Associations Between Treatment Processes, Patient Characteristics, and Outcomes in Outpatient Physical Therapy Practice

Abstract 

Deutscher D, Horn SD, Dickstein R, Hart DL, Smout RJ, Gutvirtz M, Ariel I. Associations between treatment processes, patient characteristics, and outcomes in outpatient physical therapy practice.

Objective

To identify how treatment processes are related to functional outcomes for patients seeking treatment for musculoskeletal impairments while controlling for demographic and health characteristics at intake.

Design

Prospective, observational cohort study. Treatment processes were not altered. Data were collected continuously from June 2005 to January 2008. Descriptive statistics were applied to compare patient characteristics, interventions, and outcomes between impairment categories. Ordinary least-squares multiple regressions were used to examine associations between patient characteristics at intake, treatment processes, and functional outcomes.

Setting

Fifty-four community-based outpatient physical therapy clinics of Maccabi Healthcare Services, a public health plan in Israel.

Participants

A consecutive sample of 22,019 adult patients (mean age 51.2y, standard deviation=15.7, range 18–96, 58% women) seeking treatment due to lumbar spine, knee, cervical spine, or shoulder impairments with functional measurements at intake and discharge.

Interventions

Not applicable.

Main Outcome Measure

Functional status at discharge.

Results

Explanatory power ranged from 30% to 39%. Better outcomes were associated with patient compliance with self-exercise and therapy attendance, application of therapeutic exercise and manual therapy, and completion of 3 or more functional surveys during the episode of care. Worse outcomes were associated with women, electrotherapy for pain management, and therapeutic ultrasound for shoulder impairments. Mixed results were found for group exercise programs.

Conclusions

The study of associations between treatment processes, patient characteristics, and outcomes helps to describe practice and can be used to suggest ways to improve outcomes in outpatient physical therapy practice.

Key Words: Database, Evidence-based practice, Musculoskeletal system, Rehabilitation, Therapy, physical (specialty)

List of Abbreviations: APTA, American Physical Therapy Association, BMI, body mass index, CAT, computerized adaptive testing, EHR, electronic health record, FS, functional status, ICD-9, International Classification of Diseases, 9th Revision, IRT, item response theory, PT, physical therapy