Use and Perceived Need of Physical Therapy Following Severe Lower-Extremity Trauma

Renan Carlos Castillo, Ellen J Mackenzie, Lawrence X. Webb, Michael J. Bosse, Jennifer Avery

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1722-1728
Number of pages7
JournalArchives of Physical Medicine and Rehabilitation
Volume86
Issue number9
DOIs
StatePublished - Sep 2005

Fingerprint

Lower Extremity
Wounds and Injuries
Therapeutics
Physical Therapists
Trauma Centers
Needs Assessment
Insurance
Amputation
Observational Studies
Longitudinal Studies
Inpatients
Rehabilitation
Physicians
Education
Pain
Muscles

Keywords

  • Leg
  • Physical therapy techniques
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation

Cite this

Use and Perceived Need of Physical Therapy Following Severe Lower-Extremity Trauma. / Castillo, Renan Carlos; Mackenzie, Ellen J; Webb, Lawrence X.; Bosse, Michael J.; Avery, Jennifer.

In: Archives of Physical Medicine and Rehabilitation, Vol. 86, No. 9, 09.2005, p. 1722-1728.

Research output: Contribution to journalArticle

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abstract = "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.",
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