Need of Physical Therapy Following Severe Lower-Extremity Trauma
AU - Castillo, Renan C.
AU - MacKenzie, Ellen J.
AU - Webb, Lawrence X.
AU - Bosse, Michael J.
AU - Avery, Jennifer
N1 - Funding Information:
Supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (grant no. RO1-AR42659).
PY - 2005/9
Y1 - 2005/9
N2 - Objective: To examine the utilization of physical therapy (PT), the level of perceived need for PT, and the proportion of patients with perceived need receiving no PT in a cohort of severe lower-extremity trauma patients treated at level I trauma centers. Design: Longitudinal, observational study of severe lower-extremity trauma patients. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission, and at 3, 6, 12, and 24 months postdischarge. Setting: Eight level I trauma centers. Participants: Of 601 patients age 18 to 65 enrolled in the parent study over a 40-month period, 550 with unilateral study injuries and followed up at least once over the 2-year study period were included in this analysis. Interventions: Not applicable. Main Outcome Measure: Patient reported number of PT visits at each follow-up time point, inpatient rehabilitation admissions, and their perceived need for PT. Perceived need for PT was also assessed by an orthopedic surgeon and a physical therapist. Overall, concordance between physician, physical therapist, and patient's assessment of need for PT was low, with κ statistics ranging between .12 and .41. Results: Amputation and reconstruction patients used comparable amounts of PT services. Regardless of the criteria used to evaluate need, the proportion of patients with perceived need for PT receiving no PT services increased over the course of the follow-up, from 23% to 46% at first follow-up to over 68% by 2 years. Factors associated with increased risk for having a perceived need but receiving no therapy included lack of private insurance, pain, lower levels of education, lower fitness levels at time of injury, being a smoker, and having severe muscle injury. Conclusions: The results suggest a significant proportion of patients in the severe lower-extremity trauma population have perceived need for PT, yet receive no PT services.
AB - Objective: To examine the utilization of physical therapy (PT), the level of perceived need for PT, and the proportion of patients with perceived need receiving no PT in a cohort of severe lower-extremity trauma patients treated at level I trauma centers. Design: Longitudinal, observational study of severe lower-extremity trauma patients. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission, and at 3, 6, 12, and 24 months postdischarge. Setting: Eight level I trauma centers. Participants: Of 601 patients age 18 to 65 enrolled in the parent study over a 40-month period, 550 with unilateral study injuries and followed up at least once over the 2-year study period were included in this analysis. Interventions: Not applicable. Main Outcome Measure: Patient reported number of PT visits at each follow-up time point, inpatient rehabilitation admissions, and their perceived need for PT. Perceived need for PT was also assessed by an orthopedic surgeon and a physical therapist. Overall, concordance between physician, physical therapist, and patient's assessment of need for PT was low, with κ statistics ranging between .12 and .41. Results: Amputation and reconstruction patients used comparable amounts of PT services. Regardless of the criteria used to evaluate need, the proportion of patients with perceived need for PT receiving no PT services increased over the course of the follow-up, from 23% to 46% at first follow-up to over 68% by 2 years. Factors associated with increased risk for having a perceived need but receiving no therapy included lack of private insurance, pain, lower levels of education, lower fitness levels at time of injury, being a smoker, and having severe muscle injury. Conclusions: The results suggest a significant proportion of patients in the severe lower-extremity trauma population have perceived need for PT, yet receive no PT services.
KW - Leg
KW - Physical therapy techniques
KW - Rehabilitation
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U2 - 10.1016/j.apmr.2005.03.005
DO - 10.1016/j.apmr.2005.03.005
M3 - Article
C2 - 16181933
AN - SCOPUS:25144517707
SN - 0003-9993
VL - 86
SP - 1722
EP - 1728
JO - Archives of physical medicine and rehabilitation
JF - Archives of physical medicine and rehabilitation
IS - 9
ER -