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Cai CW, Grey JA, Hubmacher D, Han WM. Biomaterial-Based Regenerative Strategies for Volumetric Muscle Loss: Challenges and Solutions. Adv Wound Care (New Rochelle) 2024. [PMID: 38775429 DOI: 10.1089/wound.2024.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Significance: Volumetric muscle loss (VML) is caused by the loss of significant amounts of skeletal muscle tissue. VML cannot be repaired by intrinsic regenerative processes, resulting in permanent loss of muscle function and disability. Current rehabilitative-focused treatment strategies lack efficacy and do not restore muscle function, indicating the need for the development of effective regenerative strategies. Recent Advances: Recent developments implicate biomaterial-based approaches for promoting muscle repair and functional restoration post-VML. Specifically, bioscaffolds transplanted in the injury site have been utilized to mimic endogenous cues of the ablated tissue to promote myogenic pathways, increase neo-myofiber synthesis, and ultimately restore contractile function to the injured unit. Critical Issues: Despite the development and preclinical testing of various biomaterial-based regenerative strategies, effective therapies for patients are not available. The unique challenges posed for biomaterial-based treatments of VML injuries, including its scalability and clinical applicability beyond small-animal models, impede progress. Furthermore, production of tissue-engineered constructs is technically demanding, with reproducibility issues at scale and complexities in achieving vascularization and innervation of large constructs. Future Directions: Biomaterial-based regenerative strategies designed to comprehensively address the pathophysiology of VML are needed. Considerations for clinical translation, including scalability and regulatory compliance, should also be considered when developing such strategies. In addition, an integrated approach that combines regenerative and rehabilitative strategies is essential for ensuring functional improvement.
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Affiliation(s)
- Charlene W Cai
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Biology, The College of New Jersey, Ewing, New Jersey, USA
| | - Josh A Grey
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cell, Developmental, and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute of Regenerative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dirk Hubmacher
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Woojin M Han
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cell, Developmental, and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute of Regenerative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Borges PRT, Sampaio RF, Dias JF, Mancini MC, Ocarino JM, Resende RA. App-based telerehabilitation program for older adults on waiting list for physiotherapy after hospital discharge: a feasibility pragmatic randomized trial. Pilot Feasibility Stud 2024; 10:98. [PMID: 38961470 PMCID: PMC11221181 DOI: 10.1186/s40814-024-01521-4] [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: 10/07/2022] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Inactivity while waiting for outpatient physiotherapy worsens the physical deconditioning of older adults after hospital discharge. Exercise programs can minimize the progression of deconditioning. In developing countries, telerehabilitation for older adults on the waiting list is still in the early stages. This study aimed to evaluate the feasibility of the study procedures of a telerehabilitation program for older adults waiting for outpatient physiotherapy after hospital discharge. METHODS This pragmatic randomized controlled trial recruited older adults (≥ 60 years) with several clinical diagnoses on the waiting list for outpatient physiotherapy in the Brazilian public health system after hospital discharge. The telerehabilitation group (n = 17) received a personalized program of multicomponent remote exercises using a smartphone app. The control group (n = 17) followed the usual waiting list. We assessed recruitment and dropout rates, safety, adherence, and satisfaction. The preliminary effects were verified on clinical outcomes. RESULTS We recruited 5.6 older adults monthly; dropouts were 12%. No serious adverse events were associated with the telerehabilitation program. The weekly adherence was 2.85 (1.43) days, and in 63.3% of the weeks the participants were enrolled, they performed the exercise program at least twice a week. Participants rated the telerehabilitation program as 9.71 (0.21), and the safety of remote exercises without professional supervision as 8.6 (2.2) on a 0-10 scale. CONCLUSIONS The telerehabilitation program using a smartphone app was safe and presented high participants' satisfaction and adequate adherence, recruitment, and dropout rates. Therefore, the definitive study can be conducted with few modifications. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020. https://ensaiosclinicos.gov.br/rg/RBR-9243v7 .
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Affiliation(s)
- Pollyana Ruggio Tristão Borges
- Department of Physiotherapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627 - Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Rosana Ferreira Sampaio
- Department of Physiotherapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627 - Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Jane Fonseca Dias
- Department of Physiotherapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627 - Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Marisa Cotta Mancini
- Department of Physiotherapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627 - Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Juliana Melo Ocarino
- Department of Physiotherapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627 - Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Renan Alves Resende
- Department of Physiotherapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627 - Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
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Chrobok L, Espejo T, Riedel HB, Kirchberger J, Overberg JA, Felber F, Perrot G, Nickel CH, Bingisser R. On-Site Physiotherapy in Emergency Department Patients Presenting with Nonspecific Low Back Pain: A Randomized Controlled Trial. J Clin Med 2024; 13:3149. [PMID: 38892860 PMCID: PMC11173222 DOI: 10.3390/jcm13113149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background: There is a high incidence of nonspecific Low Back Pain (LBP) in patients visiting Emergency Departments (EDs), but there is a lack of knowledge regarding emergency physiotherapy for LBP. The effect of on-site physiotherapy in these patients was therefore never demonstrated. We assessed short-term outcomes, feasibility and patient satisfaction with physiotherapy in ED patients presenting with nonspecific LBP. Methods: A block-randomized, controlled, open-label trial with a follow-up of 42 days. Patients aged 18 years or older presenting to an ED with nonspecific LBP were prospectively enrolled. Both groups received the same booklet with written information on LBP management and exercises. Patients in the intervention group were given additional instructions by a certified physiotherapist. Results: We included 86 patients in the primary analysis. The median age was 40, and 40.7% were female. At day 7, the median Oswestry Disability Index (ODI) was 2 points lower in the intervention group compared to the control group, which was not statistically significant. There was no between-group difference in pain at day 7. Patients who received physiotherapy felt significantly more confident with the exercises they were taught (p = 0.004, effect size = 0.3 [95% CI 0.1 to 0.5]). Conclusions: On-site physiotherapy in ED patients presenting with nonspecific low back pain is associated with higher patient satisfaction, compared to standard of care. The effect of physiotherapy was small, with only minimal improvement in disability, but without a reduction in pain. Despite the very small effect size, physiotherapeutic interventions should be investigated in larger cohorts with an extended intervention including patient education, exercises, and other physiotherapeutic modalities.
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Affiliation(s)
- Leon Chrobok
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Tanguy Espejo
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Henk B. Riedel
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Joris Kirchberger
- Department of Therapies, University Hospital, 4031 Basel, Switzerland; (J.K.); (J.-A.O.); (G.P.)
| | - Jan-Arie Overberg
- Department of Therapies, University Hospital, 4031 Basel, Switzerland; (J.K.); (J.-A.O.); (G.P.)
| | - Florina Felber
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Guido Perrot
- Department of Therapies, University Hospital, 4031 Basel, Switzerland; (J.K.); (J.-A.O.); (G.P.)
| | - Christian H. Nickel
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
| | - Roland Bingisser
- Emergency Department, University Hospital, 4031 Basel, Switzerland; (L.C.); (T.E.); (H.B.R.); (F.F.); (C.H.N.)
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Udhawani NS, Hoover DL. Differential screen and treatment of sternocleidomastoid syndrome versus eagle syndrome: a case report. Physiother Theory Pract 2024; 40:1072-1082. [PMID: 36384424 DOI: 10.1080/09593985.2022.2144560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Differential screening is a complex process in chronic pain conditions. There is significant uncertainty that surrounds the pathophysiology of many chronic pain syndromes that may lead to misdiagnosis and treatment failures. Such differential screening is even more challenging where there is regional overlapping from surrounding tissues. This case report chronicles the differential screening and treatment of a patient with sternocleidomastoid syndrome (SCMS) originally diagnosed as Eagle's syndrome (ES). CASE DESCRIPTION A 55-year-old woman, referred to a physical therapist (PT) by an ear, nose and throat (ENT) physician with the diagnosis of ES. The patient complained of yearlong left-sided otalgia, blurred vision, excessive lacrimation, dysphagia, hyperesthesia on the left side of the face, unilateral temporal headaches, and both left mandibular and anterior neck pain. OUTCOMES The PT examination revealed the patient did not exhibit hallmark findings for clinical confirmation of ES and instead demonstrated multiple signs consistent with SCMS. DISCUSSION Manual therapy techniques and therapeutic exercises resolved the patient's year-long chronic symptoms within 6 sessions.
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Affiliation(s)
- Nitin S Udhawani
- Physical Therapy Department, Three Rivers Health Outpatient Physical Therapy, Three Rivers, Michigan, United States
| | - Donald L Hoover
- Doctor of Physical Therapy Department, Western Michigan University, Kalamazoo, Michigan, United States
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Kechichian A, Pommier D, Druart L, Lowry V, Pinsault N, Desmeules F. "Cooperation between physicians and physios fosters trust you know": a qualitative study exploring patients' experience with first-contact physiotherapy for low back pain in French primary care. BMC PRIMARY CARE 2024; 25:69. [PMID: 38395795 PMCID: PMC10885482 DOI: 10.1186/s12875-024-02302-x] [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: 08/30/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Physiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage acute low back pain patients as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore patients' experience and perceptions when attending a first-contact physiotherapist (FCP) in an advanced practice collaborative primary care model for acute low back pain (LBP). METHODS A qualitative study using semi-structured interviews was conducted. Patients that consulted a FCP for acute LBP care in new collaborative model were included. Interviews were transcribed verbatim and inductive thematic analysis was performed to generate themes related to patients' experience and perceptions. RESULTS Ten patients were interviewed (3 women, 7 men; mean age 36.5 ± 9.63 years). All LBP participants experienced important level of pain and disability. Four overarching themes related to patients' experience with the new FCP model were formalized: 1) "Going to see a physiotherapist who specializes in painful movements, well that makes sense to me", 2) "Physiotherapist offered to give me exercises to do at home to relieve the back pain", 3) "I went there feeling confident", 4) "The physiotherapist can do more than just send you to see more appropriate people". Participants highlighted the need to receive timely and high-quality care and were receptive with being autonomously managed by a FCP. Overall, patients' experiences with FCP model of care were positive. Participants were highly confident in the FCP's ability to perform delegated medical tasks including making a medical diagnosis and prescribing oral medication such as analgesic drugs. Patients felt that a greater expansion of FCPs' scope of practice was needed to improve the model. CONCLUSION Findings from this study can inform the implementation of FCP in countries where patients are not typically granted FCP by underlining that patients are favourable towards the advance practice model as such models support timely and high-quality care. Further research is needed to better determine the future advance practice physiotherapists' scope of practice in French primary and secondary care settings.
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Affiliation(s)
- Amélie Kechichian
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France.
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France.
| | - Dylan Pommier
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - Léo Druart
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - Véronique Lowry
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Nicolas Pinsault
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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6
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Mekonnen TH, Di Donato M, Collie A, Russell G. Time to Service and Its Relationship with Outcomes in Workers with Compensated Musculoskeletal Conditions: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-023-10160-0. [PMID: 38214782 DOI: 10.1007/s10926-023-10160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE A comprehensive review of the literature on the time between the onset of symptoms and the first episode of care and its effects on important worker outcomes in compensated musculoskeletal conditions is currently lacking. This scoping review aimed to summarize the factors associated with time to service and describe outcomes in workers with workers' compensation accepted claims for musculoskeletal conditions. METHODS We used the JBI guidelines for scoping reviews and reported following the PRISMA-ScR protocol. We included peer-reviewed articles published in English that measured the timing of health service initiation. We conducted searches in six databases, including Medline (Ovid), Embase (Ovid), PsycINFO, Cinahl Plus (EBSCOhost), Scopus, and the Web of Science. Peer-reviewed articles published up to November 01, 2022 were included. The evidence was summarized using a narrative synthesis. RESULTS Out of the 3502 studies identified, 31 were included. Eight studies reported the factors associated with time to service. Male workers, availability of return to work programmes, physically demanding occupations, and greater injury severity were associated with a shorter time to service, whereas female workers, a high number of employees in the workplace, and having legal representation were associated with a longer time to service. The relationship between time service and worker outcomes was observed in 25 studies, with early access to physical therapy and biopsychosocial interventions indicating favourable outcomes. Conversely, early opioids, and MRI in the absence of severe underlying conditions were associated with a longer duration of disability, higher claim costs, and increased healthcare utilization. CONCLUSION Existing evidence suggests that the time to service for individuals with compensated musculoskeletal conditions was found to be associated with several characteristics. The relationship between time to service and worker outcomes was consistently indicated in the majority of the studies. This review highlights the need to consider patient-centred treatments and develop strategies to decrease early services with negative effects and increase access to early services with better outcomes.
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Affiliation(s)
- Tesfaye Hambisa Mekonnen
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia.
| | - Michael Di Donato
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia
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Callan F, Keating L, Casserley-Feeney S, French HP. ADvAnced PhysioTherapy in MuSculosKeletal Triage: Investigating prognostic factors, healthcare utilisation and clinical outcomes (ADAPT MSK) - a cohort study protocol. HRB Open Res 2023; 6:73. [PMID: 38384973 PMCID: PMC10879754 DOI: 10.12688/hrbopenres.13769.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Clinical specialist physiotherapist-led musculoskeletal triage clinics were introduced nationally in Ireland in 2011 to improve patient care and reduce waiting times for secondary care orthopaedics and rheumatology. Evidence has shown them to be effective in reducing waiting lists, however there are currently no data on longitudinal patient outcomes following clinic attendance. The primary aim of this cohort study is to identify predictors of pain and function outcomes up to one year following musculoskeletal triage review. Secondary aims include measuring self-reported use of healthcare resources over the 12-month follow-up period and to explore musculoskeletal phenotypes based on established prognostic factors for musculoskeletal pain. This is a prospective cohort study. METHODS ADvAnced PhysioTherapy in MuSculosKeletal Triage (ADAPT MSK) will recruit a cohort of 252 adults through musculoskeletal triage clinics across five secondary care sites in Ireland. The STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines will be adhered to for future reporting. Adults (≥ 18 years old) attending physiotherapist-led musculoskeletal triage clinics with musculoskeletal pain, who do not require surgical or consultant-led medical care will be considered for participation. Participant demographics, health literacy, healthcare utilisation, and self-report questionnaires on pain, function, musculoskeletal health, musculoskeletal risk stratification, fear of movement, and psychological distress will be obtained at baseline, with follow-ups at three, six, and 12 months. Primary outcomes are pain intensity and function. Secondary outcomes include musculoskeletal risk stratification status, musculoskeletal health, healthcare utilisation, and work-related factors. Descriptive statistics will be used to profile the participants and predictors of outcome will be assessed using multivariable linear regression. Musculoskeletal phenotypes will be explored using latent class analysis. RESULTS Results will be disseminated via peer-reviewed journal publication and presentation at national and international conferences. Engagement with a public patient involvement (PPI) panel will explore dissemination strategies for public and service user engagement.
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Affiliation(s)
- Fiona Callan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise Keating
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sarah Casserley-Feeney
- National Musculoskeletal Triage Initiative, National Clinical Programme for Trauma & Orthopaedic Surgery (NCPTOS), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen P. French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hernández-Lázaro H, Mingo-Gómez MT, Jiménez-Del-Barrio S, Rodríguez-Fernández AI, Areso-Bóveda PB, Ceballos-Laita L. Validation of the International Classification of Functioning, Disability, and Health (ICF) core set for post-acute musculoskeletal conditions in a primary care physiotherapy setting from the perspective of patients using focus groups. Disabil Rehabil 2023:1-8. [PMID: 37667886 DOI: 10.1080/09638288.2023.2251392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To validate the comprehensive ICF core set for post-acute musculoskeletal conditions from the perspective of patients in a primary care physiotherapy setting. MATERIALS AND METHODS A qualitative study was conducted with patients suffering from musculoskeletal problems. A phenomenological approach based on focus groups was used to identify the most relevant aspects related to physical therapy care in their condition. The data were analyzed using a meaning condensation procedure, identifying relevant themes and concepts. The identified concepts were linked to the ICF and compared to the ICF core set for post-acute musculoskeletal conditions. RESULTS Forty-three patients were included in eight focus groups. A total of 1281 relevant concepts were extracted and related to 156 ICF second-level entities. Entities in the ICF core set for post-acute musculoskeletal conditions were 95.7% confirmed. Eighty-nine additional second-level ICF entities were identified. CONCLUSIONS Entities in the ICF core set for post-acute musculoskeletal conditions are relevant to patients seen in primary care physical therapy units. However, there are areas of functioning related to community health care not covered by this ICF-based tool.IMPLICATIONS OF REHABILITATIONAn ICF-based framework is feasible for the assessment of musculoskeletal conditions.Post-acute musculoskeletal ICF core set was confirmed in patient focus groups.Additional ICF categories emerged for a primary care physical therapy setting.Community features of functioning could be addressed by a tailored ICF core set.
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Affiliation(s)
- Héctor Hernández-Lázaro
- Ólvega Primary Care Physiotherapy Unit, Soria Health Care Management, Regional Health Administration of Castilla y León (SACYL), Ólvega, Spain
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
| | - Maria Teresa Mingo-Gómez
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
| | - Sandra Jiménez-Del-Barrio
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
| | - Ana Isabel Rodríguez-Fernández
- Cervera de Pisuerga Primary Care Physiotherapy Unit, Palencia Health Care Management, Regional Health Administration of Castilla y León (SACYL), Cervera de Pisuerga, Spain
| | - Paula Begoña Areso-Bóveda
- Burgos Centro Primary Care Physiotherapy Unit, Burgos Primary Health Care Management, Regional Health Administration of Castilla y León (SACYL), Burgos, Spain
| | - Luis Ceballos-Laita
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
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9
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Cook CE, Bailliard A, Bent JA, Bialosky JE, Carlino E, Colloca L, Esteves JE, Newell D, Palese A, Reed WR, Vilardaga JP, Rossettini G. An international consensus definition for contextual factors: findings from a nominal group technique. Front Psychol 2023; 14:1178560. [PMID: 37465492 PMCID: PMC10351924 DOI: 10.3389/fpsyg.2023.1178560] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023] Open
Abstract
Objective Emerging literature suggests contextual factors are important components of therapeutic encounters and may substantially influence clinical outcomes of a treatment intervention. At present, a single consensus definition of contextual factors, which is universal across all health-related conditions is lacking. The objective of this study was to create a consensus definition of contextual factors to better refine this concept for clinicians and researchers. Design The study used a multi-stage virtual Nominal Group Technique (vNGT) to create and rank contextual factor definitions. Nominal group techniques are a form of consensus-based research, and are beneficial for identifying problems, exploring solutions and establishing priorities. Setting International. Main outcome measures The initial stages of the vNGT resulted in the creation of 14 independent contextual factor definitions. After a prolonged discussion period, the initial definitions were heavily modified, and 12 final definitions were rank ordered by the vNGT participants from first to last. Participants The 10 international vNGT participants had a variety of clinical backgrounds and research specializations and were all specialists in contextual factors research. Results A sixth round was used to identify a final consensus, which reflected the complexity of contextual factors and included three primary domains: (1) an overall definition; (2) qualifiers that serve as examples of the key areas of the definition; and (3) how contextual factors may influence clinical outcomes. Conclusion Our consensus definition of contextual factors seeks to improve the understanding and communication between clinicians and researchers. These are especially important in recognizing their potential role in moderating and/or mediating clinical outcomes.
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Affiliation(s)
- Chad E. Cook
- Department of Orthopaedics, Duke University, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | - Antoine Bailliard
- Department of Orthopaedics, Duke University, Durham, NC, United States
- Occupational Therapy Doctorate Division, Duke University, Durham, NC, United States
| | - Jennifer A. Bent
- Department of Rehabilitation, Duke University Hospital System, Durham, NC, United States
| | - Joel E. Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
- Brooks-PHHP Research Collaboration, Gainesville, FL, United States
| | - Elisa Carlino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Luana Colloca
- Departement of Pain and Translational Symptom Science and the Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Jorge E. Esteves
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Malta ICOM Educational, Gżira, Malta
| | - Dave Newell
- Anglo-European College of Chiropractic University College, Bournemouth, United Kingdom
| | - Alvisa Palese
- Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
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Coleman BC, Lisi AJ, Abel EA, Runels T, Goulet JL. Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100233. [PMID: 37440983 PMCID: PMC10333712 DOI: 10.1016/j.xnsj.2023.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023]
Abstract
Background Low back pain (LBP) is a common reason individuals seek healthcare. Nonpharmacologic management (NPM) is often recommended as a primary intervention, and earlier use of NPM for LBP shows positive clinical outcomes. Our purpose was to evaluate how timing of engagement in NPM for LBP affects downstream LBP visits during the first year. Methods This study was a secondary analysis of an observational cohort study of national electronic health record data. Patients entering the Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort with LBP from October 1, 2016 to September 30, 2017 were included. Exclusive patient groups were defined by engagement in NPM within 30 days of entry ("very early NPM"), between 31 and 90 days ("early NPM"), or not within the first 90 days ("no NPM"). The outcome was time, in days, to the final LBP follow-up after 90 days and within the first year. Cox proportional hazards regression was used to model time to final follow up, controlling for additional demographic and clinical covariables. Results The study population included 44,175 patients, with 16.7% engaging in very early NPM and 13.1% in early NPM. Patients with very early NPM (5.2 visits, SD=4.5) or early NPM (5.7 visits, SD=4.6) had a higher mean number of LBP visits within the first year than those not receiving NPM in the first 90 days (3.2 visits, SD = 2.5). The very early NPM (HR=1.50, 95% CI: 1.46-1.54; median=48 days, IQR=97) and early NPM (HR=1.27, 95% CI: 1.23-1.30; median=88 days, IQR=92) had a significantly shorter time to final follow-up than the no NPM group (median=109 days, IQR=150). Conclusions Veterans Health Administration patients receiving NPM for LBP within the first 90 days after initially seeking care demonstrate a significantly faster time to final follow-up visit within the first year compared to those who do not.
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Affiliation(s)
- Brian C. Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
- Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
| | - Anthony J. Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
- Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
| | - Erica A. Abel
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
- Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
| | - Tessa Runels
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
| | - Joseph L. Goulet
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
- Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
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Matsel K, Kirsch J, Netelbeek T, Rodriguez R, Velic E, Schwartzkopf-Phifer K. Self-Movement Screening using the Symmio Application is Reliable and Valid for Identifying Musculoskeletal Risk Factors. Int J Sports Phys Ther 2023; 18:439-449. [PMID: 37020451 PMCID: PMC10069341 DOI: 10.26603/001c.73319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 04/04/2023] Open
Abstract
Background Musculoskeletal health problems are one of the greatest healthcare expenses in the United States but patient-driven screening procedures to detect risk factors do not exist. Hypothesis/Purpose The purpose was to establish the inter-rater reliability of the Symmio Self-Screen application in untrained individuals and to investigate its accuracy to detect MSK risk factors such as pain with movement, movement dysfunction, and decreased dynamic balance. Study Design Cross-Sectional. Methods Eighty (42 male, 38 female) healthy individuals mean age 26.5 ± 9.4 participated in the study. The inter-rater reliability of Symmio application was established by comparing self-screen scores from untrained subjects with the results simultaneously determined by a trained healthcare provider. Each subject was evaluated for pain with movement, movement dysfunction, and deficits in dynamic balance by two trained evaluators who were blinded to the Symmio results. The validity of Symmio was determined by comparing self-screen performance dichotomized as pass or fail with the reference standard of pain with movement, failure on the Functional Movement Screen™, and asymmetry on the Y Balance Test-Lower Quarter™ using three separate 2x2 contingency tables. Results The mean Cohen's kappa coefficient was 0.68 (95% CI, 0.47-0.87) and the absolute agreement was 89% between self-assessment of subjects and the observation of a trained healthcare provider. There were significant associations for the presence of pain with movement (p=0.003), movement dysfunction (p=0.001), and dynamic balance deficits (p=0.003) relative to poor Symmio performance. The accuracy of Symmio to identify pain with movement, movement dysfunction, and dynamic balance deficits were 0.74 (95% CI, 0.63-0.83), 0.73 (95% CI, 0.62-0.82), and 0.69 (95% CI, 0.57-0.79), respectively. Conclusions The Symmio Self-Screen application is a reliable and feasible screening tool that can be used to identify MSK risk factors. Level of Evidence Level 2.
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Campbell P, Pope R, Simas V, Canetti E, Schram B, Orr R. The Effects of Early Physiotherapy Treatment on Musculoskeletal Injury Outcomes in Military Personnel: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13416. [PMID: 36293997 PMCID: PMC9602812 DOI: 10.3390/ijerph192013416] [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: 09/29/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
The risks and incidence rates of musculoskeletal injuries among military personnel are high, and the importance of physiotherapy in treating these injuries is well established. However, what is less clear is whether the timing of commencement of physiotherapy treatment affects musculoskeletal injury outcomes in military personnel. This lack of clarity is exacerbated by the known underreporting of injuries among military personnel, and the resulting self-management of musculoskeletal injuries using analgesics, non-steroidal anti-inflammatories and other means. This narrative review was designed to identify and synthesize current evidence regarding the effects of timing of physiotherapy treatment on musculoskeletal injury outcomes, focusing on potential benefits of early versus typical or delayed commencement of physiotherapy treatment. Overall, current evidence suggests early physiotherapy treatment of musculoskeletal injuries offers distinct advantages over typical or delayed commencement of physiotherapy treatment in military settings. Specifically, it appears early treatment expedites recovery in early phases following injury onset and benefits longer term mental health and well-being. It may also reduce the need for more invasive and costly health care interventions and enable earlier return to training and operational service. Importantly, a cultural shift within military contexts to ensure early reporting of musculoskeletal injuries is required if the benefits of early commencement of physiotherapy treatment are to be achieved.
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Affiliation(s)
- Patrick Campbell
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
| | - Rodney Pope
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, NSW 2640, Australia
| | - Vinicius Simas
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
| | - Elisa Canetti
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
- Faculty of Health Science and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Benjamin Schram
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
- Faculty of Health Science and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Robin Orr
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
- Faculty of Health Science and Medicine, Bond University, Robina, QLD 4229, Australia
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Carlesso LC, Jafarzadeh SR, Stokes A, Felson DT, Wang N, Frey-Law L, Lewis CE, Nevitt M, Neogi T. Depressive symptoms and multi-joint pain partially mediate the relationship between obesity and opioid use in people with knee osteoarthritis. Osteoarthritis Cartilage 2022; 30:1263-1269. [PMID: 35700904 PMCID: PMC9419857 DOI: 10.1016/j.joca.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the relation of obesity to opioid use in people with or at risk of knee osteoarthritis (OA), and the extent to which this association is mediated by number of painful joints or depressive symptoms. METHODS We used data from the Multicenter Osteoarthritis Study, a longitudinal cohort of older adults with or at risk of knee OA. Opioid use was identified by prescription medications and self-report. Obesity was defined as BMI ≥ 30 kg/m2. Multi-joint pain was assessed using a standardized body homunculus, and depressive symptoms using the Center for Epidemiological Studies Depression scale. We quantified the direct and indirect effect of obesity on opioid use through the number of painful joints or depressive symptoms using causal mediation analysis by natural-effects models. RESULTS We studied 2,335 participants (mean age: 68; mean BMI 31 kg/m2; 60% women). Persons with obesity had ∼50% higher odds of opioid use than those without. Estimates of indirect (mediated) effect by the number of painful joints and depressive symptoms suggested an increased odds of opioid use by 34% (odds ratio [OR] = 1.34, 95% CI: 1.04, 1.70) and 35% (OR 1.35, 95% CI: 1.05, 1.71), respectively, in obese vs non-obese individuals. The total effect of obesity on opioid use was higher in women than in men. CONCLUSIONS Multi-joint pain and depressive symptoms partially explained greater opioid use among obese persons with knee OA, demonstrating that the negative impact of obesity on knee OA extends beyond its influence on knee pain and structural progression.
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Affiliation(s)
- L C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| | | | - A Stokes
- Boston University School of Public Health, Boston, MA, USA.
| | - D T Felson
- Boston University School of Medicine, Boston, MA, USA.
| | - N Wang
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA.
| | - L Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA.
| | - C E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA.
| | - M Nevitt
- University of California, San Francisco, CA, USA.
| | - T Neogi
- Boston University School of Medicine, Boston, MA, USA.
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Long-term effectiveness of rehabilitation services delivery for Wenchuan earthquake survivors with impairments over a 4-year period: a prospective cohort study. BMJ Open 2022. [PMCID: PMC9362798 DOI: 10.1136/bmjopen-2021-057158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To examine long-term effectiveness of rehabilitation services on physical function, pain severity and post-traumatic stress disorder (PTSD) in earthquake survivors over a 4-year period. Design Prospective cohort study with early and late intervention and geographical control group. Setting Three counties of Sichuan Province, China. Participants 591 survivors of the 2008 Wenchuan earthquake were followed-up over a 4-year period ranging from 2008 to 2012. Interventions In Mianzhu county, a comprehensive hospital-based and community-based rehabilitation programme was implemented in September 2008; in Anxian county, the same programme was implemented 1 year later; in Shifang county, the programme was not implemented and survivors from this county served as a control group. Outcomes Physical function was measured using Modified Barthel Index (MBI), pain severity with Visual Analogue Scale and PTSD with the PTSD Checklist-Civilian Version. All outcomes were assessed at three time points (baseline from 2008 to 2009, 2010 and 2012) and analysed with mixed effects regression. Results 400 patients completed all assessments. In all groups, physical function and pain severity improved over time. MBI improvement per month as compared with control was greater in the late rehabilitation (b=1.69, 95% CI 1.20 to 2.19) than the early rehabilitation group (b=0.96, 95% CI 0.68 to 1.24). This rehabilitation effect was however marginally decreasing over time. Superior improvement as compared with control with regard to pain was only found in the early rehabilitation group (b=−0.05, 95% CI −0.09 to −0.02). PTSD symptoms decreased over time, but the observed differences could not be specifically linked to the rehabilitation intervention. Conclusion Physical rehabilitation of earthquake survivors appears to be effective in improving physical function and, if delivered early, pain. Effects on mental health are less clear and need further examination using more consistent and frequent assessments of relevant outcomes and determinants.
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Althobaiti S, Rushton A, Aldahas A, Falla D, Heneghan NR. Practicable performance-based outcome measures of trunk muscle strength and their measurement properties: A systematic review and narrative synthesis. PLoS One 2022; 17:e0270101. [PMID: 35714149 PMCID: PMC9205516 DOI: 10.1371/journal.pone.0270101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
The evaluation of muscle strength is frequently used as part of the physical examination process, with decreased trunk muscle strength reported in individuals with spinal disorders (e.g., low back pain). Access to practicable performance-based outcome measures (PBOM) to monitor patients’ progress in spinal rehabilitation is essential. Knowledge of the psychometric properties of the available practicable PBOM for trunk strength evaluation is therefore needed to inform practitioners and further research.
Objective
To synthesise evidence on the measurement properties of practicable measures of trunk muscle strength in adults with and without musculoskeletal pain.
Methods
Following a published and registered protocol [PROSPERO CRD42020167464], databases were searched from the database inception date up to 30th of June 2021. Citations and grey literature were also searched. Eligibility criteria comprised: 1) studies which examined the psychometric properties of the trunk strength outcome measures, 2) included adults ≥ 18 years, either asymptomatic or with spinal musculoskeletal pain. Non-English language studies were excluded. Two independent reviewers evaluated the quality and synthesized the data from included studies according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. The overall quality of evidence was evaluated using a modified Grading of Recommendations Assessment Development and Evaluation (GRADE).
Results
From 34 included studies, 15 different PBOMs were identified that have been investigated for reliability and validity, none evaluated responsiveness. In asymptomatic individuals, high quality evidence supports intra-rater reliability of digital-loading cells and moderate quality evidence supports the criterion validity of the hand-held dynamometer. Very low quality evidence exists for the reliability and validity estimates of testing tools among individuals with spinal pain.
Conclusions
Findings underpin a cautious recommendation for the use of practicable PROMs to evaluate muscle strength in individuals with spinal pain in clinical practice due to the level of evidence and the heterogeneity of the protocols used. Further high quality research to explore the psychometric properties of the practicable PBOMs with detailed methodology is now needed.
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Affiliation(s)
- Shouq Althobaiti
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Physical Therapy Department, College of Applied Medical Science, Taif University, Taif, Saudi Arabia
- * E-mail:
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Ahmad Aldahas
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
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Etheridge T, Bostick GP, Hoens AM, Holly J, Ippersiel P, Bobos P, Arumugam V, Woods S, Gielen S, Woznowski-Vu A, Campbell N. Barriers to Physiotherapists’ Use of Professional Development Tools for Chronic Pain: A Knowledge Translation Study. Physiother Can 2022. [DOI: 10.3138/ptc-2020-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherapy Association that serves physiotherapists who have an interest in better understanding and managing patients’ pain. The PSD developed evidence-based resources for its members with the goal of improving patient care by supporting professional development. However, online metrics tracking access to these resources indicated that access was low. The purpose of this study was to identify the barriers PSD members encountered to the use of PSD resources and to recommend interventions to address these barriers guided by the Theory and Techniques Tool (TTT). Method: We distributed an online survey to PSD members across Canada. We used the TTT, a knowledge translation tool, to guide the design of the questionnaire and identify actionable findings. Results: Response rates from 621 non-student members and 1,470 student members were 26.9% and 1.4%, respectively. Based on the frequency of practicing physiotherapists’ ( N = 167) agreement with items in the TTT, the primary barriers to use of the PSD resources were forgetting that the resources were available and forgetting to use them. Conclusions: The TTT can be used to identify barriers to use of professional development tools.
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Affiliation(s)
- Tori Etheridge
- Centre for Neurology Studies, Surrey, British Columbia, Canada
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
| | - Geoff P. Bostick
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Alison M. Hoens
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet Holly
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Patrick Ippersiel
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Pavlos Bobos
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Vanitha Arumugam
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Pain Management Program, St. Joseph Health Care, London, Ontario, Canada
| | | | | | - Arthur Woznowski-Vu
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Reply to Moretti et al. Would Moving Forward Mean Going Back? Comment on "Maselli et al. Direct Access to Physical Therapy: Should Italy Move Forward? Int. J. Environ. Res. Public Health 2022, 19, 555". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084620. [PMID: 35457488 PMCID: PMC9030390 DOI: 10.3390/ijerph19084620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/30/2022] [Accepted: 04/06/2022] [Indexed: 12/29/2022]
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Effect of Patient Use of Physical Therapy After Referral for Musculoskeletal Conditions on Future Medical Utilization: A Retrospective Cohort Analysis. J Manipulative Physiol Ther 2022; 44:621-636. [DOI: 10.1016/j.jmpt.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/18/2022]
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Dupuis F, Déry J, Lucas de Oliveira FC, Pecora AT, Gagnon R, Harding K, Camden C, Roy JS, Lettre J, Hudon A, Beauséjour M, Pinard AM, Bath B, Deslauriers S, Lamontagne MÈ, Feldman D, Routhier F, Desmeules F, Hébert LJ, Miller J, Ruiz A, Perreault K. Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review. J Health Serv Res Policy 2022; 27:157-167. [DOI: 10.1177/13558196211065707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy ( n = 11), occupational therapy ( n = 2), prosthetics ( n = 1), exercise physiology ( n = 1) and multidisciplinary ( n = 4) services. The methodological quality varied ( n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.
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Affiliation(s)
- Frédérique Dupuis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Julien Déry
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Fabio Carlos Lucas de Oliveira
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Ana Tereza Pecora
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Rose Gagnon
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Katherine Harding
- Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
| | - Chantal Camden
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Josiane Lettre
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Anne Hudon
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - Marie Beauséjour
- Département des Sciences de la santé communautaire, Université de Sherbrooke, Longueuil, QC, Canada
| | - Anne-Marie Pinard
- Département D’anesthésiologie et de Soins Intensifs, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Brenna Bath
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Marie-Ève Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Debbie Feldman
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | | | - Luc J. Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Physical Therapy Program, Queen’s University, Kingston, ON, Canada
| | - Angel Ruiz
- Département d’opérations et systèmes de décision, Faculté des sciences de l’administration, Université Laval, Québec, QC, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
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Beresford L, Norwood T. The Effect of Mobile Care Delivery on Clinically Meaningful Outcomes, Satisfaction, and Engagement Among Physical Therapy Patients: Observational Retrospective Study. JMIR Rehabil Assist Technol 2022; 9:e31349. [PMID: 35107436 PMCID: PMC8851343 DOI: 10.2196/31349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/23/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Musculoskeletal care is now delivered via mobile apps as a health care benefit. Although preliminary evidence shows that the clinical outcomes of mobile musculoskeletal care are comparable with those of in-person care, no research has examined the features of app-based care that secure these outcomes. Objective Drawing on the literature around in-person physical therapy, this study examines how patient-provider relationships and program engagement in app-based physical therapy affect clinically meaningful improvements in pain, function, and patient satisfaction. It then evaluates the effects of patient-provider relationships forged through in-app messages or video visits and timely, direct access to care on patients’ engagement in their recovery. Methods We conducted an observational, retrospective study of 814 pre- and postsurveyed participants enrolled in a mobile app physical therapy program where physical therapists prescribed workouts, education, and therapeutic activities after a video evaluation from February 2019 to December 2020. We estimated generalized linear models with logit functions to evaluate the effect of program engagement on clinical outcomes, minimal clinically important differences (MCIDs) in pain (ΔVisual Analogue Scale ≤−1.5) and function (ΔPatient Specific Functional Scale ≥1.3), and the effects of patient-provider relationships and clinical outcomes on patient satisfaction—participant reported likelihood to recommend the program (Net Promoter Scores of 9-10). We estimated Poisson generalized linear models to evaluate the effects of stronger patient-provider relationships and timely access to physical therapy within 24 hours on engagement including the number of weekly workouts and weeks in the program. Results The odds that participants (N=814) had a pain MCID increased by 13% (odds ratio [OR] 1.13, 95% CI 1.04-1.23; P=.003) with each weekly workout and the odds of a function MCID by 4% (OR 1.04, 95% CI 1.00-1.08; P=.03) with each week in the program. Participants with MCIDs in function and large changes in pain (Δ Visual Analogue Scale ≤−3.5) were 1.85 (95% CI 1.17-2.93; P=.01) and 2.84 times (95% CI 1.68-4.78; P<.001) more satisfied, respectively. Those with video follow-up visits were 2 to 3 times (P=.01) more satisfied. Each physical therapist’s message increased weekly workouts by 11% (OR 1.11, 95% CI 1.07-1.16; P<.001). Video follow-up visits increased weekly workouts by at least 16% (OR 1.16, 95% CI 1.04-1.29; P=.01) and weeks in the program at least 8% (OR 1.08, 95% CI 1.01-1.14; P=.02). Access was associated with a 14% increase (OR 1.14, 95% CI 1.05-1.24; P=.003) in weekly workouts. Conclusions Similar to in-person care, program engagement positively affects clinical outcomes, and strong patient-provider relationships positively affect satisfaction. In app-based physical therapy, clinical outcomes positively affect patient satisfaction. Timely access to care and strong patient-provider relationships, particularly those forged through video visits, affect engagement.
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Affiliation(s)
| | - Todd Norwood
- Omada Health Inc, San Francisco, CA, United States
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21
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Gruner MP, Hogaboom N, Hasley I, Hoffman J, Gonzalez-Carta K, Cheville AL, Li Z, Sellon JL. Prospective, Single-blind, Randomized Controlled Trial to Evaluate the Effectiveness of a Digital Exercise Therapy Application Compared With Conventional Physical Therapy for the Treatment of Nonoperative Knee Conditions. Arch Rehabil Res Clin Transl 2022; 3:100151. [PMID: 34977534 PMCID: PMC8683841 DOI: 10.1016/j.arrct.2021.100151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate the effectiveness and adherence of a home exercise therapy program using a digital exercise therapy application (DETA) compared with conventional physical therapy (PT). Design Parallel group, randomized controlled trial. Setting Two clinics in a tertiary care academic center. Participants Participants (N=60) were enrolled within 1 week after a provider visit for knee pain. Inclusion criteria: age 18-75 years, knee pain diagnosis, and clinician-prescribed PT. Interventions Participants were randomized to complete either an 8-week intervention of conventional PT (enrolled n=29; complete n=26) or the DETA (enrolled n=31; completed n=24). Main Outcome Measures Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores implemented via computer adaptive tests; number of exercise sessions completed per week (adherence). Results Compared with the PT group, the DETA group reported significant decreases in PROMIS-PI scores (−6.1±6.7 vs −1.5±6.6, P<.05, d=0.78) and increases in PROMIS-PF scores (6.0±6.6 vs −0.8±5.8, P<.01, d=0.89) after 8 weeks. No group differences in adherence were observed (P>.05). Conclusions Use of this DETA resulted in greater pain and functional improvements compared with PT, with no differences in adherence. It is possible this application may be a viable alternative to conventional PT in certain cases. A larger sample from various geographic locations is needed to improve generalizability and for subgroup analysis. Further investigation is warranted to determine the factors responsible for the differences observed between the groups.
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Affiliation(s)
- Marc P. Gruner
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
- Corresponding author Marc P. Gruner, DO, MBA, 6608 Rivertrail Ct, Bethesda, MD 20817.
| | - Nathan Hogaboom
- Center for Spinal Cord Injury Research, Kessler Foundation, West Orange, NJ
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ
| | - Ike Hasley
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jared Hoffman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Karina Gonzalez-Carta
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Andrea L. Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Zhuo Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jacob L. Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
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22
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Childs JD, Benz LN, Arellano A, Briggs AA, Walker MJ. Challenging Assumptions About the Future Supply and Demand of Physical Therapists in the United States. Phys Ther 2022; 102:6397776. [PMID: 34662413 DOI: 10.1093/ptj/pzab239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/11/2021] [Accepted: 09/18/2021] [Indexed: 11/12/2022]
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23
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Sisco-Taylor BL, Magel JS, McFadden M, Greene T, Shen J, Fritz JM. Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial. PAIN MEDICINE 2021; 23:1127-1137. [PMID: 34613379 PMCID: PMC9157170 DOI: 10.1093/pm/pnab292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/25/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Fear-Avoidance Model of chronic pain (FAM) posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT's effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year. SUBJECTS Participants were 204 patients with low-back pain of < 16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks. METHODS Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales) and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators. RESULTS Early PT led to improvements in disability and pain over 3 months, but not 1 year. In the single mediator model, four-week reductions in pain catastrophizing mediated early PT's effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations. CONCLUSIONS In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients' catastrophizing.
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Affiliation(s)
| | - John S Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT.,Department of Physical Therapy, Intermountain Healthcare, Salt Lake City, UT
| | - Molly McFadden
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT.,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Jincheng Shen
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT.,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
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Gagnon R, Perreault K, Berthelot S, Matifat E, Desmeules F, Achou B, Laroche M, Van Neste C, Tremblay S, Leblond J, Hébert LJ. Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. Acad Emerg Med 2021; 28:848-858. [PMID: 33617696 DOI: 10.1111/acem.14237] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The objective was to evaluate the effects of direct-access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. METHODS We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two-way analyses of variance, log-linear analysis, and chi-square tests. RESULTS Seventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over-the-counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow-up for imaging tests, other professionals consulted, and hospitalization rates. CONCLUSION Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge.
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Affiliation(s)
- Rose Gagnon
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) Quebec Quebec Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale‐Nationale Quebec Quebec Canada
- Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine Faculty of Medicine Université Laval Quebec Quebec Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) Quebec Quebec Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale‐Nationale Quebec Quebec Canada
- Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine Faculty of Medicine Université Laval Quebec Quebec Canada
| | - Simon Berthelot
- Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine Faculty of Medicine Université Laval Quebec Quebec Canada
- CHU de Québec–Université Laval Quebec Quebec Canada
- Centre de recherche du CHU de Québec–Université Laval Quebec Quebec Canada
| | - Eveline Matifat
- Faculté de Médecine École de RéhabilitationUniversité de Montréal Montreal Quebec Canada
- Maisonneuve‐Rosemont Hospital Research Centre Orthopaedic Clinical Research Unit Centre de recherche de l’Hôpital Maisonneuve‐RosemontCIUSSS de l’Est‐de‐l’Île‐de‐Montréal Montreal Quebec Canada
| | - François Desmeules
- Faculté de Médecine École de RéhabilitationUniversité de Montréal Montreal Quebec Canada
- Maisonneuve‐Rosemont Hospital Research Centre Orthopaedic Clinical Research Unit Centre de recherche de l’Hôpital Maisonneuve‐RosemontCIUSSS de l’Est‐de‐l’Île‐de‐Montréal Montreal Quebec Canada
| | | | | | | | | | - Jean Leblond
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) Quebec Quebec Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale‐Nationale Quebec Quebec Canada
| | - Luc J. Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) Quebec Quebec Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale‐Nationale Quebec Quebec Canada
- Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine Faculty of Medicine Université Laval Quebec Quebec Canada
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25
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Timing of physical therapy for individuals with patellofemoral pain and the influence on healthcare use, costs and recurrence rates: an observational study. BMC Health Serv Res 2021; 21:751. [PMID: 34320969 PMCID: PMC8320186 DOI: 10.1186/s12913-021-06768-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/12/2021] [Indexed: 12/05/2022] Open
Abstract
Background Early physical therapy has been shown to decrease downstream healthcare use, costs and recurrence rates in some musculoskeletal conditions, but it has not been investigated in individuals with patellofemoral pain. The purpose was to evaluate how the use and timing of physical therapy influenced downstream healthcare use, costs, and recurrence rates. Methods Seventy-four thousand four hundred eight individuals aged 18 to 50 diagnosed with patellofemoral pain between 2010 and 2011 in the Military Health System were categorized based on use and timing of physical therapy (first, early, or delayed). Healthcare use, costs, and recurrence rates were compared between the groups using descriptive statistics and a binary logit regression. Results The odds for receiving downstream healthcare use (i.e. imaging, prescription medications, and injections) were lowest in those who saw a physical therapist as the initial contact provider (physical therapy first), and highest in those who had delayed physical therapy (31–90 days after patellofemoral pain diagnosis). Knee-related costs for those receiving physical therapy were lowest in the physical therapy first group ($1,136, 95% CI $1,056, $1,217) and highest in the delayed physical therapy group ($2,283, 95% CI $2,192, $2,374). Recurrence rates were lowest in the physical therapy first group (AOR = 0.55, 95% CI 0.37, 0.79) and highest in the delayed physical therapy group (AOR = 1.78, 95% CI 1.36, 2.33). Conclusions For individuals with patellofemoral pain using physical therapy, timing is likely to influence outcomes. Healthcare use and costs and the odds of having a recurrence of knee pain were lower for patients who had physical therapy first or early compared to having delayed physical therapy.
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26
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Young JL, Snodgrass SJ, Cleland JA, Rhon DI. The relationship between knee radiographs and the timing of physical therapy in individuals with patellofemoral pain. PM R 2021; 14:496-503. [PMID: 34288533 DOI: 10.1002/pmrj.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Routine knee radiographs are discouraged for individuals with non-traumatic knee pain, but they are often still ordered despite limited evidence for their value in guiding treatment choices. Radiograph utilization may delay the use of physical therapy, which has been associated with improved outcomes and lower long-term costs. OBJECTIVE To examine the relationship between obtaining knee radiographs for patients with patellofemoral pain (PFP) and the timing of physical therapy, and the association between ordering radiographs for patients who use physical therapy and the likelihood of knee pain recurrence. STUDY DESIGN Retrospective cohort. SETTING United States Military Health System civilian and military clinics. PATIENTS 23,332 individuals aged 18 to 50 diagnosed with PFP between 2010 and 2011 in the United States Military Health System who received physical therapy. INTERVENTIONS Physical therapy provided to individuals who did or did not receive an initial radiograph. MAIN OUTCOME MEASURES Timing of physical therapy and recurrence of knee pain were compared between groups (with and without initial radiographs). RESULTS If radiographs were used, the odds of initiating physical therapy (aOR = 0.78; 95% CI 0.64 to 0.94) within 30 days of the initial diagnosis were significantly lower. The mean days from diagnosis to initiating physical therapy was 12.1 (95% CI 9.1 to 16.1) if patients had radiographs versus 6.9 (95% CI 5.2 to 9.1) without. The odds of knee pain recurrence were no greater if radiographs were used (aOR = 1.01; 95% CI 0.83 to 1.22). CONCLUSIONS Receiving knee radiographs as part of initial care for PFP was associated with delayed initiation of physical therapy, but there was no association between early knee radiographs and recurrence of knee pain. Routine use of radiographs for PFP is not warranted, and can potentially delay appropriate treatment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jodi L Young
- Doctor of Science in Physical Therapy, Bellin College, 3201 Eaton Rd., Green Bay, WI, USA.,Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, University Dr., Callaghan, NSW, Australia
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, University Dr., Callaghan, NSW, Australia
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel I Rhon
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, University Dr., Callaghan, NSW, Australia.,TX, USA.,Physical Therapy Department, Baylor University, Stanley, TX, USA
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27
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Wassinger CA, Sole G. Agreement and screening accuracy between physical therapists ratings and the Ӧrebro Musculoskeletal Pain Questionnaire in screening for risk of chronic pain during Musculoskeletal evaluation. Physiother Theory Pract 2021; 38:2949-2955. [PMID: 34266347 DOI: 10.1080/09593985.2021.1949766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Identifying patients at risk for chronic musculoskeletal pain can inform evaluation and treatment decisions. The ability of physical therapists to assess patients' risk for chronic pain without use of validated tools has been questioned. The Ӧrebro Musculoskeletal Pain Questionnaire (OMPQ) is used to determine risk for chronic pain.Methods: The aim of this pragmatic study was to prospectively quantify the agreement between physical therapists' assessment of patients' risk for chronic symptoms compared to the OMPQ. Patients were asked to complete the OMPQ during the initial visit. Physical therapists, blinded to OMPQ risk classification, carried out their usual patient assessment procedures. The physical therapists rated patients as either high or low risk for chronic pain based on their clinical assessment. Agreement between therapist and OMPQ was determined using Cohen's Kappa (κ) and screening accuracy compared clinician risk to the OMPQ risk classification (reference standard) by way of contingency table analysis.Results: Ninety-six (96) patients' risk classifications and 15 corresponding physical therapists' risk estimates were available for analysis. The OMPQ identified a 47% prevalence for high risk of chronic pain. Agreement (κ and 95% confidence interval) between physical therapist rating and OMPQ was slight, κ = 0.272 (0.033-0.421), p = .026. Therapists' sensitivity and specificity (95% CI) for determining risk classifications were 60.0% (44.3-74.3) and 62.8% (48.1-75.6), respectively. The positive and negative likelihood ratios (95% CI) were 1.61 (1.05-2.47) and 0.64 (0.42-0.97).Discussion: The use of validated self-report questionnaires are recommended to supplement clinician prognosis for patients at risk of chronic musculoskeletal pain.
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Affiliation(s)
- Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, USA
| | - Gisela Sole
- School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
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Szymanek E, Jones M, Shutt-Hoblet C, Halle R. Implementation of Direct Access Physical Therapy Within the Military Medical System. Mil Med 2021; 187:e649-e654. [PMID: 34245295 DOI: 10.1093/milmed/usab245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/30/2020] [Accepted: 06/18/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Readiness is the Army's number one priority. Physical therapists (PTs) are musculoskeletal (MSK) experts and have been serving as physician extenders in a direct access role in the military since Vietnam. Utilizing a PT in the direct access role has demonstrated a reduction in imaging, medication prescribed, number of physical therapy visits, and overall reduction in healthcare utilization. MATERIALS AND METHODS The Joint Base Lewis-McChord physical therapy service line initiated a readiness-focused direct access initiative in May 2018. A simple algorithm was developed to help screen and identify appropriate service members for direct access physical therapy sick call. Physical therapy sick call hours were established at seven Joint Base Lewis-McChord Physical Therapy clinics. RESULTS During the initial 18 months of this direct access PT initiative, a total of 3,653 initial physical therapy evaluations were completed. Injury location included 26% (953) knee, 26% (945) ankle, 16% (585) low back, 15% (551) shoulder, 9% (316) hip, and 8% (303) leg. CONCLUSION In the military, where readiness is the number one priority, it is essential that we optimize the medical resources available to our service members in order to minimize lost duty days and overall long-term disability. This project demonstrates a way to optimize the military healthcare system in order to reduce cost and healthcare utilization and minimize duty days lost to MSK injuries. Utilizing a conservative estimate, $3.6 million was potentially saved in military healthcare utilization costs. The subanalysis performed at one clinic comparing referral-based care with the direct access model demonstrated a reduction in imaging, days on profile, cost savings, reduction in referral to specialty care, and decreased long-term disability. In the military healthcare system, where our primary care team resources are limited, it is important to consider the PT as part of the acute MSK injury management team.
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Affiliation(s)
- Eliza Szymanek
- Madigan Army Medical Center, JBLM, Tacoma, WA 98431, USA
| | - Megan Jones
- Madigan Army Medical Center, JBLM, Tacoma, WA 98431, USA
| | | | - Robert Halle
- Madigan Army Medical Center, JBLM, Tacoma, WA 98431, USA
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Bhavsar NA, Doerfler SM, Giczewska A, Alhanti B, Lutz A, Thigpen CA, George SZ. Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions. PLoS One 2021; 16:e0251336. [PMID: 34048440 PMCID: PMC8162651 DOI: 10.1371/journal.pone.0251336] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Chronic pain affects 50 million Americans and is often treated with non-pharmacologic approaches like physical therapy. Developing a no-show prediction model for individuals seeking physical therapy care for musculoskeletal conditions has several benefits including enhancement of workforce efficiency without growing the existing provider pool, delivering guideline adherent care, and identifying those that may benefit from telehealth. The objective of this paper was to quantify the national prevalence of no-shows for patients seeking physical therapy care and to identify individual and organizational factors predicting whether a patient will be a no-show when seeking physical therapy care. DESIGN Retrospective cohort study. SETTING Commercial provider of physical therapy within the United States with 828 clinics across 26 states. PARTICIPANTS Adolescent and adult patients (age cutoffs: 14-117 years) seeking non-pharmacological treatment for musculoskeletal conditions from January 1, 2016, to December 31, 2017 (n = 542,685). Exclusion criteria were a primary complaint not considered an MSK condition or improbable values for height, weight, or body mass index values. The study included 444,995 individuals. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of no-shows for musculoskeletal conditions and predictors of patient no-show. RESULTS In our population, 73% missed at least 1 appointment for a given physical therapy care episode. Our model had moderate discrimination for no-shows (c-statistic:0.72, all appointments; 0.73, first 7 appointments) and was well calibrated, with predicted and observed no-shows in good agreement. Variables predicting higher no-show rates included insurance type; smoking-status; higher BMI; and more prior cancellations, time between visit and scheduling date, and between current and previous visit. CONCLUSIONS The high prevalence of no-shows when seeking care for musculoskeletal conditions from physical therapists highlights an inefficiency that, unaddressed, could limit delivery of guideline-adherent care that advocates for earlier use of non-pharmacological treatments for musculoskeletal conditions and result in missed opportunities for using telehealth to deliver physical therapy.
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Affiliation(s)
- Nrupen A. Bhavsar
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United Stated of America
| | - Shannon M. Doerfler
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Anna Giczewska
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Adam Lutz
- ATI Physical Therapy, Greenville, SC, United Stated of America
- Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
| | - Charles A. Thigpen
- ATI Physical Therapy, Greenville, SC, United Stated of America
- Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
- Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
| | - Steven Z. George
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United Stated of America
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30
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Briggs MS, Ulses C, VanEtten L, Mansfield C, Ganim A, Hand BN, Quatman-Yates CC. Predictive Factors for Patients' Failure to Show for Initial Outpatient Physical Therapist Evaluation. Phys Ther 2021; 101:6124132. [PMID: 33528021 DOI: 10.1093/ptj/pzab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/19/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to examine primary factors that may predict patients' failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting. METHODS A retrospective analysis of patients' demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to the clinic were analyzed. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. RESULTS A total of 6971 patients were included in the final analysis, with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042-1.074), unemployment status (OR = 1.96; 95% CI = 1.41-2.73), unknown employment status (OR = 3.22; 95% CI = 1.12-8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43-6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10-4.49), unknown payer source (OR = 262.84; 95% CI = 188.72-366.08), and distance traveled 8 or more kilometers (OR = 1.31; 95% CI = 1.01-1.70). Female sex (OR = 0.73; 95% CI = 0.57-0.95) and age 40 years or older (OR = 0.44; 95% CI = 0.33-0.60) decreased the odds of a no-show event. CONCLUSIONS Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit. IMPACT Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.
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Affiliation(s)
- Matthew S Briggs
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christine Ulses
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucas VanEtten
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cody Mansfield
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anthony Ganim
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brittany N Hand
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Catherine C Quatman-Yates
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Karmali RN, Skinner AC, Trogdon JG, Weinberger M, George SZ, Hassmiller Lich K. The association between the supply of select nonpharmacologic providers for pain and use of nonpharmacologic pain management services and initial opioid prescribing patterns for Medicare beneficiaries with persistent musculoskeletal pain. Health Serv Res 2020; 56:275-288. [PMID: 33006158 DOI: 10.1111/1475-6773.13561] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To test the relationship between the supply of select nonpharmacologic providers (physical therapy (PT) and mental health (MH)) and use of nonpharmacologic services among older adults with a persistent musculoskeletal pain (MSP) episode. DATA SOURCES/STUDY SETTING Claims data from a 5 percent random sample of Medicare beneficiaries enrolled fee-for-service (2007-2014) and the Area Health Resource File (AHRF). STUDY DESIGN This retrospective study used generalized estimating equations to estimate the association between the county nonpharmacologic provider supply and individual service use with opioid prescriptions filled during Phase 1 (first three months of an episode) and Phase 2 (three months following Phase 1). DATA COLLECTION/EXTRACTION METHODS We identified beneficiaries (>65 years) with ≥2 MSP diagnoses ≥90 days apart and no opioid prescription six months before the first pain diagnosis (N = 69 456). Beneficiaries' county characteristics were assigned using the AHRF. PRINCIPAL FINDINGS About 13.9 percent of beneficiaries used PT, 1.8 percent used MH services, and 10.7 percent had an opioid prescription during the first three months of a persistent MSP episode. An additional MH provider/10 000 people/county [aOR: 0.97, 95% CI: 0.96-0.98] and PT/10 000 people/county [aOR: 0.98, 95% CI: 0.97-1.00] was associated with lower odds of filling an opioid prescription in Phase 1. An additional MH provider/10 000 people/county [aOR: 0.97, 95% CI: 0.96-0.98] and PT use in Phase 1 [aOR: 0.62, 95% CI: 0.58-0.67] were associated with lower odds of filling an opioid prescription in Phase 2. The associations between the supply of providers and nonpharmacologic service use in Phase 1 and Phase 1 opioid prescriptions significantly differed by metropolitan and rural counties (P-value: .019). CONCLUSIONS Limited access to nonpharmacologic services is associated with opioid prescriptions at the onset of a persistent MSP episode. Initiating PT at the onset of an episode may reduce future opioid use. Strategies for engaging beneficiaries in nonpharmacologic services should be tailored for metropolitan and rural counties.
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Affiliation(s)
- Ruchir N Karmali
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Oakland, California, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Asheley C Skinner
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Oakland, California, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Oakland, California, USA
| | - Steven Z George
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.,Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Oakland, California, USA
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McKay SE, Buono FD, Walker J, Glinski C, Printz DMB, Brienza R. Impact of interprofessional embedding of physical therapy in a primary care training clinic. J Interprof Care 2020; 35:532-537. [PMID: 32917104 DOI: 10.1080/13561820.2020.1798898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Musculoskeletal pain is a prominent complaint in primary care resulting in increased referrals to physical therapy (PT); however, the referral system often results in delays and discontinuation of care. Several models have been developed to improve the referral process including integrating PT into primary care clinics. The Veterans Health Administration (VHA) Center of Excellence in Primary Care Education (CoEPCE), which educates post-graduate trainees in interprofessional teams, began (in 2015) embedding physical therapists into primary care clinics enabling patients to see a physical therapist during their primary care visit. To evaluate the efficacy of this model we tracked the numbers of PT referrals, the number of completed referrals, and the length of time between referral and completion. PT referral parameters from PT-integrated trainees in the CoEPCE were compared to two traditional primary care training clinics at the same VHA site (Firm A and Firm B). Results indicate that the CoEPCE placed and completed more PT referrals and did so with a shorter turnaround time than was seen in the other two clinics. Further analysis suggests that the decreased turnaround time can be attributed to the integration of PTs into the primary care clinic. The results support extending the use of interprofessional clinics that integrate PT into primary care settings.
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Affiliation(s)
- Sharen E McKay
- VA Connecticut Healthcare System, Center of Excellence in Primary Care Education, West Haven, CT, USA.,Acute Care/GEPN Program, Yale School of Nursing, Orange, CT, USA.,Department of Internal Medicine, Yale School of Medicine, West Haven, CT, USA
| | - Frank D Buono
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Jennifer Walker
- VA Connecticut Healthcare System, Center of Excellence in Primary Care Education, West Haven, CT, USA
| | - Carly Glinski
- VA Connecticut Healthcare System, Center of Excellence in Primary Care Education, West Haven, CT, USA
| | | | - Rebecca Brienza
- VA Connecticut Healthcare System, Center of Excellence in Primary Care Education, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, West Haven, CT, USA
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Magel J, Kim J, Fritz JM, Freburger JK. Time Between an Emergency Department Visit and Initiation of Physical Therapist Intervention: Health Care Utilization and Costs. Phys Ther 2020; 100:1782-1792. [PMID: 32478851 PMCID: PMC7530572 DOI: 10.1093/ptj/pzaa100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 05/26/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to examine the association between the length of time between an emergency department (ED) visit and the subsequent initiation of physical therapist intervention for low back pain (LBP) on 1-year LBP-related health care utilization (ie, surgery, advanced imaging, injections, long-term opioid use, ED visits) and costs. METHODS This retrospective cohort study focused on individuals who consulted the ED for an initial visit for LBP. Claims from a single statewide, all-payers database were used. LBP-related health care use and costs for the 12 months after the ED visit were extracted. Poisson and general linear models weighted with inverse probability treatment weights were used to compare the outcomes of patients who attended physical therapy early or delayed after the ED visit. RESULTS Compared with the delayed physical therapy group (n = 94), the early physical therapy group (n = 171) had a lower risk of receiving lumbar surgery (relative risk [RR] = 0.47, 95% CI = 0.26-0.86) and advanced imaging (RR = 0.72, 95% CI = 0.55-0.95), and they were less likely to have long-term opioid use (RR = 0.45, 95% CI = 0.28-0.76). The early physical therapy group incurred lower costs (mean = $3,806, 95% CI = $1,998-$4,184) than those in the delayed physical therapy group (mean = $8,689, 95% CI = $4,653-$12,727). CONCLUSION Early physical therapy following an ED visit was associated with a reduced risk of using some types of health care and reduced health care costs in the 12 months following the ED visit. IMPACT STATEMENT The ED is an entry point into the health care system for patients with LBP. Until now, the impact of the length of time between an ED visit and physical therapy for LBP has not been well understood. This study shows that swift initiation of physical therapy following an ED visit for LBP is associated with lower LBP-related health utilization for some important outcomes and lower LBP-related health care costs.
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Affiliation(s)
- John Magel
- Address all correspondence to Dr Magel at:
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, University of Utah
| | | | - Janet K Freburger
- Department of Physical Therapy, School of Health & Rehabilitation Sciences, University of Pittsburg, Pittsburgh, Pennsylvania
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Brunner MC, Sheehan SE, Yanke EM, Sittig DF, Safdar N, Hill B, Lee KS, Orwin JF, Vanness DJ, Hildebrand CJ, Bruno MA, Erickson TJ, Zea R, Moberg DP. Joint Design with Providers of Clinical Decision Support for Value-Based Advanced Shoulder Imaging. Appl Clin Inform 2020; 11:142-152. [PMID: 32074651 DOI: 10.1055/s-0040-1701256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Provider orders for inappropriate advanced imaging, while rarely altering patient management, contribute enough to the strain on available health care resources, and therefore the United States Congress established the Appropriate Use Criteria Program. OBJECTIVES To examine whether co-designing clinical decision support (CDS) with referring providers will reduce barriers to adoption and facilitate more appropriate shoulder ultrasound (US) over magnetic resonance imaging (MRI) in diagnosing Veteran shoulder pain, given similar efficacies and only 5% MRI follow-up rate after shoulder US. METHODS We used a theory-driven, convergent parallel mixed-methods approach to prospectively (1) determine medical providers' reasons for selecting MRI over US in diagnosing shoulder pain and identify barriers to ordering US, (2) co-design CDS, informed by provider interviews, to prompt appropriate US use, and (3) assess CDS impact on shoulder imaging use. CDS effectiveness in guiding appropriate shoulder imaging was evaluated through monthly monitoring of ordering data at our quaternary care Veterans Hospital. Key outcome measures were appropriate MRI/US use rates and transition to ordering US by both musculoskeletal specialist and generalist providers. We assessed differences in ordering using a generalized estimating equations logistic regression model. We compared continuous measures using mixed effects analysis of variance with log-transformed data. RESULTS During December 2016 to March 2018, 569 (395 MRI, 174 US) shoulder advanced imaging examinations were ordered by 111 providers. CDS "co-designed" in collaboration with providers increased US from 17% (58/335) to 50% (116/234) of all orders (p < 0.001), with concomitant decrease in MRI. Ordering appropriateness more than doubled from 31% (105/335) to 67% (157/234) following CDS (p < 0.001). Interviews confirmed that generalist providers want help in appropriately ordering advanced imaging. CONCLUSION Partnering with medical providers to co-design CDS reduced barriers and prompted appropriate transition to US from MRI for shoulder pain diagnosis, promoting evidence-based practice. This approach can inform the development and implementation of other forms of CDS.
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Affiliation(s)
- Michael C Brunner
- Department of Radiology, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States.,Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Scott E Sheehan
- Department of Radiology, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States.,Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Eric M Yanke
- Department of Medicine, William S. Middleton Memorial Veteran Hospital, Madison, Wisconsin, United States
| | - Dean F Sittig
- Department of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, United States
| | - Nasia Safdar
- Department of Medicine, William S. Middleton Memorial Veteran Hospital, Madison, Wisconsin, United States.,Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Barbara Hill
- Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - John F Orwin
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - David J Vanness
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, United States
| | - Christopher J Hildebrand
- Department of Medicine, William S. Middleton Memorial Veteran Hospital, Madison, Wisconsin, United States.,Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Michael A Bruno
- Department of Radiology, The Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Timothy J Erickson
- Department of Physical Medicine and Rehabilitation, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States
| | - Ryan Zea
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - D Paul Moberg
- Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
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35
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Lentz TA, Goode AP, Thigpen CA, George SZ. Value-Based Care for Musculoskeletal Pain: Are Physical Therapists Ready to Deliver? Phys Ther 2019; 100:621-632. [PMID: 31764990 PMCID: PMC7439230 DOI: 10.1093/ptj/pzz171] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/23/2019] [Accepted: 08/18/2019] [Indexed: 12/22/2022]
Abstract
Early physical therapy models hold great promise for delivering high-value care for individuals with musculoskeletal pain. However, existing physical therapist practice and research standards are misaligned with value-based principles, which limits the potential for growth and sustainability of these models. This Perspective describes how the value proposition of early physical therapy can be improved by redefining harm, embracing a prognostic approach to clinical decision making, and advocating for system-wide guideline-adherent pain care. It also outlines the need to adopt a common language to describe these models and embrace new, rigorous study designs and analytical approaches to better understand where and how early physical therapy delivers value. The goal is to define a clear path forward to ensure physical therapists are aligned within health care systems to deliver on the American Physical Therapy Association's vision of high-value care in a rapidly changing health care environment.
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Affiliation(s)
- Trevor A Lentz
- Duke Clinical Research Institute, Duke University, and Department of Orthopaedic Surgery, Duke University, 200 Morris St, Durham, NC 22701 USA,Address all correspondence to Dr Lentz at:
| | - Adam P Goode
- Duke Clinical Research Institute, Department of Orthopedic Surgery, and Department of Population Health Sciences, Duke University
| | - Charles A Thigpen
- ATI Physical Therapy, Greenville, South Carolina, and Center for Effectiveness Research in Orthopaedics, University of South Carolina, Greenville, South Carolina
| | - Steven Z George
- FAPTA, Duke Clinical Research Institute, and Department of Orthopedic Surgery, Duke University
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Kazis LE, Ameli O, Rothendler J, Garrity B, Cabral H, McDonough C, Carey K, Stein M, Sanghavi D, Elton D, Fritz J, Saper R. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open 2019; 9:e028633. [PMID: 31542740 PMCID: PMC6756340 DOI: 10.1136/bmjopen-2018-028633] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP). DESIGN A retrospective cohort study of patients with new-onset LBP from 2008 to 2013. SETTING The study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP. PARTICIPANTS 216 504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance. EXPOSURES The primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists). MAIN OUTCOME MEASURES Short-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days' supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months). RESULTS Short-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively). CONCLUSIONS Initial visits to chiropractors or physical therapists is associated with substantially decreased early and long-term use of opioids. Incentivising use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.
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Affiliation(s)
- Lewis E Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Omid Ameli
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- OptumLabs, Cambridge, Massachusetts, USA
| | - James Rothendler
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Brigid Garrity
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christine McDonough
- University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA
| | - Kathleen Carey
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | | | - Julie Fritz
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Robert Saper
- Boston University Medical Campus, Boston, Massachusetts, USA
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Rhon DI, Greenlee TA, Fritz JM. The Influence of a Guideline-Concordant Stepped Care Approach on Downstream Health Care Utilization in Patients with Spine and Shoulder Pain. PAIN MEDICINE 2019; 20:476-485. [PMID: 30412232 DOI: 10.1093/pm/pny212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Stepped care approaches are emphasized in guidelines for musculoskeletal pain, recommending less invasive or risky evidence-based intervention, such as manual therapy (MT), before more aggressive interventions such as opioid prescriptions. The order and timing of care can alter recovery trajectories. OBJECTIVE To compare one-year downstream health care utilization in patients with spine or shoulder disorders who received only MT vs MT and opioids. The secondary aim was to compare differences based on order and timing of opioids and MT. DESIGN Retrospective observational cohort. METHODS Patients with an initial consultation for a spine or shoulder disorder who received at least one visit for MT were included. Person-level data from the Military Health System Management and Reporting Tool (M2) database were aggregated by a senior health care analyst at Madigan Army Medical Center. Groups were created based on the order and timing of interventions provided. Outcomes included health care utilization (medical costs and visits) over the year following initial consultation. Control measures included metabolic, mental health, chronic pain, sleep, and substance abuse comorbidities, as well as prior opioid prescriptions. Generalized linear models with gamma log links were run due to the heavily skewed nature of cost data. RESULTS From 1,876 unique patients with spine or shoulder disorders receiving MT, 1,162 (61.9%) also received prescription opioids. Mean one-year costs in the MT-only group ($5,410, 95% confidence interval [CI] = $5,109 to $5,730) were significantly lower than in the MT+opioid group ($10,498, 95% CI = $10,043 to $10,973). When patients had both treatments, mean one-year costs in the MT-first ($10,782, 95% CI = $10,050 to $11,567) were significantly lower (P = 0.030) than opioid-first ($11,938, 95% CI = $11,272 to $12,643), and MT-first had a significantly lower mean days' supply of opioids (34.2 vs 70.9, P < 0.001) and mean number of unique opioid prescriptions (3.1 vs 6.5, P < 0.001). CONCLUSIONS MT alone resulted in lower downstream costs than with opioid prescriptions. Both the order of treatment (MT before opioid prescriptions) and the timing of treatment (MT < 30 days) resulted in a significant reduction of resources (costs, visits, and opioid utilization) in the year after initial consultation. Clinicians should consider the implications of first-choice decisions and the timing of care for treatment choices utilized for patients with spine and shoulder disorders.
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Affiliation(s)
- Daniel I Rhon
- Center for the Intrepid, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam, Houston, Texas.,Doctoral Programs in Physical Therapy, Baylor University, San Antonio, Texas
| | - Tina A Greenlee
- Center for the Intrepid, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam, Houston, Texas
| | - Julie M Fritz
- College of Health, University of Utah, Salt Lake City, Utah, USA
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Deslauriers S, Déry J, Proulx K, Laliberté M, Desmeules F, Feldman DE, Perreault K. Effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders: a systematic review. Disabil Rehabil 2019; 43:611-620. [PMID: 31304824 DOI: 10.1080/09638288.2019.1639222] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE This systematic review aimed to assess the scientific evidence on the effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders. METHODS A literature search was conducted in three databases (Medline, CINAHL, and Embase) for articles assessing the effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders. Clinical and health system outcomes were analyzed. RESULTS Sixteen studies met the inclusion criteria for this review. The studies varied in designs, settings, and populations. The definition of waiting also varied between studies. The studies were of low to high methodological quality. Waiting for outpatient physiotherapy services was shown to have mixed results on clinical and health system outcomes. Results from included studies suggest the possible detrimental effects of waiting on pain, disability, quality of life, and psychological symptoms in persons with musculoskeletal disorders. There was also evidence of higher healthcare utilization and costs for patients who wait longer before physiotherapy services. CONCLUSIONS This review provides mixed evidence that suggest potential detrimental effects on the health of individuals with MSDs and at the health system level. Further high-quality studies are needed, such as longitudinal studies specifically addressing the effects of waiting due to lack of access to physiotherapy services.IMPLICATIONS FOR REHABILITATIONThe findings from this review suggest potential detrimental effects on health outcomes when patients wait longer before receiving physiotherapy services.The findings also suggest higher healthcare utilization and costs for patients with longer wait times compared to those who receive physiotherapy services more rapidly.This review suggests the need to assess and implement strategies and policies to ensure timely access to physiotherapy.
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Affiliation(s)
- Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Julien Déry
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Ketsia Proulx
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Maude Laliberté
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Maisonneuve-Rosemont Hospital Research Centre (CRHMR), Montreal, Canada
| | - Debbie E Feldman
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Public Health Research Institute of Université de Montréal, Montréal, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
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39
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Arnold E, La Barrie J, DaSilva L, Patti M, Goode A, Clewley D. The Effect of Timing of Physical Therapy for Acute Low Back Pain on Health Services Utilization: A Systematic Review. Arch Phys Med Rehabil 2019; 100:1324-1338. [DOI: 10.1016/j.apmr.2018.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
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Neilson AR, Jones GT, Macfarlane GJ, Walker-Bone K, Burton K, Heine PJ, McCabe CS, McConnachie A, Palmer KT, Coggon D, McNamee P. Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: an economic evaluation of data from a randomized controlled trial. Fam Pract 2019; 36:179-186. [PMID: 29878103 PMCID: PMC6425461 DOI: 10.1093/fampra/cmy047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Arm pain is common, costly to health services and society. Physiotherapy referral is standard management, and while awaiting treatment, advice is often given to rest, but the evidence base is weak. OBJECTIVE To assess the cost-effectiveness of advice to remain active (AA) versus advice to rest (AR); and immediate physiotherapy (IP) versus usual care (waiting list) physiotherapy (UCP). METHODS Twenty-six-week within-trial economic evaluation (538 participants aged ≥18 years randomized to usual care, i.e. AA (n = 178), AR (n = 182) or IP (n = 178). Regression analysis estimated differences in mean costs and Quality-Adjusted Life Years (QALYs). Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were generated. Primary analysis comprised the 193 patients with complete resource use (UK NHS perspective) and EQ-5D data. Sensitivity analysis investigated uncertainty. RESULTS Baseline-adjusted cost differences were £88 [95% confidence interval (CI): -14, 201) AA versus AR; -£14 (95% CI: -87, 66) IP versus UCP. Baseline-adjusted QALY differences were 0.0095 (95% CI: -0.0140, 0.0344) AA versus AR; 0.0143 (95% CI: -0.0077, 0.0354) IP versus UCP. There was a 71 and 89% probability that AA (versus AR) and IP (versus UCP) were the most cost-effective option using a threshold of £20,000 per additional QALY. The results were robust in the sensitivity analysis. CONCLUSION The difference in mean costs and mean QALYs between the competing strategies was small and not statistically significant. However, decision-makers may judge that IP was not shown to be any more effective than delayed treatment, and was no more costly than delayed physiotherapy. AA is preferable to one that encourages AR, as it is more effective and more likely to be cost-effective than AR.
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Affiliation(s)
- Aileen R Neilson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gareth T Jones
- Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, UK
| | - Gary J Macfarlane
- Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, UK
| | - Karen Walker-Bone
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Kim Burton
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, UK
| | - Peter J Heine
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Candy S McCabe
- Royal United Hospitals NHS Foundation Trust, Bath, UK
- University of West of England, Bristol, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Keith T Palmer
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - David Coggon
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Ramirez MM, Brennan GP. Using the value-based care paradigm to compare physical therapy access to care models in cervical spine radiculopathy: a case report. Physiother Theory Pract 2019; 36:1476-1484. [PMID: 30776939 DOI: 10.1080/09593985.2019.1579878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The efficiency and effectiveness of multiple physical therapy care delivery models can be measured using the value-based care paradigm. Entering physical therapy through direct access can decrease health-care utilization and improve patient outcomes. Limited evidence exists which compares direct access physical therapy to referral using the value-based care paradigm specific to cervical spine radiculopathy. Case Description: The patient was a 39-year-old woman who presented to physical therapy through physician referral with the diagnoses of acute cervical radiculopathy. The patient was evaluated, provided guideline adherent treatment and discharged with a home exercise program. Sixteen months from being discharged, the same patient returned through direct access due to an acute onset of cervical spine symptoms and was evaluated and provided treatment that same morning. Outcomes: Direct access physical therapy saved the patient and third-party payer $434.30 and $3264.75 respectively. A 5×'s higher efficiency per visit and a 6.2×'s higher value in reducing disability was demonstrated when the patient accessed physical therapy directly. Physician referral and direct access entry pathways demonstrated neck disability index improvements of 6% and 16%, respectively. Discussion: This case report describes a clinical example of previous research that demonstrates improved cost efficiency, outcomes, and increased value with a patient who presented to physical therapy with cervical radiculopathy through two different access to care models. The results of this case demonstrate a clinical example of the use of the value-based care paradigm in comparing value and efficiency of two access to care models in a patient with cervical radiculopathy without other neurological deficits.
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Affiliation(s)
- Michelle M Ramirez
- Department of Sports Medicine and Rehabilitation, AdventHealth Orlando-Adventist Health System , Orlando, FL, USA
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Bornhöft L, Larsson ME, Nordeman L, Eggertsen R, Thorn J. Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial. Ther Adv Musculoskelet Dis 2019; 11:1759720X19827504. [PMID: 30800175 PMCID: PMC6378424 DOI: 10.1177/1759720x19827504] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/09/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Physiotherapists and general practitioners (GPs) both act as primary assessors for patients with musculoskeletal disorders in primary care. Previous studies have shown that initial triaging to physiotherapists at primary healthcare centres has advantages regarding efficiency in the work environment and utilization of healthcare. In this study, we aimed primarily to determine whether triaging to physiotherapists affects the progression of health aspects over time differently than traditional management with initial GP assessment. The secondary aim was to determine whether triaging to physiotherapists affects patients’ attitudes of responsibility for musculoskeletal disorders. Methods: This was a pragmatic trial where both recruitment and treatment strategies were determined by clinical, not study-related parameters, and was initiated at three primary care centres in Sweden. Working-age patients of both sexes seeking primary care for musculoskeletal disorders and nurse assessed as suitable for triaging to physiotherapists were randomized to initial consultations with either physiotherapists or GPs. They received self-assessment questionnaires before the initial consultation and were followed up at 2, 12, 26 and 52 weeks with the same questionnaires. Outcome measures were current and mean (3 months) pain intensities, functional disability, risk for developing chronic musculoskeletal pain, health-related quality of life and attitudes of responsibility for musculoskeletal conditions. Trends over time were analysed with a regression model for repeated measurements. Results: The physiotherapist-triaged group showed significant improvement for health-related quality of life at 26 weeks and showed consistent but nonsignificant tendencies to greater reductions of current pain, mean pain in the latest 3 months, functional disability and risk for developing chronic pain compared with traditional management. The triage model did not consistently affect patients’ attitudes of responsibility for musculoskeletal disorders. Conclusions: Triaging to physiotherapists for primary assessment in primary care leads to at least as positive health effects as primary assessment by GPs and can be recommended as an alternative management pathway for patients with musculoskeletal disorders. ClinicalTrials.gov identifier: NCT148611.
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Affiliation(s)
- Lena Bornhöft
- Göteborgs universitet Sahlgrenska Akademin, Box 455, Gothenburg 405 30, Sweden
| | | | - Lena Nordeman
- Göteborgs universitet Sahlgrenska Akademin, Gothenburg, Sweden
| | | | - Jörgen Thorn
- Göteborgs universitet Sahlgrenska Akademin, Gothenburg, Sweden
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Ojha H, Masaracchio M, Johnston M, Howard RJ, Egan WE, Kirker K, Davenport TE. Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review. Physiother Theory Pract 2019; 36:1179-1200. [PMID: 30739564 DOI: 10.1080/09593985.2019.1571135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: Currently there is a large and perhaps unwarranted variation regarding physical therapy utilization for individuals with low back pain (LBP). The purpose of this systematic review was to compare the effects of minimal physical therapy utilization/education (two visits or less) versus typical physical therapy utilization (three visits or more) on patient-important outcomes for patients with LBP. Methods: Two independent reviewers searched Cochrane, Medline, CINAHL, Web of Science, and PEDro from database inception until March 2017. Eligible studies used a randomized design, included subjects with LBP, and compared minimal versus higher utilization. The GRADE approach was used to provide an overall level of evidence regarding utilization. Eight articles (1153 individual subjects) met the inclusion criteria. Effect sizes for each outcome measure were calculated using Hedge's g and were adjusted for baseline values at each time period. Findings: When compared with minimal utilization, higher utilization demonstrated no significant differences on pain, disability, or quality of life at the 1-year follow-up. However, two of the three studies that analyzed cost-effectiveness found higher utilization to be more cost-effective at 1-year follow-up. Moreover, there was insufficient evidence available to investigate patient subgroups (acuity, risk for chronicity), multiple levels of utilization dosage (low, typical, and high), or intervention type. Conclusions: This review identifies the need for further research on the dosage of physical therapy among various subgroups of patients with LBP. While higher utilization may not result in significant improvements in patient-important outcomes, it may be more cost-effective for patients with chronic or complex LBP conditions when compared to minimal utilization.
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Affiliation(s)
- Heidi Ojha
- Department of Physical Therapy, Temple University , Philadelphia, PA, USA
| | | | - Matthew Johnston
- Department of Physical Therapy, Apex Physical Therapy , Chalfont, PA, USA
| | - Ralph J Howard
- Department of Physical Therapy, St. Mary Home Health , Langhorne, PA, USA
| | - William E Egan
- Department of Physical Therapy, Temple University , Philadelphia, PA, USA
| | - Kaitlin Kirker
- Department of Physical Therapy, Long Island University , Brooklyn, NY, USA
| | - Todd E Davenport
- Department of Physical Therapy, University of the Pacific, Thomas J Long School of Pharmacy and Health Sciences , Stockton, CA, USA
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Noon CT, Nwose EU, Breheny L. Evaluation of gender differences in exercise adherence for low back pain: case reviews and survey. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1468815] [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)
- Chelsea T. Noon
- School of Community Health, Charles Sturt University, Orange, New South Wales, Australia
| | - Ezekiel U. Nwose
- School of Community Health, Charles Sturt University, Orange, New South Wales, Australia
| | - Louise Breheny
- School of Community Health, Charles Sturt University, Orange, New South Wales, Australia
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Effectiveness and Downstream Healthcare Utilization for Patients That Received Early Physical Therapy Versus Usual Care for Low Back Pain: A Randomized Clinical Trial. Spine (Phila Pa 1976) 2018; 43:1313-1321. [PMID: 29489568 DOI: 10.1097/brs.0000000000002619] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE The aim of this study was to compare early physical therapy versus usual care in patients with low back pain. SUMMARY OF BACKGROUND DATA Early physical therapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system. METHODS Military service members seeking care from a general practitioner were recruited. Patients attended a 20-minute self-management class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physical therapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4- and 12-week follow-up, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year. Analysis of covariance was used to compare differences between groups, significance set at 0.05. TRIAL REGISTRATION clinicaltrials.gov: NCT01556581 RESULTS.: A total of 119 patients (mean age 27.2 years; mean BMI 27.8 kg/m; 15.1% female) enrolled (61 randomized to UC; 58 to PT). No between-group differences found on the Oswestry after 1 year. A between-group difference in Oswestry was present at 4 weeks (mean difference = 4.4; 95% CI: 0.41-10.1; P = 0.042) favoring PT. Total 1-year mean healthcare costs did not differ significantly between groups (UC $5037; 95 CI $4171-$6082 and PT $5299; 95 CI $4367-$6431). The portion of total mean healthcare costs related to low back pain was lower for UC ($1096; 95% CI $855-$1405) compared to PT ($2016, 95% CI $1570-$2590). CONCLUSION There was no difference between usual care and early PT after 1 year. PT provided greater improvement in disability after 4 weeks. As both groups improved, the impact of the education may have been underestimated. Patients in the PT group utilized greater back-pain-related healthcare resources, but overall healthcare costs did not differ compared to UC. LEVEL OF EVIDENCE 2.
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Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2018; 30:754-772. [PMID: 30168261 DOI: 10.1111/1742-6723.13131] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/14/2018] [Accepted: 06/10/2018] [Indexed: 12/13/2022]
Abstract
Neck pain and whiplash injuries are a common presentation to the ED, and a frequent cause of disability globally. This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years addressing acute neck pain assessment, management or prognosis in the ED were included. Data extraction was conducted, followed by quality appraisal to rate levels of evidence where possible. The search revealed 2080 articles, of which 51 were included (n = 22 primary articles, n = 13 systematic reviews and n = 16 guidelines). Consistent evidence was found to support the use of 'red flags' to screen for serious pathologies, judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance. Clinicians may also consider applying risk-stratification methods, such as using a clinical prediction rule, to guide patient discharge and referral plans; however, the evidence is still emerging in this population. This rapid review provides clinicians managing neck pain in the ED a summary of the best available evidence to enhance quality of care and optimise patient outcomes.
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Affiliation(s)
- Kirsten Strudwick
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan McPhee
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anthony Bell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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47
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Liu X, Hanney WJ, Masaracchio M, Kolber MJ, Zhao M, Spaulding AC, Gabriel MH. Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs. Phys Ther 2018; 98:336-347. [PMID: 29669083 DOI: 10.1093/ptj/pzy023] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/19/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial. OBJECTIVE The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP. DESIGN The design was a retrospective cohort study. METHODS Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed. RESULTS Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures. LIMITATIONS This study was based on commercial insurance claims data from 1 state. CONCLUSIONS When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs.
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Affiliation(s)
- Xinliang Liu
- Department of Health Management and Informatics, University of Central Florida, 4000 Central Florida Blvd, HPA II - 204, Orlando, FL 32816-2205 (USA)
| | | | | | - Morey J Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida
| | - Mei Zhao
- Department of Health Administration, University of North Florida, Jacksonville, Florida
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Meghan H Gabriel
- Department of Health Management and Informatics, University of Central Florida
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Deslauriers S, Raymond MH, Laliberté M, Lavoie A, Desmeules F, Feldman DE, Perreault K. Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across Quebec, Canada. J Eval Clin Pract 2017; 23:1489-1497. [PMID: 29063716 DOI: 10.1111/jep.12838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/12/2017] [Accepted: 09/26/2017] [Indexed: 01/02/2023]
Abstract
RATIONALE The prevalence of musculoskeletal disorders is high and expected to increase in the next decade. Persons suffering from musculoskeletal disorders benefit from early physiotherapy services. However, access to publicly funded physiotherapy services has been shown to be compromised by long waiting times and limited availability of resources in many countries around the world. Decisions on resource allocation may create geographic disparities in provision and access to services, which may result in inequity in access. AIMS AND OBJECTIVES This study aimed to assess variations in demand and provision of publicly funded outpatient physiotherapy services across the province of Quebec, Canada, as well as to assess the demand to provision relationship. METHODS We conducted a secondary analysis of data retrieved from the 2008 Quebec Health Survey and data obtained from a survey of hospitals in the province of Quebec in 2015. We used geographic information systems analyses and descriptive analyses to assess geographic variations and the relationship between demand and provision. RESULTS Our results indicate substantial variations in the provision and demand for physiotherapy services in the province of Quebec. The variations in service provision did not follow the variations in demand. Long waiting times and insufficient provision of services were found in many regions. CONCLUSIONS The variations in provision of physiotherapy services between regions reported in our study did not correspond to the variations in demand. Such geographic variations and demand to provision mismatches may create inequity in access to services, especially for those unable to afford private services.
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Affiliation(s)
- Simon Deslauriers
- Faculty of Medicine, Université Laval; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
| | - Marie-Hélène Raymond
- School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Maude Laliberté
- School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Amélie Lavoie
- Faculty of Medicine, Université Laval; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal; Maisonneuve-Rosemont Hospital Research Centre, Montréal, Canada
| | - Debbie E Feldman
- School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval; CIRRIS, Quebec City, Canada
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Masaracchio M, Hanney WJ, Liu X, Kolber M, Kirker K. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS One 2017; 12:e0178295. [PMID: 28575058 PMCID: PMC5456061 DOI: 10.1371/journal.pone.0178295] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/10/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the role of early initiation of rehabilitation on length of stay (LOS) and cost following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty. DATA SOURCES Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, and the Cochrane Library were searched in July 2016. Five additional trials were identified through reference list scanning. STUDY SELECTION Eligible studies were published in English language peer-reviewed journals; included participants that had undergone total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty reported clearly defined timing of rehabilitation onset for at least two groups; and reported at least one measure of LOS or cost. Inclusion criteria were applied by 2 independent authors, with disagreements being determined by a third author. Searching identified 1,029 potential articles, of which 17 studies with 26,614 participants met the inclusion criteria. DATA EXTRACTION Data was extracted independently by 2 authors, with disagreements being determined by a third author. Methodological quality of each study was evaluated independently by 2 authors using the Downs and Black checklist. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate standardized mean differences (SMD) and 95% confidence intervals for LOS. DATA SYNTHESIS When compared with standard care, early initiation of physical therapy demonstrated a decrease in length of stay for the 4 randomized clinical trials (SMD = -1.90; 95% CI -2.76 to -1.05; I2 = 93%) and for the quasi-experimental and 5 prospective studies (SMD = -1.47; 95% CI -1.85 to -1.10; I2 = 88%). CONCLUSION Early initiation of rehabilitation following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty is associated with a shorter LOS, a lower overall cost, with no evidence of an increased number of adverse reactions. Additional high quality studies with standardized methodology are needed to further examine the impact of early initiation of physical therapy among patients with joint replacement procedures.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/rehabilitation
- Humans
- Length of Stay/economics
- Physical Therapy Modalities/economics
- Treatment Outcome
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Affiliation(s)
- Michael Masaracchio
- Department of Physical Therapy, Long Island University, Brooklyn, New York, United States of America
| | - William J. Hanney
- Department of Health Professions, University of Central Florida, Orlando, Florida, United States of America
| | - Xinliang Liu
- Department of Health Management and Informatics, University of Central Florida, Orlando, Florida, United States of America
| | - Morey Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Kaitlin Kirker
- Department of Physical Therapy, Long Island University, Brooklyn, New York, United States of America
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