Abstract
Objective
To investigate whether a direct measure of need for physical therapy (PT), mobility
status, was associated with acute care PT utilization and whether this relationship
differs across sociodemographic factors and insurance type.
Design
In a secondary analysis of electronic health records data, we estimated logistic regression
models to determine whether mobility status was associated with acute care PT utilization.
Interactions between mobility and both sociodemographic factors (sex, age, significant
other, minority status) and insurance type were included to investigate whether the
relationship between mobility and PT utilization varied across patient characteristics.
Setting
Five regional hospitals from 1 health system.
Participants
A total of 60,459 adults admitted between 2014 and 2018 who received a PT evaluation.
Interventions
None.
Main Outcome Measures
Received acute care PT; Activity Measure for Post-Acute Care “6-Clicks” measure of
mobility.
Results
Half of patients who received a PT evaluation received subsequent treatment. Patients
with mobility limitations were more likely to receive PT. Interaction terms indicated
that among patients with mobility limitations, those who (1) were younger, (2) had
significant others, and (3) had private insurance (vs public) were more likely to
receive PT. Among patients with greater mobility status, older patients and those
without a significant other were more likely to receive PT.
Conclusions
The relationship between acute care PT need and utilization differed across sociodemographic
factors and insurance type. We offer potential explanations for these findings to
guide efforts targeting equitable distribution of beneficial PT services.
Keywords
List of abbreviations:
AM-PAC (Activity Measure for Post-Acute Care), ICC (intraclass correlation coefficient), OR (odds ratio), PT (physical therapy), VA (Veterans Affairs)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence and outcomes of low mobility in hospitalized older patients.J Am Geriatr Soc. 2004; 52: 1263-1270
- Physical therapists’ management of patients in the acute care setting: an observational study.Phys Ther. 2009; 89: 1158-1181
- A qualitative study of clinical decision making in recommending discharge placement from the acute care setting.Phys Ther. 2003; 83: 224-236
- AM-PAC “6-Clicks” functional assessment scores predict acute care hospital discharge destination.Phys Ther. 2014; 94: 1252-1261
- Association of rehabilitation intensity for stroke and risk of hospital readmission.Phys Ther. 2015; 95: 1660-1667
- Use of hospital-based rehabilitation services and hospital readmission following ischemic stroke in the United States.Arch Phys Med Rehabil. 2019; 100: 1218-1225
- Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis.Physiotherapy. 2018; 104: 25-35
- Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and subacute conditions: an updated systematic review and meta-analysis.Arch Phys Med Rehabil. 2018; 99: 2299-2312
- The relationship between duration of physical therapy services in the acute care setting and change in functional status in patients with lower-extremity orthopedic problems.Phys Ther. 1998; 78: 19-24
- Variation in acute care rehabilitation and 30-day hospital readmission or mortality in adult patients with pneumonia.JAMA Netw Open. 2020; 3e2012979
- Association between use of rehabilitation in the acute care hospital and hospital readmission or mortality in patients with stroke.Arch Phys Med Rehabil. 2021; 102: 1700-1707
- Improving access to care.(editor)in: Kominski GF Changing the U.S. health care system: key issues in health services policy and management. Jossey-Bass, San Francisco, CA2014: 33-69
- Delivery of physical therapy in the acute care setting: a population-based study.Phys Ther. 2012; 92: 251-265
- Physical and occupational therapy from the acute to community setting after stroke: predictors of use, continuity of care, and timeliness of care.Arch Phys Med Rehabil. 2018; 99: 1077-1089
- Patterns of utilization and effects of hospital-specific factors on physical, occupational, and speech therapy for critically ill patients with acute respiratory failure in the USA: results of a 5-year sample.Crit Care. 2019; 23: 175
- Variation in hospital-based rehabilitation services among patients with ischemic stroke in the United States.Physical Therapy. 2019; 99: 494-506
- The relationship between fall risk and hospital-based therapy utilization is moderated by demographic characteristics and insurance type.Arch Phys Med Rehabil. 2021; 102: 1124-1133
- Examining the association between comorbidity indexes and functional status in hospitalized Medicare fee-for-service beneficiaries.Phys Ther. 2016; 96: 232-240
- Activity outcome measurement for postacute care.Med Care. 2004; : I49-I61
- Validity of the AM-PAC “6-Clicks” inpatient daily activity and basic mobility short forms.Phys Ther. 2014; 94: 379-391
- Interrater reliability of AM-PAC “6-Clicks” basic mobility and daily activity short forms.Phys Ther. 2015; 95: 758-766
Centers for Medicare and Medicaid Services. Design and development of the Diagnosis Related Group (DRG). Available at: https://www.cms.gov/icd10m/version37-fullcode-cms/fullcode_cms/Design_and_development_of_the_Diagnosis_Related_Group_(DRGs).pdf. Accessed June 23, 2022.
- Identifying increased risk of readmission and in-hospital mortality using hospital administrative data.Med Care. 2017; 55: 698-705
- An introduction to multilevel modeling for social and personality psychology.Social and Personality Psychology Compass. 2008; 2: 842-860
- Probing interactions in fixed and multilevel regression: inferential and graphical techniques.Multivariate Behav Res. 2005; 40: 373-400
- The Johnson-Neyman technique, its theory and application.Psychometrika. 1950; 15: 349-367
- Physical therapy in the COVID-19 pandemic: forging a paradigm shift for rehabilitation in acute care.Phys Ther. 2020; 100: 1265-1267
- Ancillary service utilization in academic health center hospitals: use of physical therapy for the treatment of stroke and hip arthroplasty.JCOM (Wayne, Pa). 2000; 7: 20-30
- Prevalence of cognitive impairment: results from the MRC trial of assessment and management of older people in the community.Age Ageing. 2005; 34: 242-248
- Variation in inpatient rehabilitation utilization after hospitalization for burn injury in the United States.J Burn Care Res. 2015; 36: 613-618
- Race and insurance disparities in discharge to rehabilitation for patients with traumatic brain injury.J Neurotrauma. 2013; 30: 2057-2065
- Racial and insurance disparities in the utilization of supportive care after inpatient admission for proximal humerus fracture.Shoulder Elbow. 2014; 6: 283-290
- Should health studies measure wealth? A systematic review.Am J Prev Med. 2007; 33: 250-264
- Disparities in outcomes among patients with stroke associated with insurance status.Stroke. 2007; 38: 1010-1016
- Use of a standardized assessment to predict rehabilitation care after acute stroke.Arch Phys Med Rehabil. 2015; 96: 210-217
Article info
Publication history
Published online: January 07, 2022
Accepted:
December 16,
2021
Received in revised form:
November 3,
2021
Received:
April 12,
2021
Footnotes
This work was not supported by the Veterans Health Administration, and the views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense, Department of Veterans Affairs, or the United States government.
Disclosures: none
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine.
