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Chau A, Kim DH, Sison SDM, Shi SM. Mobility Device Use and Frailty Progression in Community-Dwelling Older Adults With Mobility Limitations. J Aging Health 2024:8982643241242927. [PMID: 38565230 PMCID: PMC11445395 DOI: 10.1177/08982643241242927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective: Examine the association between mobility device use and changes in a frailty index (FI) over one year in community-dwelling older adults with mobility limitations. Methods: Analyses utilized 2015-2016 data from the National Health and Aging Trends Study community-dwelling older adults (n = 3934). We calculated a validated 40-item deficit accumulation frailty index (FI) in 2015 and 2016 and compared one year change in FI in older adults with/without canes or walkers using multivariable logistic regression. Analyses were repeated with stratification by baseline frailty. Results: Device use was not associated with worsening frailty in the overall cohort, but was associated with worsening frailty in non-frail individuals when stratified by baseline frailty. Discussion: Device use does not worsen frailty in individuals who are frail at baseline. Device users who were not frail at baseline experienced worsening frailty suggesting additional contributing factors to their frailty aside from mobility limitations.
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Affiliation(s)
- Amanda Chau
- University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
| | - Dae H. Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie Denise M. Sison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sandra M. Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Moyo P, Merlin JS, George M, Shireman TI, Marshall BD. Association of Opioid Use Disorder Diagnosis With Use of Physical Therapy and Chiropractic Care Among Chronic Low Back Pain Patients: A Group-Based Trajectory Analysis. THE JOURNAL OF PAIN 2024; 25:742-754. [PMID: 37820847 PMCID: PMC10922407 DOI: 10.1016/j.jpain.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
Nonpharmacologic approaches are recommended as first-line treatment for chronic pain, and their importance is heightened among individuals with co-occurring opioid use disorder (OUD), in whom opioid therapies may be particularly detrimental. Our objectives were to assess the receipt and trajectories of nonpharmacologic pain treatment and determine the association of OUD diagnosis with these trajectories. This retrospective cohort study used Medicare claims data from 2016 to 2018 and applied group-based trajectory models to identify distinct patterns of physical therapy (PT) or chiropractic care treatment over the 12 months following a new episode of chronic low back pain. We used logistic regression models to estimate the association of co-occurring OUD with group membership in PT and chiropractic trajectories. Our sample comprised 607,729 beneficiaries at least 18 years of age, of whom 11.4% had a diagnosis of OUD. The 12-month prevalence of PT and chiropractic treatment receipt was 24.7% and 27.1%, respectively, and lower among Medicare beneficiaries with co-occurring OUD (PT: 14.6%; chiropractic: 6.8%). The final models identified 3 distinct trajectories each for PT (no/little use [76.6% of sample], delayed and increasing use [8.2%], and early and declining use [15.2%]); and chiropractic (no/little use [75.0% of sample], early and declining use [17.3%], and early and sustained use [7.7%]). People with OUD were more likely to belong in trajectories with little/no PT or chiropractic care as compared to other trajectories. The findings indicate that people with co-occurring chronic pain and OUD often do not receive early or any nonpharmacologic pain therapies as recommended by practice guidelines. PERSPECTIVE: PT and chiropractic care use were low overall and even lower among Medicare beneficiaries with co-occurring OUD compared with those without OUD. As updated guidelines on pain management are promulgated, targeted interventions (eg, insurance policy, provider, and patient education) are needed to ensure equitable access to guideline-recommended pain therapies.
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Affiliation(s)
- Patience Moyo
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Jessica S. Merlin
- Challenges in Managing and Preventing Pain Clinical Research Center, Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Miriam George
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Theresa I. Shireman
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA
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McCormick S, Jarvis JM, Terhorst L, Richardson A, Kaseman L, Kesbhat A, Yepuri Y, Beyene E, VonVille H, Bendixen R, Treble-Barna A. Patient-report and caregiver-report measures of rehabilitation service use following acquired brain injury: a systematic review. BMJ Open 2024; 14:e076537. [PMID: 38382949 PMCID: PMC10882343 DOI: 10.1136/bmjopen-2023-076537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To review patient-report/caregiver-report measures of rehabilitation service use following acquired brain injury (ABI). DATA SOURCES Medline, APA PsycINFO, Embase and CINAHL were searched on November 2021 and November 2022. Authors were contacted if measures were not included in manuscripts/appendices. STUDY SELECTION Included articles were empirical research or a research protocol, available in English and described measures of patient report/caregiver report of rehabilitation service use post-ABI via quantitative or qualitative methods. Two reviewers independently screened 5290 records using DistillerSR. Discrepancies were resolved by team adjudication. DATA EXTRACTION Data extraction was piloted with high levels of agreement (k=.94). Data were extracted by a single member with team meetings to seek guidance as needed. Data included administration characteristics (reporter, mode of administration, recall period), psychometric evidence and dimensions assessed (types of services, setting, frequency, duration, intensity, qualitative aspects). DATA SYNTHESIS One hundred and fifty-two measures were identified from 85 quantitative, 56 qualitative and 3 psychometric studies. Psychometric properties were reported for four measures, all of which focused on satisfaction. Most measures inquired about the type of rehabilitation services used, with more than half assessing functional (eg, physical therapy) and behavioural health rehabilitation services, but fewer than half assessing community and academic reintegration (eg, special education, vocational rehabilitation) or cognitive (eg, neuropsychology) services. Fewer than half assessed qualitative aspects (eg, satisfaction). Recall periods ranged from 1 month to 'since the ABI event' or focused on current use. Of measures that could be accessed (n=71), many included a limited checklist of types of services used. Very few measures assessed setting, frequency, intensity or duration. CONCLUSIONS Despite widespread interest, the vast majority of measures have not been validated and are limited in scope. Use of gold-standard psychometric methods to develop and validate a comprehensive patient-report/caregiver-report measure of rehabilitation service use would have wide-ranging implications for improving rehabilitation research in ABI.
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Affiliation(s)
- Sophie McCormick
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica M Jarvis
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, SHRS Data Center, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amanda Richardson
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Kaseman
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aboli Kesbhat
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Yamini Yepuri
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Beyene
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Helena VonVille
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roxanna Bendixen
- Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amery Treble-Barna
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Rusinga A, Setchell J, Jang S, Costa N. Exploring the Systemic Structures That Affect Access to Physical Therapist Services for Non-Indigenous Black People in Australia. Phys Ther 2024; 104:pzad139. [PMID: 37839057 DOI: 10.1093/ptj/pzad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/14/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Physical therapy is generally considered to be a white profession in Western nations. Australia's increasingly diverse population, driven largely by growth in immigration, invites Australian health systems to be responsive to factors that may impact on non-white Australian population's access to health care. Here, the authors sought to explore non-Indigenous Black people's perspectives of physical therapy in Australia. METHODS Eligible participants (n = 12) took part in semistructured, in-depth interviews and were prompted to discuss their experiences and perceptions of physical therapy. Interview data were analyzed using critical discourse analysis, underpinned by critical race theory. RESULTS Participants were on average 29.4 years (SD = 12.9) from diverse cultural and linguistic backgrounds. Participants described mostly positive experiences with physical therapists, but they noted that it was not widely accessed by their communities, with 2 key discourses underpinning these discussions. Discourse 1, "physiotherapy is a solution for white people," established physical therapy as primarily accessed by and welcoming of white people. "Whiteness" and the perpetuation of Western norms in physical therapy resulted in little consideration of other cultural practices. Participants' discussions also pointed to the intersections of systemic racism and social inequities such as low income and language barriers, impacting Black people's engagement with physical therapy. Discourse 2, "physiotherapists are white," was mostly concerned with how the perceived "whiteness" of professionals and lack of Black physical therapists impacts cultural safety and comfort when accessing physical therapy. CONCLUSION Our results suggest that Westernization and whiteness persist among discourses surrounding physical therapy. Such discourses are likely to inform Black people's perceptions and experiences of physical therapy. Our analyses suggest avenues to enhance the cultural diversity of the profession and improve physical therapy accessibility for Black people in Australia by providing culturally appropriate material, including critical reflexivity, epistemic and cultural humility in the curricula, recruiting staff from diverse backgrounds, and providing outreach services to underserved populations. IMPACT These findings highlight the need for increased cultural safety and diversity within the physical therapy profession to improve equity.
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Affiliation(s)
- Adelaide Rusinga
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Jenny Setchell
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Sarah Jang
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Nathalia Costa
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
- The University of Sydney, Sydney School of Health Sciences, Sydney, New South Wales, Australia
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Li X, Shi Y, Zhao D, Jin K, Zhu J, Wang Y. Unmet needs for rehabilitation service of middle-aged and older adult residents in Chengdu, Sichuan, China: A cross-sectional study. Sci Rep 2023; 13:11989. [PMID: 37491428 PMCID: PMC10368734 DOI: 10.1038/s41598-023-38960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
To investigate the unmet needs for rehabilitation services among middle-aged and older adults in Chengdu, Sichuan, China, and identify the associated factors. This cross-sectional study was conducted on middle-aged and older adults in Chengdu, Sichuan, China, between 2015 and 2016. The questionnaire included demographic data and questions about rehabilitation needs. Multivariable logistic regression analysis was used to identify the associated factors of unmet needs for rehabilitation services. Among 663 participants, 91.70% needed medical rehabilitation (608/663), 26.55% of who need auxiliary equipment (176/663), 77.07% of who need daily care and social participation (511/663), and 79.34% of who need recreational therapy activities (526/663), while < 30% required auxiliary equipment. Multivariate logistic regression analysis showed that residents who were married, had annual income < CNY 80,000, had no medical insurance, had three or more health problems, were aged ≥ 60, and the disability status were independently associated with unmet needs for rehabilitation services (all P < 0.05). Marital status, annual income, medical insurance, health problems, and disability might be factors independently associated with the unmet needs for rehabilitation services. Attention should be paid to the financial burden of the population on rehabilitation services, and in addition to the disabled, the slow patients should also be given priority.
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Affiliation(s)
- Xichun Li
- Department of Rehabilitation Medicine, Chengfei Hospital, Chengdu, 610073, People's Republic of China
| | - Yingxi Shi
- Department of Medical Oncology, School of Medicine UESTC, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China
| | - Dan Zhao
- Department of Medical Oncology, School of Medicine UESTC, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China
| | - Ke Jin
- Department of Medical Oncology, School of Medicine UESTC, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China
| | - Jianmei Zhu
- Department of Medical Oncology, School of Medicine UESTC, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China
| | - Ying Wang
- Department of Medical Oncology, School of Medicine UESTC, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China.
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Vincenzo JL, Brach JS, Bean J, Curran GM. Developing and Testing Implementation Strategies to support the Centers for Disease Control and Prevention's Initiative for Falls Risk Management in Outpatient Physical Therapy: A Protocol. Arch Rehabil Res Clin Transl 2023; 5:100268. [PMID: 37312984 PMCID: PMC10258383 DOI: 10.1016/j.arrct.2023.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Objectives To develop and test implementation strategies to support implementing the Centers for Disease Control and Preventions' Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative for falls prevention and falls risk management in a novel setting, outpatient physical therapy. Design A feasibility implementation study engaging key partners involved in or affected by the implementation throughout the study. Setting Five outpatient physical therapy clinics embedded in a health system. Participants Key partners (physical therapists, physical therapist assistants, referring physicians, administrative clinic staff, older adults, and caregivers) involved in or affected by the implementation (N=48) will participate in surveys and interviews to identify barriers and facilitators prior to implementation and post implementation. Twelve key partners representing at least 1 of each group will participate in evidence-based quality improvement panels to identify which barriers and facilitators are most important and feasible to address and to assist in choosing and designing implementation strategies to support the uptake of STEADI in outpatient rehabilitation. STEADI will be implemented in 5 outpatient physical therapy clinics as a standard of care for the ∼1200 older adults attending those clinics annually. Outcomes Primary outcomes include clinic- and provider-level (physical therapists and physical therapist assistant) adoption and fidelity to STEADI screening, multifactorial assessment, and falls risk interventions for older adults (65 years or older) attending outpatient physical therapy. Key partners' perceived feasibility, acceptability, and appropriateness of STEADI in outpatient physical therapy will also be measured using validated implementation science questionnaires. Exploratory clinical outcomes of older adults' falls risk pre- and post rehabilitation will be investigated.
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Affiliation(s)
- Jennifer L. Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, Arkansas
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts
| | - Geoffrey M. Curran
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
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Albrecht JS, Kumar A, Falvey JR. Association Between Race and Receipt of Home- and Community-Based Rehabilitation After Traumatic Brain Injury Among Older Medicare Beneficiaries. JAMA Surg 2023; 158:350-358. [PMID: 36696119 PMCID: PMC9878433 DOI: 10.1001/jamasurg.2022.7081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/22/2022] [Indexed: 01/26/2023]
Abstract
Importance Non-Hispanic Black (hereafter Black) patients with traumatic brain injury (TBI) experience worse long-term outcomes and residual disability compared with non-Hispanic White (hereafter White) patients. Receipt of appropriate rehabilitation can improve function among older adults after TBI. Objective To assess the association between race and receipt of home- and community-based rehabilitation among a nationally representative sample of older Medicare beneficiaries with TBI. Design, Setting, and Participants This cohort study analyzed a random sample of Medicare administrative claims data for community-dwelling Medicare beneficiaries aged 65 years or older who were hospitalized with a primary diagnosis of TBI and discharged alive to a nonhospice setting from 2010 through 2018. Claims data for Medicare beneficiaries of other races and ethnicities were excluded due to the small sample sizes within each category. Data were analyzed January 21 to August 30, 2022. Exposures Black or White race. Main Outcomes and Measures Monthly use rates of home-based or outpatient rehabilitation were calculated over the 6 months after discharge from the hospital. The denominator for rate calculations accounted for variation in length of hospital and rehabilitation facility stays and loss to follow-up due to death. Rates over time were modeled using generalized estimating equations, controlling for TBI acuity, demographic characteristics, comorbidities, and socioeconomic factors. Results Among 19 026 Medicare beneficiaries (mean [SD] age, 81.6 [8.1] years; 10 781 women [56.7%]; and 994 Black beneficiaries [5.2%] and 18 032 White beneficiaries [94.8%]), receipt of 1 or more home health rehabilitation visits did not differ by race (Black vs White, 47.4% vs 46.2%; P = .46), but Black beneficiaries were less likely to receive 1 or more outpatient rehabilitation visits compared with White beneficiaries (3.4% vs 7.1%; P < .001). In fully adjusted regression models, Black beneficiaries received less outpatient therapy over the 6 months after TBI (rate ratio, 0.60; 95% CI, 0.38-0.93). However, Black beneficiaries received more home health rehabilitation therapy over the 6 months after TBI than White beneficiaries (rate ratio, 1.15; 95% CI, 1.00-1.32). Conclusions and Relevance This cohort study found relative shifts in rehabilitation use, with markedly lower outpatient therapy use and modestly higher home health care use among Black patients compared with White patients with TBI. These disparities may contribute to reduced functional recovery and residual disability among racial and ethnic minority groups. Additional studies are needed to assess the association between the amount of outpatient rehabilitation care and functional recovery after TBI in socioeconomically disadvantaged populations.
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Affiliation(s)
- Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Amit Kumar
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Jason R. Falvey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore
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Schmiesing A, Liang Y, Turner BJ. Association of nonpharmacologic chronic pain management with function in a low-income population: Evidence from a survey of a sample of Latinos from five states. PM R 2022; 14:1343-1350. [PMID: 34464031 DOI: 10.1002/pmrj.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Low-income minority populations often confront barriers to professional nonpharmacologic management of chronic pain and, without this care, may have poorer daily function. OBJECTIVE To examine the association of professional nonpharmacologic chronic pain management in the past year categorized as physical interventions or mind-body interventions with current functional status. DESIGN Online, population-based survey. SETTING Community-dwelling Latinos from five southwestern states (California, Texas, Arizona, Nevada, and New Mexico). PARTICIPANTS The survey was offered to all Latino online panel members aged 35 to 75 years in 5 states (N = 1007). With weights, this sample represented 11,016,135 persons. Of 516 respondents (51%), 486 (94%) had valid surveys and, of these, 102 members (21%) had chronic noncancer pain. With weights, they represented 1,140,170 persons with chronic pain. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Daily impairment in mobility and in activities of daily living (ADLs). RESULTS Of the weighted sample, 37.2% reported daily impairment in mobility and 29.4% in ADLs. Professional physical interventions for chronic pain were received by 41.2% and mind-body interventions received by 33.4% but usually with physical interventions. Adjusted odds ratios (AOR) of daily mobility impairment for respondents who used physical interventions with mind-body interventions or alone were both less than 0.10 (p < .01) versus none. Only professional physical intervention was associated with decreased odds for daily impairment in ADLs (AOR = 0.07; 95% confidence interval = 0.01 to 0.94; p = .045). CONCLUSIONS In a weighted sample of Latinos with chronic pain, professional physical interventions reduced the likelihood of daily impairment in mobility and ADLs.
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Affiliation(s)
- Allie Schmiesing
- Department of Rehabilitation, Stanford Healthcare, Stanford, California, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Barbara J Turner
- Department of Medicine, Keck Medical Center of University of Southern California, Los Angeles, California, USA
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Richter RR, Chrusciel T, Salsich G, Austin T, Scherrer JF. Disparities Exist in Physical Therapy Utilization and Time to Utilization Between Black and White Patients With Musculoskeletal Pain. Phys Ther 2022; 102:6649124. [PMID: 35871435 DOI: 10.1093/ptj/pzac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/24/2022] [Accepted: 04/05/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Black patients are less likely than White patients to receive physical therapy for musculoskeletal pain conditions. Current evidence, however, is limited to self-reported conditions and health services use. The purpose of this study was to use a large electronic health record database to determine whether a race disparity existed in use of physical therapy within 90 days of a new musculoskeletal diagnosis. METHODS Eligible patients (n = 52,384) were sampled from an Optum deidentified electronic health record database of 5 million adults distributed throughout the United States. In this database, patients were designated as "Black" and "White." Patients were eligible if they had a new diagnosis for musculoskeletal neck, shoulder, back, or knee pain between January 1, 2012, and December 31, 2017. Logistic regression and Cox proportional hazard models were computed before and after adjusting for covariates to estimate the association between race and receipt of physical therapy services within 90 days of musculoskeletal pain diagnoses. RESULTS Patients were on average 47.5 (SD = 14.9) years of age, 12.8% were Black, 87.2% were White, and 52.7% were female. Ten percent of Black patients and 15.5% of White patients received physical therapy services within 90 days of musculoskeletal pain diagnoses. After adjusting for covariates, White patients were 57% more likely (odds ratio = 1.57; 95% CI = 1.44-1.71) to receive physical therapy compared with Black patients and had significantly shorter time to physical therapy than Black patients (hazard ratio = 1.53; 95% CI = 1.42-1.66). CONCLUSIONS In a nationally distributed cohort, Black patients were less likely than White patients to utilize physical therapy and had a longer time to utilization of physical therapy for musculoskeletal pain. IMPACT These findings highlight the need to determine the mechanisms underlying the observed disparities and how these disparities influence health outcomes.
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Affiliation(s)
- Randy R Richter
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Timothy Chrusciel
- Department of Health and Clinical Outcomes Research, Salus Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Gretchen Salsich
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Tricia Austin
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Leclair LL, Zawaly K, Korall AMB, Edwards J, Katz A, Sibley KM. Exploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2245-e2254. [PMID: 34850489 DOI: 10.1111/hsc.13662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/26/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
As the global population of older people increases, policies aimed at improving health care delivery for older people often include supports for ageing in place. Living in the community not only reduces institutionalisation but also improves quality of life and reduces health care costs. For older people, community rehabilitation offers the opportunity to preserve and maximise function while maintaining the ability to live in the community. However, limited research examines the delivery, coordination and integration of community rehabilitation services in health systems. Our case study explored the perspectives of service providers, managers and health system administrators on the strengths, limitations and gaps in community rehabilitation for older people in one Canadian urban health region. Using interpretive description and thematic analysis, we analysed interview data from: 16 service providers, eight managers and five health system administrators. Three themes were identified: (a) Limited Access to Programs and Services; (b) Need to Emphasise Promoting, Maintaining and Restoring Function; and (c) Lack of Flow Across the System. Participants highlighted that restrictive eligibility criteria limited access to services. Services were organised around health conditions that did not address the needs of older people. Long waitlists meant that services were delayed. Transportation costs limited participation of individuals from lower socioeconomic status (SES). Age restrictions did not reflect differences in the ageing process and the health inequities individuals from lower SES groups experienced. There was a lack of emphasis in community rehabilitation programs on maintaining or restoring function in older people, which is the primary focus of rehabilitation. Furthermore, key stakeholders stressed the need for strengthening the integration of service delivery across the continuum of care. The findings underscore the need to develop a conceptual framework for community rehabilitation to promote greater system integration, access and availability of services and to optimise functional outcomes for older people.
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Affiliation(s)
- Leanne L Leclair
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathleen Zawaly
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexandra M B Korall
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
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Vincenzo JL, Patton SK, Lefler LL, Falvey JR, McElfish PA, Curran G, Wei J. Older Adults' Perceptions Regarding the Role of Physical Therapists in Fall Prevention: A Qualitative Investigation. J Geriatr Phys Ther 2022; 45:E127-E136. [PMID: 33782360 PMCID: PMC8589106 DOI: 10.1519/jpt.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Falls are a leading cause of injury, morbidity, and mortality among older adults. Physical therapists are underutilized for fall prevention despite strong evidence and recommendations regarding their effectiveness. The purpose of this study was to explore older adults' awareness of and perceptions regarding the role of physical therapists for fall prevention. A secondary purpose of the study was to identify barriers to utilization of preventive rehabilitation services. METHODS A qualitative, descriptive, phenomenological approach was used. Participant demographics and fall history were obtained with a standard questionnaire. Four focus groups were conducted with 27 community-dwelling older adults (average age = 78 years). Focus groups were recorded, transcribed, and coded using thematic analysis. RESULTS Surveys indicated 37% of participants experienced a fall in the last year and 26% reported sustaining an injury. Four main themes and 5 subthemes about older adults' perceptions of physical therapy providers emerged: (1) awareness of fall prevention (subthemes: I can or have taken action to prevent falls, I don't think about it, and I am more careful); (2) learning how to fall and being able to get up from the floor; (3) limited knowledge regarding the role of physical therapists for fall prevention; and (4) a physical therapist should be seen for a specific problem, or after a fall (subthemes: perceived need and costs, and access requires a doctor's prescription). CONCLUSION Older adults lack awareness about the role of physical therapists for fall prevention, believing they should only seek treatment from a physical therapist to address a specific problem, or after a fall. The profession should consider addressing misconceptions and underutilization by educating the public that physical therapists can and do play an important role in the prevention of falls. Being explicit about the prevention of falls throughout an older adults' episode of care may further help reinforce the role of physical therapists for fall prevention and improve dissemination of this knowledge.
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Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences, Fayetteville
| | - Susan Kane Patton
- Department of Nursing, College of Education and Health Professions, University of Arkansas, Fayetteville
| | - Leanne L Lefler
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock
| | - Jason R Falvey
- Departments of Physical Therapy and Rehabilitation Science and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Pearl A McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Fayetteville
| | - Geoffrey Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, and Central Arkansas Veterans Healthcare System, Little Rock
| | - Jeanne Wei
- Department of Geriatrics, College of Medicine, Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock
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Shi S, McCarthy EP, Mitchell SL, Kim DH. Feasibility of Measuring Frailty and Patient-Reported Outcomes During and After Post-Acute Skilled Nursing Facility Rehabilitation. Gerontol Geriatr Med 2022; 8:23337214221116978. [PMID: 35958035 PMCID: PMC9358557 DOI: 10.1177/23337214221116978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Functional status and quality of life are not routinely assessed after skilled nursing facility (SNF) discharge. We determined feasibility of measuring frailty among adults ≥65 years admitted to SNF after hospitalization, and post-discharge outcomes. We calculated a frailty index (non-frail [≤0.25], mild frailty [0.26-0.35], moderate [0.36-0.45], and severe [>0.45]). After SNF discharge, we conducted serial telephone interviews measuring ability to perform functional activities and Patient Reported Outcome Measurement Information System (PROMIS) scores. Overall of 68 screened patients, 42 were eligible, and 24 (57.1%) eligible patients were enrolled. Of these, 5 (20.8%) were admitted after elective hospitalizations, 17 (70.8%) were female, and 11 (45.8%) had moderate-to-severe frailty. Frailty was measured in all participants in a mean 32.1 minutes. At 90 days, a total of three participants died, and two were lost to follow-up. Post-discharge functional status varied by frailty, with moderate-to-severe frailty having persistent impairment and lower PROMIS scores (worse quality of life) compared to those with no or mild frailty (38.2 [13.7] vs. 47.3 [8.1] p = .04). Measuring frailty and quality of life in older patients admitted to SNF is feasible. Furthermore, measuring frailty may help identify those at particularly high risk of poor recovery and lower quality of life after discharge.
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Affiliation(s)
- Sandra Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Susan L. Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Stransky ML, Oshita JY, Morris MA. Receipt of treatment among a nationally representative sample of US adults with communication disorders. JOURNAL OF COMMUNICATION DISORDERS 2021; 94:106148. [PMID: 34509749 DOI: 10.1016/j.jcomdis.2021.106148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION A robust body of literature exists on clinical research outcomes for persons with communication disorders (CD). Comparatively few studies have examined population-based health service outcomes for CD-related services, which capture persons with CDs who may not be part of clinical or administrative data. This is important to describe access to treatment and the factors impacting access. We address this gap, describing four CD-related healthcare outcomes among adults reporting problems with communication (voice, speech, and language): (1) utilization, (2) utilization determinants, (3) professionals providing CD care, and (4) patient-reported service-related outcomes. METHODS We conducted a retrospective, cross-sectional study of community-dwelling adults (≥18 years) in the US self-reporting CD on the nationally representative 2012 National Health Interview Survey. Separate analyses examined adults with voice (n = 1,323), speech (n = 658), and language (n = 396) disorders. We used survey weighted logistic regression to assess the likelihood of treatment, controlling for health, disorder, and sociodemographic characteristics; Pearson's chi square was calculated for other outcomes. RESULTS An estimated 10% of adults reporting CD described receiving care addressing their CD. Employment, sociodemographic and economic status, health insurance, level of severity, and presence of co-occurring CD were associated with receiving treatment. Over half of respondents with speech and language disorders and less than a fifth of respondents with voice disorders reported receiving care from speech-language pathologists. Adults who received CD-related services reported improvements in activities (52-69% overall) and CD (33-48% overall). CONCLUSIONS This population-based study shows that general access to CD services is low. Underserved populations have less access to treatment than their counterparts with more resources. Improving access to CD services requires creative interventions addressing patient and provider needs, as well as healthcare system design. Population-based follow-up studies are necessary to track progress toward improving access to care.
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Affiliation(s)
- Michelle L Stransky
- Department of Pediatrics, Boston Medical Center, 801 Albany St., Boston, MA 02119, USA.
| | - Jennifer Y Oshita
- Clinical and Translational Sciences Program, University of Vermont, USA; University of Vermont Medical Center, Rehabilitation Therapies Department, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Megan A Morris
- Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Aurora, CO 80045, USA
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Meisingset I, Bjerke J, Taraldsen K, Gunnes M, Sand S, Hansen AE, Myhre G, Evensen KAI. Patient characteristics and outcome in three different working models of home-based rehabilitation: a longitudinal observational study in primary health care in Norway. BMC Health Serv Res 2021; 21:887. [PMID: 34454475 PMCID: PMC8403406 DOI: 10.1186/s12913-021-06914-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background The organisation of health care services for older adults varies within and between countries. In Norway, primary care physiotherapy services offer home-based rehabilitation to older adults. The aim of this study was to compare patients’ characteristics and treatment outcomes in three working models of home-based rehabilitation. Methods Patients referred to home-based rehabilitation in a large municipality in Norway were invited to participate in this prospective observational study. The three working models, early intervention, reablement and regular physiotherapy, were organised according to the patients’ function and degree of independence. The older adults (≥ 65 years) were allocated to the different models by either a multidisciplinary group of health care personnel or by direct referral. Patients’ demographic and clinical characteristics, including physical function (Patient-specific functional scale, PSFS), physical performance (Short Physical Performance Battery, SPPB) and health-related quality of life (EQ-5D) were registered at baseline and follow-up (maximum 6 months after baseline). One-way ANOVA was used to analyse group differences in clinical characteristics and paired t-tests to analyse changes from baseline to follow-up. Results In total, 603 and 402 patients (median (interquartile range) age: 84 (77–88) years) completed baseline and follow-up assessments, respectively. Patients in all three working models had an increased risk for functional decline. Patients receiving early intervention (n = 62) had significantly (p < 0.001) better physical performance and health-related quality of life (SPPB mean 7.9, SD 2.7; EQ-5D:mean 0.59, SD 0.19), than patients receiving reablement (n = 132) (SPPB: mean 5.5, SD 2.6; EQ-5D: mean 0.50, SD 0.15) and regular physiotherapy (n = 409) (SPPB: mean 5.6, SD 2.8; EQ-5D: mean 0.41, SD 0.22). At follow-up, the three working models showed significantly improvements in physical function (PSFS: mean change (95 % CI): 2.5 (1.9 to 3.2); 1.8 (0.5 to 3.1); 1.7 (0.8 to 2.6), for regular physiotherapy, reablement, and early intervention, respectively). Patients receiving regular physiotherapy and reablement also significantly improved physical performance and health-related quality of life. Conclusions While older adults receiving reablement and regular physiotherapy showed similar patient characteristics and treatment outcomes, early intervention identified older patients at risk of functional decline at an earlier stage. These results are relevant for policy makers when designing and improving prevention and rehabilitation strategies in primary health care.
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Affiliation(s)
- Ingebrigt Meisingset
- Department of Public Health and Nursing, NTNU, Trondheim, Norway. .,Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway.
| | - Joakim Bjerke
- Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mari Gunnes
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sylvi Sand
- Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
| | - Anne E Hansen
- Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
| | - Gard Myhre
- Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
| | - Kari Anne I Evensen
- Department of Public Health and Nursing, NTNU, Trondheim, Norway.,Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway.,Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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15
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Braaten AD, Hanebuth C, McPherson H, Smallwood D, Kaplan S, Basirico D, Clewley D, Rethorn Z. Social determinants of health are associated with physical therapy use: a systematic review. Br J Sports Med 2021; 55:1293-1300. [PMID: 34083223 DOI: 10.1136/bjsports-2020-103475] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to identify and summarise the social determinants of health (SDH) cited in the literature and evaluate their association with individuals using physical therapy services. DESIGN A systematic review using qualitatively synthesised information to describe the association between SDH and physical therapy use. DATA SOURCES The electronic databases Medline, Embase and Scopus were searched from inception to February 2021, identifying observational and qualitative studies. ELIGIBILITY CRITERIA Published studies included all adults, aged 18 or older, who independently sought to use physical therapy, in all practice settings from all geographical locations. RESULTS Of the 9248 studies screened, 36 met the inclusion criteria for the review. The participants represented 8 countries and totaled 2 699 437. The majority of the papers reported moderate strength of association for each SDH. Female gender, non-Hispanic white race/ethnicity, increased education attainment, urban environment, access to transportation, employment, high socioeconomic status and private insurance were associated with higher likelihood of physical therapy use. CONCLUSION This systematic review identifies predisposing and enabling factors impacting physical therapy usage among adults in different countries and across physical therapy settings. The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.
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Affiliation(s)
- Amanda Day Braaten
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Cannon Hanebuth
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Holt McPherson
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Dashae Smallwood
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University, Durham, North Carolina, USA
| | - David Basirico
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Derek Clewley
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Zachary Rethorn
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
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16
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Bove AM, Dong ER, Hausmann LRM, Piva SR, Brach JS, Lewis A, Fitzgerald GK. Exploring Race Differences in Satisfaction with Rehabilitation Following Total Knee Arthroplasty: a Qualitative Study. J Gerontol A Biol Sci Med Sci 2021; 77:e48-e55. [PMID: 33978153 DOI: 10.1093/gerona/glab132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA). METHODS We conducted a series of qualitative focus group discussions with groups of Non-Hispanic White and Non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of post-operative physical therapy received, and overall satisfaction with the post-operative rehabilitation process. RESULTS Thirty-six individuals participated in focus groups. Three major themes emerged: (1) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in "prehabilitation", and often mentioned specific interventions they felt were most helpful in their recovery. (2) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (3) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers. CONCLUSIONS Individuals undergoing TKA can largely expect positive rehabilitation experiences post-operatively. However, some barriers to post-operative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.
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Affiliation(s)
- Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Erin R Dong
- Penn Presbyterian Medical Center; Philadelphia, PA, USA
| | - Leslie R M Hausmann
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System; Pittsburgh, PA, USA
| | - Sara R Piva
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Allen Lewis
- School of Health Professions, SUNY Downstate Health Sciences University; Brooklyn, NY, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
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17
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Association of Occupational and Physical Therapy With Duration of Prescription Opioid Use After Hip or Knee Arthroplasty: A Retrospective Cohort Study of Medicare Enrollees. Arch Phys Med Rehabil 2021; 102:1257-1266. [PMID: 33617862 DOI: 10.1016/j.apmr.2021.01.086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To establish whether nonpharmacologic interventions, such as occupational and physical therapy, were associated with a shorter duration of prescription opioid use after hip or knee arthroplasty. DESIGN This retrospective cohort study used data from a national 5% Medicare sample database between January 1, 2010 and December 31, 2015. SETTING Home health or outpatient. PARTICIPANTS Adults 66 years or older with an inpatient total hip (n=4272) or knee (n=9796) arthroplasty (N=14,068). INTERVENTIONS We dichotomized patients according to whether they had received any nonpharmacologic pain intervention within 1 year after hospital discharge (eg, occupational or physical therapy evaluation). Using Cox proportional hazards, we treated exposure to nonpharmacologic interventions as time dependent to determine if skilled therapy was associated with duration of opioid use. MAIN OUTCOME MEASURES Duration of prescription opioid use. RESULTS Median time to begin nonpharmacologic interventions was 91 days (95% confidence interval [CI], 74-118d) for hip and 27 days (95% CI, 27-28d) for knee arthroplasty. Median time to discontinue prescription opioids was 16 days (hip: 95% CI, 15-16d) and 30 days (knee: 95% CI, 29-31d). Nonpharmacologic interventions delivered with home health increased the likelihood of discontinuing opioids after hip (hazard ratio [HR], 1.15; 95% CI, 1.01-1.30) and knee (HR, 1.10; 95% CI, 1.03-1.17) arthroplasty. A sensitivity analysis found these estimates to be robust and conservative. CONCLUSIONS Occupational and physical therapy with home health was associated with a shorter duration of prescription opioid use after hip and knee arthroplasty. Occupational and physical therapy can address pain and sociobehavioral factors associated with postsurgical opioid use.
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Older Adults' Socio-Demographic Determinants of Health Related to Promoting Health and Getting Preventive Health Care in Southern United States: A Secondary Analysis of a Survey Project Dataset. NURSING REPORTS 2021; 11:120-132. [PMID: 33791080 PMCID: PMC8009605 DOI: 10.3390/nursrep11010012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: This exploratory survey study examined the relationship between older adults’ five socio-demographic determinants (urban/rural residence, gender, age, marital status, and education) and their self-reported perception of importance, desire to perform, and ability to perform nine self-care behaviors related to promoting health and getting preventive health care. Methods: We reported a secondary analysis of a dataset from an exploratory survey project; we analyzed 2015–2016 retrospective data collected from a cross-sectional survey study, including 123 adults aged 65 years and older living in southern United States. Data were collected from the Patient Action Inventory for Self-Care and a demographic questionnaire and analyzed using binary and multiple logistic regression analyses. Results: Advancing age, marital separation, and holding less than a high school education were significantly associated with at least one of the unfavorable perceptions of the importance, the desire to perform, and the ability to perform three self-care behaviors. These three behaviors were: (1) creating habits that will improve health and prevent disease, (2) discussing the use of health screening tests with healthcare providers, and (3) joining in local health screening or wellness events. Gender and urban/rural residence were not significant. Conclusions: Comprehensive health care should include an individual’s socio-demographic context and self-care perception of importance, desire, and ability.
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Simning A, Caprio TV, Infurna FJ, Seplaki CL. Is well-being prior to receiving rehabilitation services associated with postrehabilitation mental health and functioning? Aging Ment Health 2021; 25:269-276. [PMID: 31762298 PMCID: PMC7246159 DOI: 10.1080/13607863.2019.1693973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Millions of older adults receive rehabilitation services every year, which aim to restore, maintain, or limit decline in functioning. We examine whether lower reported well-being prior to receiving rehabilitation services is associated with increased odds of worsening anxiety symptoms, depressive symptoms, and impairment in self-care and household activities following rehabilitation. METHODS Data come from the National Health and Aging Trends Study (NHATS), an annual survey of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Our sample consists of 811 NHATS participants who, in the 2015 interview, had information on well-being and, in the 2016 interview, reported receiving rehabilitation services in the prior year. RESULTS In multivariable logistic regression analyses, compared to the highest quartile, those in the lowest quartile of well-being at baseline have increased odds of having worsening depressive symptoms (OR = 9.25, 95% CI: 3.78-22.63) and worsening impairments in self-care activities (OR = 2.39, 95% CI: 1.12-5.11). CONCLUSION Our findings suggest that older adults with the lowest levels of baseline well-being may be susceptible to having worsening depressive symptoms and impairment in self-care activities following rehabilitation services. Examination on whether consideration of well-being during the rehabilitation process could lead to better mental health and functional outcomes following rehabilitation is needed.
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Affiliation(s)
- Adam Simning
- Department of Psychiatry, University of Rochester Medical Center (URMC), Rochester, NY, USA
| | - Thomas V. Caprio
- Division of Geriatrics & Aging, Department of Medicine, URMC, Rochester, NY, USA
| | | | - Christopher L. Seplaki
- Department of Public Health Sciences, URMC, Rochester, NY, USA;,Office for Aging Research and Health Services, URMC, Rochester, NY, USA
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20
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England DL, Miller TA, Stevens PM, Campbell JH, Wurdeman SR. Assessment of a Nine-Item Patient-Reported Outcomes Measurement Information System Upper Extremity Instrument Among Individuals With Upper Limb Amputation. Am J Phys Med Rehabil 2021; 100:130-137. [PMID: 32675705 DOI: 10.1097/phm.0000000000001531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the validity of a customized nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity instrument being used with individuals with upper extremity amputation to inform potential modifications for clinical efficiency. DESIGN A sample of 239 adults with upper extremity amputation (mean age = 48 ± 16 yrs; female = 69; prosthesis users = 150) were included. After clinical implementation of the nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity, the following psychometric properties were examined: structural and known-groups validity, differential item functioning, and reliability. RESULTS The nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity short form demonstrated satisfactory psychometric properties. Convincing evidence of structural validity included no violation of unidimensionality, local independence (all local dependence χ2 < 10), monotonicity (Hij > 0, Hi > 0.3, and H = 0.57), and adequate model fit (P > 0.006). Known-groups analysis demonstrated that the nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity instrument was able to discriminate between prosthesis users and nonprosthesis users and amputation level. The Cronbach's α and item response theory reliability at the selected range of T scores were greater than 0.9 indicating high reliability. No items were flagged for age in differential item functioning. CONCLUSIONS The customized nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity met the minimum criteria, according to the Patient-Reported Outcomes Measurement Information System plan, for psychometric validity supporting its use within the population of individuals with upper extremity amputation.
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Affiliation(s)
- Dwiesha L England
- From the Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas (DLE, TAM, PMS, JHC, SRW); Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina (TAM); School of Medicine, University of Utah, Salt Lake City, Utah (PMS); and Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska (SRW)
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21
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Nguyen DQ, Ifejika NL, Reistetter TA, Makam AN. Factors Associated with Duration of Rehabilitation Among Older Adults with Prolonged Hospitalization. J Am Geriatr Soc 2020; 69:10.1111/jgs.16988. [PMID: 33393088 PMCID: PMC8217402 DOI: 10.1111/jgs.16988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVES Older adults are prone to functional decline during prolonged hospitalization. Although rehabilitation therapy is critical to preserving function, little is known about rehabilitation duration (RD) in this population. We sought to determine the extent of rehabilitation therapy provided to older adults during prolonged hospitalization, and whether this differs by sociodemographic and clinical characteristics. DESIGN Retrospective cohort. SETTING Single-site safety-net hospital. PARTICIPANTS Older adults (≥65 years) hospitalized for ≥14 days between 2016 and 2017. MEASUREMENTS The primary outcome was RD, defined as the average number of minutes of physical and occupational therapy per week. We used a multivariable generalized linear model to assess for differences in RD by sociodemographic and clinical characteristics. For a sub-cohort of hospitalizations with a baseline mobility assessment, we repeated analyses including mobility limitation as a covariate. RESULTS Among 1,031 hospitalizations by 925 unique patients (median age 72, 49% female, 79% non-white, 40% non-English speaking), the median RD was 61.3 minutes/week (interquartile range = 16.5-127.3). Covariates associated with lesser RD included black (57.2 fewer minutes/week; 95% confidence interval (CI) = 22.9-91.4) and Hispanic (75.6 fewer minutes/week; 95% CI = 33.8-117.4) race/ethnicity, speaking a language other than English or Spanish (51.7 fewer minutes/week; 95% CI = 21.3-82.0), prolonged mechanical ventilation (30.0 fewer minutes/week; 95% CI = 6.6-53.3), and do-not-resuscitate code status (36.0 fewer minutes/week; 95% CI = 17.1-54.8). The inclusion of mobility limitation among the sub-cohort (n = 350) did not meaningfully change the associations. CONCLUSION We found large disparities in RD for racial/ethnic and language minorities and clinically vulnerable older adults (mechanical ventilation and do-not-resuscitate code status), independent of clinical severity and functional and cognitive impairment. Greater RD for these groups may improve functional outcomes and narrow the disparity gap.
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Affiliation(s)
- Danh Q. Nguyen
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Nneka L. Ifejika
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Timothy A. Reistetter
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas
- Department of Occupational Therapy, University of Texas Health Science Center, San Antonio, Texas
| | - Anil N. Makam
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, California
- Center for Vulnerable Populations, University of California, San Francisco, California
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Miller TA, Paul R, Forthofer M, Wurdeman SR. Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation. Am J Phys Med Rehabil 2020; 99:1026-1031. [PMID: 33060371 PMCID: PMC7547875 DOI: 10.1097/phm.0000000000001473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective was to assess the impact of a prosthesis and the timing of prosthesis receipt on total direct healthcare costs in the 12-mo postamputation period. DESIGN Data on patients with lower limb amputation (n = 510) were obtained from a commercial claims database for retrospective cohort analysis. Generalized linear multivariate modeling was used to determine differences in cost between groups according to timing of prosthesis receipt compared with a control group with no prosthesis. RESULTS Receipt of a prosthesis between 0 and 3 mos post lower limb amputation yielded a reduced total cost by approximately 0.23 in log scale within 12 mos after amputation when compared with the no-prosthesis group. Despite the included costs of a prosthesis, individuals who received a prosthesis either at 4-6 mos postamputation or 7-9 mos postamputation incurred costs similar to the no-prosthesis group. CONCLUSION Earlier receipt of a prosthesis is associated with reduced spending in the 12 mos postamputation of approximately $25,000 compared with not receiving a prosthesis. The results of this study suggest that not providing or delaying the provision of a prosthesis increases costs by about 25%.
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Affiliation(s)
- Taavy A Miller
- From the Department of Public Health, University of North Carolina at Charlotte, Charlotte, North Carolina (TAM, RP, MF); Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas (TAM, SRW); and Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska (SRW)
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Masterson EE, Moreland BL, Strogatz DS, Kasper JD, Mielenz TJ. Utilization of driving and other transportation rehabilitation in the National Health and Aging Trends Study. Disabil Health J 2020; 13:100911. [PMID: 32111571 DOI: 10.1016/j.dhjo.2020.100911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/15/2020] [Accepted: 02/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND As people age, their mobility begins to decrease. In an effort to maintain mobility, this population can seek out rehabilitation services with the goal of improving their driving. However, it is unclear who has sought out rehabilitation for this purpose. OBJECTIVE To better understand, identify, and describe the characteristics of older adults who utilize rehabilitation with the purpose of improved driving. METHODS Data was analyzed from the fifth round of the National Health and Aging Trends study (NHATS), which is made up of Medicare beneficiaries over the age of 65 that are community-dwelling. Rehabilitation utilization specifically for improved driving and other transportation was analyzed. Adjusted weighted logistic regression was conducted to better understand and identify the characteristics of the study population that received rehabilitation services for the purpose of improved driving ability. RESULTS Nineteen percent (N = 1,335) of this cohort received rehabilitation in the past year. Of those, 10% (N = 128) received rehabilitation to specifically improve driving and 2% (N = 25) did so to improve other transportation. Older adults who were single, separated, or never married were less likely to use rehabilitation for improving driving ability, compared to older adults who were married (OR: 0.29; 95% CI: 0.11-0.80). CONCLUSION Older adults who are married were more likely to report they wanted to improve their driving ability with rehabilitation. The role of rehabilitation services to improve driving among older adults will play a key role in the coming years as older adults strive to maintain their independence.
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Affiliation(s)
- Erin E Masterson
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, New York, NY, USA.
| | - Briana L Moreland
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, New York, NY, USA.
| | - David S Strogatz
- The Mary Imogene Bassett Hospital, Research Institute, One Atwell Road, Cooperstown, NY, USA.
| | - Judith D Kasper
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy and Management, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Thelma J Mielenz
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, New York, NY, USA.
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Forte ML, Maiers M. Differences in Function and Comorbidities Between Older Adult Users and Nonusers of Chiropractic and Osteopathic Manipulation: A Cross-sectional Analysis of the 2012 National Health Interview Survey. J Manipulative Physiol Ther 2019; 42:450-460. [PMID: 31324378 DOI: 10.1016/j.jmpt.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/10/2018] [Accepted: 12/03/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this cross-sectional study was to compare functional limitations and comorbidity prevalence between older adult users and nonusers of chiropractic and osteopathic (DC/DO) manipulation to inform provider training. METHODS We conducted a secondary analysis of the 2012 National Health Interview Survey data. Adults age 65 or older who responded to the survey were included. Descriptive statistics are reported for adults who used DC/DO manipulation (vs nonusers) regarding function, comorbidities, musculoskeletal complaints, and medical services. Weighted percentages were derived using SAS and compared with χ2 tests. RESULTS The DC/DO users were more often female, overweight or obese, and of white race than nonusers. More DC/DO users reported arthritis (55.3% vs 47.0%, <0.01) or asthma (15.0% vs 10.0%, P < .01) than nonusers; hypertension (61.9% vs 55.5%, P = .02) and diabetes (20.3% vs 15.7%, P = .02) were more prevalent in nonusers; and other comorbidities were comparable. The DC/DO users reported more joint pain/stiffness (55.7% vs 44.8%), chronic pain (19.8% vs 14.2%), low back pain (27.8% vs 18.4%), low back with leg pain (18.8% vs 10.6%), and neck pain (24.2% vs 13.1%) than nonusers (all P < .01). Functional limitations affected two-thirds overall, but DC/DO users reported more difficulties stooping and bending; other limitations were comparable. One in 9 reported activities of daily living or instrumental activities of daily living limitations; nonusers were more affected. Surgery was more common among DC/DO users (26.1% vs 19.3%, <0.01); emergency room visits were comparable. CONCLUSION Differences existed between older adult manipulation users and nonusers, especially surgical utilization, musculoskeletal complaints, and comorbidities; functional differences were modest. Our findings highlight areas for provider training and awareness regarding comorbidity burden and management needs in older patients who may simultaneously use manipulation and medical care for musculoskeletal complaints.
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Affiliation(s)
- Mary L Forte
- Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, Bloomington, Minnesota.
| | - Michele Maiers
- Center for Healthcare Innovation and Policy, Northwestern Health Sciences University, Bloomington, Minnesota
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Simning A, Caprio TV, Szanton SL, Temkin-Greener H, Conwell Y. The association of patient-reported improvement and rehabilitation characteristics with mortality. Geriatr Nurs 2019; 40:620-628. [PMID: 31296405 DOI: 10.1016/j.gerinurse.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/26/2022]
Abstract
This study aims to investigate the association of patient-reported improvement and rehabilitation characteristics with mortality among older adults who received rehabilitation. To do so, a national sample of Medicare beneficiaries from the National Health and Aging Trends Study was examined. Among those who reported receiving rehabilitation services in the 2015 interview (N = 1,188), 4.2% were deceased at the 2016 follow-up interview. Mortality was more common among those who had received rehabilitation in nursing home or inpatient and in-home settings compared to outpatient rehabilitation settings. In multivariable analyses accounting for demographics and health status, patient-reported worsening of functioning during rehabilitation (OR=15.69; 95% CI: 1.84-133.45) and cardiovascular disease (OR=4.15; 95% CI: 1.41-12.17) were associated with mortality. Among older adults who received rehabilitation, 1 in 25 were deceased at follow-up. That patient-reported functioning is associated with mortality suggests that more systematically including patient-reported outcomes in rehabilitation care may be clinically pertinent.
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Affiliation(s)
- Adam Simning
- Department of Psychiatry, University of Rochester Medical Center (URMC), 300 Crittenden Blvd, Rochester, NY 14642, USA.
| | - Thomas V Caprio
- Division of Geriatrics, Department of Medicine, URMC, 435 East Henrietta Road, Rochester, NY 14620, USA
| | - Sarah L Szanton
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street #424, Baltimore, MD 21205, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, URMC, 265 Crittenden Blvd, Rochester, NY 14642, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center (URMC), 300 Crittenden Blvd, Rochester, NY 14642, USA; Office for Aging Research and Health Services, URMC, 300 Crittenden Blvd, Rochester, NY 14642, USA
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Did Clarification of Medicare Guidelines Change Outpatient Physical Therapy and Occupational Therapy Usage? A Retrospective Analysis. Arch Phys Med Rehabil 2019; 100:78-85. [DOI: 10.1016/j.apmr.2018.07.435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/22/2018] [Indexed: 11/21/2022]
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Gell NM, Patel KV. Rehabilitation Services Use of Older Adults According to Fall-Risk Screening Guidelines. J Am Geriatr Soc 2018; 67:100-107. [PMID: 30295320 DOI: 10.1111/jgs.15625] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To characterize rehabilitation services use of older adults according to fall-risk classification based on screening guidelines. DESIGN Cross-sectional analysis of 2015 National Health and Aging Trends Study. SETTING Study participants' homes. PARTICIPANTS National sample of 7,440 community-dwelling Medicare beneficiaries. MEASUREMENTS In-person interviews and functional assessments. Based on Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths and Injuries criteria, participants were classified as low, moderate, or high fall risk. RESULTS Twenty-three percent of older adults classified as moderate fall-risk (n = 2602) and 40.6% of those at high fall-risk (n = 940) reported rehabilitation services use in the past year. Among older adults who reported rehabilitation services in the past year (n = 1,505), treatment to address falls was reported by 2.8%, 12.6%, and 34.7% of those classified with low, moderate, and high fall-risk, respectively (p < 0.001). Older adults with high fall-risk who did not receive rehabilitation services had significantly better self-reported physical capacity (p = 0.02) but comparable physical performance (all p's > 0.05) relative to those who received rehabilitation. CONCLUSION Older adults at high risk for falls were significantly more likely to report rehabilitation services use compared to those with low and moderate risk of falling. The findings also indicate that there is low adherence to national clinical recommendations for rehabilitation services use in older adults vulnerable to falls-related injury. Among the high fall-risk group, those who did not receive rehabilitation services had similarly low physical function as compared with those who received rehabilitation, indicating potential unmet need to address physical impairments related to fall-risk. J Am Geriatr Soc 67:100-107, 2019.
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Affiliation(s)
- Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.,Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington
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Patient-Reported Outcomes in Functioning Following Nursing Home or Inpatient Rehabilitation. J Am Med Dir Assoc 2018; 19:864-870. [PMID: 30056009 DOI: 10.1016/j.jamda.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our study examines factors associated with patient-reported outcomes in functioning among Medicare beneficiaries who reported receiving rehabilitation services in a nursing home or inpatient (ie, hospital or rehabilitation facility) setting in the prior year. DESIGN Data are from the 2015 and 2016 rounds of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING AND PARTICIPANTS A total of 479 participants in the 2016 sample who reported receiving rehabilitation services in a nursing home or inpatient setting in the past year. MEASURES Bivariate and logistic regression analyses examined the association of demographic, socioeconomic status, and health variables (from the 2015 interview) and rehabilitation characteristics (from the 2016 interview) with patient-reported improvement in "functioning and ability to do activities" while receiving rehabilitation services in the past year. RESULTS Among Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings, 33.4% (weighted percent) reported no improvement in functioning while they were receiving rehabilitation. In a regression analysis that accounted for demographics, those with a high school education or less (compared with those with a college degree), instrumental activities of daily living impairments, certain primary conditions for rehabilitation, less than 1-month total duration of rehabilitation services, and no outpatient rehabilitation services had greater odds of reporting no improvement. CONCLUSIONS/IMPLICATIONS Our weighted sample represents approximately 2.3 million Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings. In this sample, 1 in 3 reported no improvement in functioning, with differences in patient-reported outcomes across socioeconomic status, health status, and rehabilitation characteristics domains. Consideration of characteristics across these domains may be clinically pertinent, but investigation as to why these differences are present and whether services can be optimized to further improve patient-reported outcomes is warranted.
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Freedman VA, Kasper JD, Jette A. Can Older Adults Accurately Report Their Use of Physical Rehabilitation Services? Arch Phys Med Rehabil 2018; 99:1507-1513. [PMID: 29653109 DOI: 10.1016/j.apmr.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/30/2018] [Accepted: 03/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home). DESIGN Longitudinal observational study. SETTING Participants' homes. PARTICIPANTS Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service. RESULTS Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels. CONCLUSIONS Survey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans.
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Affiliation(s)
- Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, MI.
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Alan Jette
- Center for Interprofessional Studies & Innovation, MGH Institute of Health Professions, Boston, MA
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Rehabilitation Utilization for Falls Among Community-Dwelling Older Adults in the United States in the National Health and Aging Trends Study. Arch Phys Med Rehabil 2018; 99:1568-1575. [PMID: 29545001 DOI: 10.1016/j.apmr.2018.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/05/2018] [Accepted: 02/11/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the characteristics of community-dwelling older adults receiving fall-related rehabilitation. DESIGN Cross-sectional analysis of the fifth round (2015) of the National Health and Aging Trends Study (NHATS). Fall-related rehabilitation utilization was analyzed using weighted multinomial logistic regression with SEs adjusted for the sample design. SETTING In-person interviews of a nationally representative sample of community-dwelling older adults. PARTICIPANTS Medicare beneficiaries from NHATS (N=7062). INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Rehabilitation utilization categorized into fall-related rehabilitation, other rehabilitation, or no rehabilitation. RESULTS Fall status (single fall: odds ratio [OR]=2.96; 95% confidence interval [CI], 1.52-5.77; recurrent falls: OR=14.21; 95% CI, 7.45-27.10), fear of falling (OR=3.11; 95% CI, 1.90-5.08), poor Short Physical Performance Battery scores (score 0: OR=6.62; 95% CI, 3.31-13.24; score 1-4: OR=4.65; 95% CI, 2.23-9.68), and hip fracture (OR=3.24; 95% CI, 1.46-7.20) were all associated with receiving fall-related rehabilitation. Lower education level (less than high school diploma compared with 4-y college degree: OR=.21; 95% CI, .11-.40) and Hispanic ethnicity (OR=.37; 95% CI, .15-.87) were associated with not receiving fall-related rehabilitation. CONCLUSIONS Hispanic older adults and older adults who are less educated are less likely to receive fall-related rehabilitation. Recurrent fallers followed by those who fell once in the past year were more likely to receive fall-related rehabilitation than are older adults who have not had a fall in the past year.
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Horowitz BP, Lopez A, Smith CR. Culturally competent strategies: Evidence and case studies to improve health and occupational participation in the United States. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2018. [DOI: 10.1080/14473828.2018.1432313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Beverly P. Horowitz
- Occupational Therapy Department, York College, City University of New York, Jamaica, NY, USA
| | - Alexander Lopez
- Occupational Therapy Department, New York Institute of Technology, Old Westbury, NY, USA
| | - Cristina Reyes Smith
- Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC, USA
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Keeney T, Jette AM, Freedman VA, Cabral H. Racial Differences in Patterns of Use of Rehabilitation Services for Adults Aged 65 and Older. J Am Geriatr Soc 2017; 65:2707-2712. [PMID: 29114848 DOI: 10.1111/jgs.15136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services. DESIGN Secondary analysis of the 2016 National Health and Aging Trends Study (NHATS). SETTING Standardized in-person home interviews. PARTICIPANTS Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months. MEASUREMENTS Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services. RESULTS Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial differences in improvement in function. CONCLUSION Strategies are needed to identify possible barriers to use of rehabilitation services for vulnerable groups of aging individuals who need rehabilitation services, particularly older blacks.
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Affiliation(s)
- Tamra Keeney
- Institute of Health Professiowns, Massachusetts General Hospital, Boston, Massachusetts
| | - Alan M Jette
- Institute of Health Professiowns, Massachusetts General Hospital, Boston, Massachusetts
| | - Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Howard Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
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