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Mobility Status and Acute Care Physical Therapy Utilization: The Moderating Roles of Age, Significant Others, and Insurance Type

Published:January 07, 2022DOI:https://doi.org/10.1016/j.apmr.2021.12.013

      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)
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      References

        • Brown CJ
        • Friedkin RJ
        • Inouye SK.
        Prevalence and outcomes of low mobility in hospitalized older patients.
        J Am Geriatr Soc. 2004; 52: 1263-1270
        • Jette DU
        • Brown R
        • Collette N
        • Friant W
        • Graves L.
        Physical therapists’ management of patients in the acute care setting: an observational study.
        Phys Ther. 2009; 89: 1158-1181
        • Jette DU
        • Grover L
        • Keck CP.
        A qualitative study of clinical decision making in recommending discharge placement from the acute care setting.
        Phys Ther. 2003; 83: 224-236
        • Jette DU
        • Stilphen M
        • Ranganathan VK
        • Passek SD
        • Frost FS
        • Jette AM.
        AM-PAC “6-Clicks” functional assessment scores predict acute care hospital discharge destination.
        Phys Ther. 2014; 94: 1252-1261
        • Andrews AW
        • Li D
        • Freburger JK.
        Association of rehabilitation intensity for stroke and risk of hospital readmission.
        Phys Ther. 2015; 95: 1660-1667
        • Kumar A
        • Resnik L
        • Karmarkar A
        • et al.
        Use of hospital-based rehabilitation services and hospital readmission following ischemic stroke in the United States.
        Arch Phys Med Rehabil. 2019; 100: 1218-1225
        • Henderson KG
        • Wallis JA
        • Snowdon DA.
        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
        • Peiris CL
        • Shields N
        • Brusco NK
        • Watts JJ
        • Taylor NF.
        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
        • Roach KE
        • Ally D
        • Finnerty B
        • et al.
        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
        • Freburger JK
        • Chou A
        • Euloth T
        • Matcho B.
        Variation in acute care rehabilitation and 30-day hospital readmission or mortality in adult patients with pneumonia.
        JAMA Netw Open. 2020; 3e2012979
        • Freburger JK
        • Chou A
        • Euloth T
        • Matcho B
        • Bilderback A.
        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
        • Anderson RM
        • Davidson PL
        • Baumeister SE.
        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
        • Freburger JK
        • Heatwole Shank K
        • Knauer SR
        • Montmeny RM
        Delivery of physical therapy in the acute care setting: a population-based study.
        Phys Ther. 2012; 92: 251-265
        • Freburger JK
        • Li D
        • Johnson AM
        • Fraher EP.
        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
        • Prohaska CC
        • Sottile PD
        • Nordon-Craft A
        • et al.
        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
        • Kumar A
        • Adhikari D
        • Karmarkar A
        • et al.
        Variation in hospital-based rehabilitation services among patients with ischemic stroke in the United States.
        Physical Therapy. 2019; 99: 494-506
        • Kinney AR
        • Graham JE
        • Sharp J
        • Hoffman A
        • Malcolm MP.
        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
        • Kumar A
        • Graham JE
        • Resnik L
        • et al.
        Examining the association between comorbidity indexes and functional status in hospitalized Medicare fee-for-service beneficiaries.
        Phys Ther. 2016; 96: 232-240
        • Haley SM
        • Coster WJ
        • Andres PL
        • et al.
        Activity outcome measurement for postacute care.
        Med Care. 2004; : I49-I61
        • Jette DU
        • Stilphen M
        • Ranganathan VK
        • Passek SD
        • Frost FS
        • Jette AM.
        Validity of the AM-PAC “6-Clicks” inpatient daily activity and basic mobility short forms.
        Phys Ther. 2014; 94: 379-391
        • Jette DU
        • Stilphen M
        • Ranganathan VK
        • Passek S
        • Frost FS
        • Jette AM.
        Interrater reliability of AM-PAC “6-Clicks” basic mobility and daily activity short forms.
        Phys Ther. 2015; 95: 758-766
      1. 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.

        • Moore BJ
        • White S
        • Washington R
        • Coenen N
        • Elixhauser A.
        Identifying increased risk of readmission and in-hospital mortality using hospital administrative data.
        Med Care. 2017; 55: 698-705
        • Nezlek JB.
        An introduction to multilevel modeling for social and personality psychology.
        Social and Personality Psychology Compass. 2008; 2: 842-860
        • Bauer DJ
        • Curran PJ.
        Probing interactions in fixed and multilevel regression: inferential and graphical techniques.
        Multivariate Behav Res. 2005; 40: 373-400
        • Johnson PO
        • Fay LC.
        The Johnson-Neyman technique, its theory and application.
        Psychometrika. 1950; 15: 349-367
        • Keeney T.
        Physical therapy in the COVID-19 pandemic: forging a paradigm shift for rehabilitation in acute care.
        Phys Ther. 2020; 100: 1265-1267
        • Freburger JK
        • Hurley RE.
        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
        • Rait G
        • Fletcher A
        • Smeeth L
        • et al.
        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
        • Greene NH
        • Pham TN
        • Esselman PC
        • Rivara FP.
        Variation in inpatient rehabilitation utilization after hospitalization for burn injury in the United States.
        J Burn Care Res. 2015; 36: 613-618
        • Asemota AO
        • George BP
        • Cumpsty-Fowler CJ
        • Haider AH
        • Schneider EB.
        Race and insurance disparities in discharge to rehabilitation for patients with traumatic brain injury.
        J Neurotrauma. 2013; 30: 2057-2065
        • Menendez ME
        • Ring D.
        Racial and insurance disparities in the utilization of supportive care after inpatient admission for proximal humerus fracture.
        Shoulder Elbow. 2014; 6: 283-290
        • Pollack CE
        • Chideya S
        • Cubbin C
        • Williams B
        • Dekker M
        • Braveman P.
        Should health studies measure wealth? A systematic review.
        Am J Prev Med. 2007; 33: 250-264
        • Shen JJ
        • Washington EL.
        Disparities in outcomes among patients with stroke associated with insurance status.
        Stroke. 2007; 38: 1010-1016
        • Stein J
        • Bettger JP
        • Sicklick A
        • Hedeman R
        • Magdon-Ismail Z
        • Schwamm LH.
        Use of a standardized assessment to predict rehabilitation care after acute stroke.
        Arch Phys Med Rehabil. 2015; 96: 210-217