Abstract
Objective
To update a previous review on whether additional physical therapy services reduce
length of stay, improve health outcomes, and are safe and cost-effective for patients
with acute or subacute conditions.
Data Sources
Electronic database (AMED, CINAHL, EMBASE, MEDLINE, Physiotherapy Evidence Database
[PEDro], PubMed) searches were updated from 2010 through June 2017.
Study Selection
Randomized controlled trials evaluating additional physical therapy services on patient
health outcomes, length of stay, or cost-effectiveness were eligible. Searching identified
1524 potentially relevant articles, of which 11 new articles from 8 new randomized
controlled trials with 1563 participants were selected. In total, 24 randomized controlled
trials with 3262 participants are included in this review.
Data Extraction
Data were extracted using the form used in the original systematic review. Methodological
quality was assessed using the PEDro scale, and the Grading of Recommendation Assessment,
Development, and Evaluation approach was applied to each meta-analysis.
Data synthesis
Postintervention data were pooled with an inverse variance, random-effects model to
calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs).
There is moderate-quality evidence that additional physical therapy services reduced
length of stay by 3 days in subacute settings (mean difference [MD]=–2.8; 95% CI,
–4.6 to –0.9; I2=0%), and low-quality evidence that it reduced length of stay by 0.6 days in acute
settings (MD=–0.6; 95% CI, –1.1 to 0.0; I2=65%). Additional physical therapy led to small improvements in self-care (SMD=.11;
95% CI, .03–.19; I2=0%), activities of daily living (SMD=.13; 95% CI, .02–.25; I2=15%), and health-related quality of life (SMD=.12; 95% CI, .03–.21; I2=0%), with no increases in adverse events. There was no significant change in walking
ability. One trial reported that additional physical therapy was likely to be cost-effective
in subacute rehabilitation.
Conclusions
Additional physical therapy services improve patient activity and participation outcomes
while reducing hospital length of stay for adults. These benefits are likely safe,
and there is preliminary evidence to suggest they may be cost-effective.
Keywords
List of abbreviations:
CI (confidence interval), GRADE (Grading of Recommendation Assessment, Development, and Evaluation), MD (mean difference), PEDro (Physiotherapy Evidence Database), SMD (standardized mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 07, 2018
Footnotes
Clinical Trial Registration No.: CRD42017064827 (registered with PROSPERO database of systematic reviews).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
