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Wilson CM, Arena SK, Calleja K, Patterson S, Randazzo H. Administrative Analysis of the Home-Based Older Persons Upstreaming Prevention Physical Therapy Program: A Pilot Observational Study. Cureus 2024; 16:e67290. [PMID: 39310421 PMCID: PMC11415000 DOI: 10.7759/cureus.67290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Traditionally, physical therapist (PT) services do not commence until an injury, fall, or health issue has already occurred although there is increasing evidence that preventative programs administered by PTs may decrease the fall risk among elderly individuals. The purpose of this study was to examine billing, reimbursement, and administrative outcomes of the previously established and investigated prevention-based screening and intervention HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program delivered by a physical therapist in the home of older adults after being referred by a community partner. A randomized controlled trial of the HOP-UP-PT program demonstrated an 8-fold reduction in falls for participants at moderate and high fall risk compared to those who did not participate in the program. Methods A prospective observational study was performed to examine administrative and payment outcomes of HOP-UP-PT participation. Participants were referred into the HOP-UP-PT program via a local community center. Physician authorization for physical therapy participation was obtained for each participant as required for payment under United States' Center for Medicare and Medicaid Services (CMS) guidelines. The HOP-UP-PT program is preventative physical therapy delivered in the person's home with five in person visits (approximately one per month) followed by a monthly telehealth visit and a final in-person visit. Interventions included a balance program, home safety recommendations, health coaching, and addressing individual risks of falling or becoming homebound. A retrospective analysis was performed on the administrative and insurance payment data from this study which was then analyzed descriptively. Results Six participants with four different insurances completed the 7-month program (mean age=77 years) in 2021. The physical therapy visits were submitted to the participants' Medicare Part B plan. One participant's physical therapy visits were not submitted for payment as the health system did not have an active agreement with that health insurer. Due to the unclear status of telehealth visits in 2021, these services were not submitted to the insurance company for payment. All other PT visits were paid by the insurance companies. The mean amount paid for the initial evaluation code was $102.83 and the mean payment for the ~15 minute treatment codes was $25.90 per unit. Initial pilot data demonstrated a potential for a 4.2% positive operating margin when considering salary costs and travel. The mean delay from the initial referral into the HOP-UP-PT program until the physician provided written authorization for physical therapy was 69.7 days. Conclusion This study demonstrated initial evidence that payment for prevention-focused outpatient physical therapist services delivered in the home was feasible, however delays and costs in procuring physician authorization was a substantial barrier to prevention-focused physical therapy. A 4.2% operating margin demonstrated that, when efficiently operated, similar programs are likely to be viable. Furthermore, if telehealth services would have been paid, the operating margin was estimated to increase to 32%. Physical therapists are highly qualified to deliver efficient, effective preventative services which has the potential to reduce falls and institutionalization and subsequent healthcare cost savings.
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Affiliation(s)
- Christopher M Wilson
- Rehabilitation Services, Beaumont Health, Troy, USA
- Human Movement Science/Physical Therapy, Oakland University, Rochester, USA
| | - Sara K Arena
- Human Movement Science/Physical Therapy, Oakland University, Rochester, USA
| | - Kathryn Calleja
- Human Movement Science/Physical Therapy, Oakland University, Rochester, USA
| | - Shane Patterson
- Human Movement Science/Physical Therapy, Oakland University, Rochester, USA
| | - Hannah Randazzo
- Human Movement Science/Physical Therapy, Oakland University, Rochester, USA
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Boyle EM, Evans K, Coates S, Fary RE, Bennell K, Sterling M, Rebbeck T, Beales DJ. Patient experiences of referral practices and primary care physiotherapy for chronic nonspecific low back pain. Physiother Theory Pract 2024; 40:1326-1342. [PMID: 36331383 DOI: 10.1080/09593985.2022.2141599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings. PURPOSE This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy. METHODS An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices. RESULTS Four themes described the participants' experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices. CONCLUSION Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist's role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people's experiences of care and health outcomes.
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Affiliation(s)
- Eileen M Boyle
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
- Healthia Limited, Bowen Hills Queensland, Australia
| | - Sonia Coates
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
| | - Robyn E Fary
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
| | - Kim Bennell
- Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Parkville Carlton, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMR Centre of Research Excellence in Road Traffic Injury recovery, The University of Queensland, Brisbane City Queensland, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
| | - Darren J Beales
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
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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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Baumbach L, Feddern W, Kretzler B, Hajek A, König HH. Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists: A Systematic Review of Trial-Based Evaluations. SPORTS MEDICINE - OPEN 2024; 10:38. [PMID: 38613739 PMCID: PMC11016054 DOI: 10.1186/s40798-024-00713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists. METHODS We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist. RESULTS We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons. CONCLUSIONS High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments.
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Affiliation(s)
- Linda Baumbach
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Wiebke Feddern
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Barrett DR, Nielsen LM, Rhon DI, Young JL. What are patients' perspectives on the value of physical therapy? A prospective cohort study. Musculoskeletal Care 2024; 22:e1871. [PMID: 38393306 DOI: 10.1002/msc.1871] [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: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. METHODS The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. RESULTS A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p = 0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p = 0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r = -0.18, p = 0.048) and higher physical function scores (r = 0.22, p = 0.03). CONCLUSIONS Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.
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Affiliation(s)
- Dustin R Barrett
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | | | - Daniel I Rhon
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
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Vignaud H, Molins C, Legaux C, Slusznis A, Sarhan FR, Demont A. Description of the abilities of physiotherapists in terms of diagnostic hypothesis and management decision for self-referred patients with musculoskeletal disorders in France using clinical vignettes: A cross-sectional survey. Musculoskeletal Care 2023; 21:1592-1600. [PMID: 37902190 DOI: 10.1002/msc.1836] [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: 09/30/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Direct access to physiotherapy has been introduced in several countries. In France, the healthcare system is evolving towards its introduction; however, no study has described the ability of physiotherapists in this context. OBJECTIVE To describe the ability of physiotherapists practicing in France to formulate correct diagnostic hypotheses and make appropriate management decisions using clinical vignettes. METHODS Pre-existing validated clinical vignettes were used and integrated into a numerical questionnaire. The percentages of correct answers were calculated from the results concerning the choice of diagnostic hypothesis and the management decision, both overall and for the three different patient categories: musculoskeletal, non-critical medical, and critical medical. RESULTS Four hundred eighty-two participants (1.7%) responded to the study. For the formulation of a diagnostic hypothesis, there were 43.0% (415/964), 26.6% (128/482), and 17.8% (86/482) correct answers respectively for the musculoskeletal, non-critical medical, and critical medical categories. For management decisions, there were 60.8% (586/964), 61.6% (297/482), and 85.1% (410/482) correct answers respectively for the same categories. CONCLUSIONS Our results related to the management decision were better than those for the diagnostic hypothesis, especially for the critical medical category. There is still room for improvement. It might be interesting to support this initial study by using more clinical vignettes validated in a French context.
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Affiliation(s)
- Hermine Vignaud
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
| | - Constance Molins
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
| | - Clara Legaux
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
| | - Anouchka Slusznis
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
| | - François-Régis Sarhan
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- UR 7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France
| | - Anthony Demont
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologique et Statistique Sorbonne Paris Cité, Paris, France
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Gagnon R, Hébert LJ, Guertin JR, Berthelot S, Desmeules F, Perreault K. Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation. PLoS One 2023; 18:e0277369. [PMID: 37708179 PMCID: PMC10501643 DOI: 10.1371/journal.pone.0277369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES 1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period. METHODS Obj.1: The costs incurred by participants in the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method. These costs will be compared using generalized linear models. Obj. 2: The ICER of the two models will be evaluated over three months via a cost-utility analysis that will combine costs and effectiveness data (quality-adjusted life years) using both Health system and Societal perspectives (patient + health system costs). Obj. 3: The 2-year ICER of the three above-mentioned models will be estimated using a mathematical model including a decision tree (0-3 months post-visit) and a Markov model (3-24 months post-visit), also using both Health system and Societal perspectives. Data to answer the three objectives will come from data collected during a randomized clinical trial (n = 78, CHU de Québec)which will be supplemented with data obtained via some of the CHU de Québec administrative databases (nominative data; SIURGE (ED management software), Cristal-Net (patient electronic record), and the ED's pharmacy transactions directory; administrative data: drug costs repository), the literature, and public cost repositories. CONCLUSION This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services.
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Affiliation(s)
- Rose Gagnon
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Luc J. Hébert
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Jason R. Guertin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
| | - Simon Berthelot
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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Gallotti M, Campagnola B, Cocchieri A, Mourad F, Heick JD, Maselli F. Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review. J Clin Med 2023; 12:5832. [PMID: 37762773 PMCID: PMC10531538 DOI: 10.3390/jcm12185832] [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: 08/03/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists' characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261.
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Affiliation(s)
- Marco Gallotti
- Catholic University of the Sacred Heart, Rome Campus, 00168 Rome, Italy
| | - Benedetta Campagnola
- University Hospital Foundation Campus Bio-Medico, Rome University, 00128 Rome, Italy
| | | | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Luxembourg, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Luxembourg, Luxembourg
| | - John D. Heick
- Department of Physical Therapy, Northern Arizona University, P.O. Box 15105, Flagstaff, AZ 86011, USA
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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Alshareef N, Cozad M, Macauda M, Ostermann J, Thigpen C. Patient attitudes and beliefs associated with self-referral to physical therapy for musculoskeletal complaints: a qualitative study. BMC Health Serv Res 2023; 23:80. [PMID: 36698120 PMCID: PMC9875530 DOI: 10.1186/s12913-022-08989-x] [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] [Received: 06/25/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Non-pharmacologic treatments such as physical therapy (PT) are advocated for musculoskeletal pain. Early access to PT through self-referral has been shown to decrease costs and improve outcomes. Although self-referral is permitted in most U.S. states and supported by some health insurance plans, patients' utilization of self-referral remains low. OBJECTIVE To identify factors, beyond legislative policies and health insurance, associated with patients' decisions to access physical therapy through self-referral or provider-referral. METHODS We recruited 26 females and 6 males whose employer-sponsored insurance benefits included financial incentives for self-referral to physical therapy. Between August 2017 and March 2018, participants completed semi-structured interviews about their beliefs about physical therapy and reasons for choosing self-referral (15 participants) or provider referral (17 participants) for accessing physical therapy. Grounded theory approach was employed to identify themes in the data. RESULTS Patients selecting self-referral reported major thematic differences compared to the provider-referral patients including knowledge of the direct access program, attitudes and beliefs about physical therapy and pharmacologic treatment, and prior experiences with physical therapy. Self-referral patients were aware that their plan benefits included reduced cost for self-referral and felt confident in selecting that pathway. They also had negative beliefs about the effectiveness of pharmacological treatments and surgery, and previously had positive direct or indirect experiences with physical therapy. CONCLUSION Knowledge of the ability to self-refer, attitudes and beliefs about treatment, and prior experience with physical therapy were associated with self-referral to physical therapy. Interventions aimed at improving knowledge and changing attitudes toward self-referral to physical therapy to increase utilization appear warranted.
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Affiliation(s)
- Noor Alshareef
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA.
| | - Melanie Cozad
- Department of Health Services Research and Administration, Collage of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Mark Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
| | - Charles Thigpen
- ATI Physical Therapy, 200 Patewood Dr, Greenville, SC, 29615, USA
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10
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Gagnon R, Hébert LJ, Guertin JR, Berthelot S, Desmeules F, Perreault K. L’évaluation économique en physiothérapie ou comment en avoir pour son argent. Physiother Can 2022. [DOI: 10.3138/ptc-2022-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Rose Gagnon
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
- Faculté de médecine, Université Laval
| | - Luc J. Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
- Faculté de médecine, Université Laval
| | - Jason R. Guertin
- Faculté de médecine, Université Laval
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval
| | - Simon Berthelot
- Faculté de médecine, Université Laval
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval
- CHU de Québec – Université Laval
| | | | - Kadija Perreault
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
- Faculté de médecine, Université Laval
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Clark B, Clark L, Showalter C, Stoner T. A call to action: direct access to physical therapy is highly successful in the US military. When will professional bodies, legislatures, and payors provide the same advantages to all US civilian physical therapists? J Man Manip Ther 2022; 30:199-206. [PMID: 35906773 PMCID: PMC9344959 DOI: 10.1080/10669817.2022.2099893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES In 2000, the American PT Association (APTA) published its Vision statement advocating for DA (DA) to PT. This narrative review of the literature aims to identify the current state of DA in the United States (US) and compare that status to the US Military. METHODS Initial PubMed search in the English language with keywords physical therapy (PT), physiotherapy, DA, self-referral, and primary contact from the year 2000 onwards with subsequent focused searches using keywords DA/self-referral/primary contact of physical therapists/physiotherapists on outcomes/autonomous practice/economic impact/patient satisfaction yielded 103 applicable studies on the topic. This paper excluded 40 international articles to focus on US military and civilian research. RESULTS Current literature supports Physical Therapists (PTs) in an initial contact role based on patient safety, satisfaction, access to care, efficiency, healthcare utilization, and potential cost savings. CONCLUSIONS Despite its success in the US Military, DA to PT in the US civilians remains limited and incomplete. PTs still await unrestricted DA and privileges associated with autonomous practice including the ability to order imaging and prescribe some medications.
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Affiliation(s)
- Bryant Clark
- Sentara Therapy Center: Indian River 5660 Indian River Road, Virginia Beach, VA, USA
| | - Lindsay Clark
- Sentara Primary Care and Therapy Center: Oceanfront, Virginia Beach, VA, USA
| | - Chris Showalter
- Maitland-Australian Physiotherapy Seminars, Cutchogue, NY, USA
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12
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Crawford T, Parsons J, Webber S, Fricke M, Thille P. Strategies to Increase Access to Outpatient Physiotherapy Services: A Scoping Review. Physiother Can 2022; 74:197-207. [PMID: 37323714 PMCID: PMC10262743 DOI: 10.3138/ptc-2020-0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/16/2021] [Accepted: 07/25/2021] [Indexed: 07/20/2023]
Abstract
Purpose: Multiple Canadian jurisdictions have curtailed public funding for outpatient physiotherapy services, impacting access and potentially creating or worsening inequities in access. We sought to identify evaluated organizational strategies that aimed to improve access to physiotherapy services for community-dwelling persons. Method: We used Arksey and O'Malley's scoping review methods, including a systematic search of CINAHL, MEDLINE, and Embase for relevant peer-reviewed texts published in English, French, or German, and we performed a qualitative content analysis of included articles. Results: Fifty-one peer-reviewed articles met inclusion criteria. Most studies of interventions or system changes to improve access took place in the United Kingdom (17), the United States (12), Australia (9), and Canada (8). Twenty-nine studies aimed to improve access for patients with musculoskeletal conditions; only five studies examined interventions to improve equitable access for underserved populations. The most common interventions and system changes studied were expanded physiotherapy roles, direct access, rapid access systems, telerehabilitation, and new community settings. Conclusions: Studies evaluating interventions and health system changes to improve access to physiotherapy services have been limited in focus, and most have neglected to address inequities in access. To improve equitable access to physiotherapy services in Canada, physiotherapy providers in local settings can implement and evaluate transferable patient-centred access strategies, particularly telerehabilitation and primary care integration.
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Affiliation(s)
- Tory Crawford
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joanne Parsons
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sandra Webber
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moni Fricke
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Thille
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Ho-Henriksson CM, Svensson M, Thorstensson CA, Nordeman L. Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial. BMC Musculoskelet Disord 2022; 23:260. [PMID: 35300671 PMCID: PMC8932301 DOI: 10.1186/s12891-022-05201-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Over the next decade, the number of osteoarthritis consultations in health care is expected to increase. Physiotherapists may be considered equally qualified as primary assessors as physicians for patients with knee osteoarthritis. However, economic evaluations of this model of care have not yet been described. To determine whether physiotherapists as primary assessors for patients with suspected knee osteoarthritis in primary care are a cost-effective alternative compared with traditional physician-led care, we conducted a cost-effectiveness analysis alongside a randomized controlled pragmatic trial. Methods Patients were randomized to be assessed and treated by either a physiotherapist or physician first in primary care. A cost-effectiveness analysis compared costs and effects in quality adjusted life years (QALY) for the different care models. Analyses were applied with intention to treat, using complete case dataset, and missing data approaches included last observation carried forward and multiple imputation. Non-parametric bootstrapping was conducted to assess sampling uncertainty, presented with a cost-effectiveness plane and cost-effectiveness acceptability curve. Results 69 patients were randomized to a physiotherapist (n = 35) or physician first (n = 34). There were significantly higher costs for physician visits and radiography in the physician group (p < 0.001 and p = 0.01). Both groups improved their health-related quality of life 1 year after assessment compared with baseline. There were no statistically significant differences in QALYs or total costs between groups. The incremental cost-effectiveness ratio for physiotherapist versus physician was savings of 24,266 €/lost QALY (societal perspective) and 15,533 €/lost QALY (health care perspective). There is a 72–80% probability that physiotherapist first for patients with suspected knee osteoarthritis is less costly and differs less than ±0.1 in QALY compared to traditional physician-led care. Conclusion These findings suggest that physiotherapist-led care model might reduce health care costs and lead to marginally less QALYs, but confidence intervals were wide and overlapped no difference at all. Health consequences depending on the profession of the first assessor for knee osteoarthritis seem to be comparable for physiotherapists and physicians. Direct access to physiotherapist in primary care seems to lead to fewer physician consultations and radiography. However, larger clinical trials and qualitative studies to evaluate patients’ perception of this model of care are needed. Clinical trial registration The study was retrospectively registered in clinicaltrial.gov, ID: NCT03822533. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05201-3.
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Affiliation(s)
- Chan-Mei Ho-Henriksson
- Region Västra Götaland, Primary Care Rehabilitation, Närhälsan Lidköping Rehabmottagning, Lidköping, Sweden. .,Department of Health and rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
| | - Mikael Svensson
- University of Gothenburg, Sahlgrenska Academy, Institute of Medicine, School of Public Health and Community Medicine, Gothenburg, Sweden
| | - Carina A Thorstensson
- Department of Health and rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Research and Development Department at Region Halland, Halmstad, Sweden
| | - Lena Nordeman
- Department of Health and rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Research, Education, Development and Innovation Centre Södra Älvsborg, Borås, Sweden
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14
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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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15
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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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16
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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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George SZ, Lentz TA, Goertz CM. Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health. Transl Res 2021; 234:129-140. [PMID: 33901699 PMCID: PMC8340679 DOI: 10.1016/j.trsl.2021.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain. First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.
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Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Trevor A Lentz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Christine M Goertz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
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18
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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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21
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Rundell SD, Maitland ME, Manske RC, Beneck GJ. Survey of Physical Therapists' Attitudes, Knowledge, and Behaviors Regarding Diagnostic Imaging. Phys Ther 2021; 101:5928443. [PMID: 33395477 DOI: 10.1093/ptj/pzaa187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/11/2020] [Accepted: 09/10/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to describe physical therapists' attitudes, knowledge, and behaviors regarding the use of diagnostic imaging. METHODS Physical therapists in the United States were recruited from July 2018 through May 2019 to complete a web-based, cross-sectional survey. Participants were asked about demographics, their perceived knowledge base and skills for recommending or ordering different imaging modalities, and their behaviors regarding diagnostic imaging. Descriptive statistics were used to characterize the participants' demographics and responses to all questions. Chi-square tests were performed to compare responses by characteristics of survey participants and Wilcoxon signed-rank tests to compare levels of agreement. RESULTS The mean age was 43 years, and of the 739 respondents, 58% (n = 417) were female. Ninety-two percent of respondents (n = 595) reported having recommended diagnostic imaging to another provider at least once. Only 11.6% (n = 75) reported having ever directly ordered diagnostic imaging. Participants' attitudes about their knowledge base and skills for recommending or ordering plain radiographs were stronger compared with any other imaging modalities followed by magnetic resonance imaging (MRI) over other imaging techniques. Participants' attitudes on recommending plain radiographs or MRI differed by professional education level, board-certification status, fellowship completion, and years since graduation. CONCLUSION It is common for physical therapists to recommend imaging, but few have directly ordered imaging. Most survey participants believed that they have an adequate knowledge base and skills for recommending and ordering plain radiographs and MRI. IMPACT These results can serve as a benchmark for future comparison as policies and educations evolve. Understanding physical therapists' attitudes, knowledge, and use of diagnostic imaging is important to inform research, policy, and education.
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Affiliation(s)
- Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA 98194-6490, USA; and Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Murray E Maitland
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Robert C Manske
- Department of Physical Therapy, Wichita State University, Wichita, Kansas, USA
| | - George J Beneck
- Department of Physical Therapy, California State University, Long Beach, Long Beach, California, USA
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Hon S, Ritter R, Allen DD. Cost-Effectiveness and Outcomes of Direct Access to Physical Therapy for Musculoskeletal Disorders Compared to Physician-First Access in the United States: Systematic Review and Meta-Analysis. Phys Ther 2021; 101:5999910. [PMID: 33245117 DOI: 10.1093/ptj/pzaa201] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/09/2020] [Accepted: 10/08/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Direct access to physical therapy provides an alternative to physician-first systems for patients who need physical therapy for musculoskeletal disorders (MSDs). Direct access across multiple countries and the United States (US) military services has produced improved functional outcomes and/or cost-effectiveness at clinical and health care system levels; however, data remain scarce from civilian health care systems within the United States. The purpose of this study was to compare evidence regarding costs and clinical outcomes between direct access and physician-first systems in US civilian health services. METHODS A database search of PubMed, CINAHL, Cochrane Reviews, and PEDro was conducted through May 2019. Studies were selected if they specified civilian US, physical therapy for MSDs, direct access or physician-first, and extractable outcomes for cost, function, or number of physical therapy visits. Studies were excluded if interventions utilized early or delayed physical therapy access compared with physician-first. Five retrospective studies met the criteria. Means and standard deviations for functional outcomes, cost, and number of visits were extracted, converted to effect sizes (d) and 95% CI, and combined into grand effect sizes using fixed-effect or random-effects models depending on significance of the Q heterogeneity statistic. RESULTS Direct access to physical therapy showed reduced physical therapy costs (d = -0.23; 95% CI = -0.35 to -0.11), total health care costs (d = -0.19; 95% CI = -0.32 to -0.07), and number of physical therapy visits (d = -0.17; 95% CI = -0.29 to -0.05) compared to physician-first systems. Disability decreased in both direct access (d = -1.78; 95% CI = -2.28 to -1.29) and physician-first (d = -0.89; 95% CI = -0.92 to -0.85) groups; functional outcome improved significantly more with direct access (z score = 0.89; 95% CI = 0.40 to 1.39). CONCLUSIONS Direct access to physical therapy is more cost-effective, resulting in fewer visits than physician-first access in the United States, with greater functional improvement. IMPACT These findings within civilian US health care services support a cost-effective health care access alternative for spine-related MSDs and can inform health care policy makers.
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Affiliation(s)
- Sandra Hon
- Graduate Program in Physical Therapy, University California, San Francisco/San Francisco State University, San Francisco, California, USA
| | - Richard Ritter
- Graduate Program in Physical Therapy, University California, San Francisco/San Francisco State University, San Francisco, California, USA
| | - Diane D Allen
- Graduate Program in Physical Therapy, University California, San Francisco/San Francisco State University, San Francisco, California, USA
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Talty FT, Roberts ME, Dang C, Clewley DJ, Horn ME. Using a behavioral model to identify factors associated with choice of provider for neck and low back pain: A systematic review. Musculoskelet Sci Pract 2020; 49:102223. [PMID: 32763791 DOI: 10.1016/j.msksp.2020.102223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND It remains unclear as to what factors influence a patient's choice to seek care from a specific healthcare provider for low back and neck pain. OBJECTIVE Utilize Andersen's Behavioral Model of Health Service Utilization as a conceptual framework to identify the predisposing, enabling and need factors associated with choice of healthcare provider for back and/or neck pain. METHODS PubMed, CINAHL, EMBASE, and SCOPUS databases were searched for studies that included 1) patients seeking care for acute or chronic low back or neck pain; 2) patients at least 18 years of age; 3) reported any healthcare provider type chosen to be seen. Significant factors addressing a patient's choice of provider seen for back pain, neck pain, or both were extracted from studies and analyzed under the Behavioral Model of Health Service Utilization. RESULTS 20 studies were included in this review: 17 quantitative studies and 3 qualitative studies. Provider types identified were medical physicians, chiropractors, physical therapists, acupuncturists and CAM providers. Age and sex were the most commonly reported predisposing factors; financial and personal factors were the most common enabling factors; patients' duration of pain and self-reported level of functioning were the most commonly reported need factors. CONCLUSIONS While predisposing and need factors are important, enabling factors also have an influence in choice of healthcare provider for back and/or neck pain.
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Affiliation(s)
- Francis T Talty
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA.
| | | | - Christine Dang
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
| | - Derek J Clewley
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
| | - Maggie E Horn
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Physical therapy and opioid use for musculoskeletal pain management: competitors or companions? Pain Rep 2020; 5:e827. [PMID: 33490834 PMCID: PMC7808685 DOI: 10.1097/pr9.0000000000000827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/16/2020] [Accepted: 05/24/2020] [Indexed: 12/29/2022] Open
Abstract
Existing evidence is reviewed and gaps in the literature are identified to better understand how physical therapy has been used to provide exposure to nonpharmacological treatments. Musculoskeletal (MSK) pain conditions are highly prevalent and a leading cause of disability globally. When people with MSK pain seek health care, they often receive treatment not aligned with best practices, including initial management options such as opioids. In recent practice guidelines, nonpharmacological treatments have been emphasized for initial pain management, and physical therapists are providers who routinely deliver nonpharmacological treatments. The purpose of this review is to describe the current and future state for how physical therapy may be used to increase exposure to nonpharmacological treatments for MSK pain conditions. For the current state, we review existing observational evidence investigating early exposure to physical therapy and its influence on subsequent opioid use. For the future state, we propose clinical research questions that could define the role of physical therapy on interdisciplinary teams working towards improving effectiveness of nonpharmacological treatments through more rigorous study designs. These clinical questions are intended to guide health services research and clinical trials when building an evidence base of nonpharmacological care options for MSK pain conditions.
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Albornoz-Cabello M, Pérez-Mármol JM, Cardero-Durán MDLÁ, Barrios-Quinta CJ, Espejo-Antúnez L. Construction, Factor Structure, and Internal Consistency Reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165857. [PMID: 32806784 PMCID: PMC7459722 DOI: 10.3390/ijerph17165857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
Patient satisfaction is a crucial aspect in the evaluation of the quality of health care provided by health services and units, especially in patients that require physical rehabilitation. This study aims to design and analyze the factor structure and internal consistency reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS) measuring the level of physical therapy patient satisfaction in hospital rehabilitation services. This study has a multicenter cross-sectional survey design. This study used the structural validity and internal consistency domains from COSMIN (consensus-based standards for the selection of health status measurement instruments) guideline. The H-PTPS questionnaire consists of 20 closed questions. A sample of 384 adult patients from physical therapy units from three Spanish public hospitals completed this questionnaire. A factor structure and internal consistency reliability analysis were performed. The factor analysis including the 20 items of the H-PTPS showed an adequacy index of 0.922 according to the Kaiser–Meyer–Olkin measure and the Barlett test allowed us to reject the null hypothesis (p < 0.001). In the rotated component matrix, four specific factors were obtained, explaining 66.75% of the accumulated variance. All factors present satisfactory internal reliability, achieving Cronbach’s alpha indices and Omega coefficients higher than 0.74. The H-PTPS questionnaire has shown a four-factor solution with satisfactory reliability evaluating the satisfaction of Spanish patients treated in physical therapy units in the hospital rehabilitation services.
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Affiliation(s)
| | - José Manuel Pérez-Mármol
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada-ibs.GRANADA, 18012 Granada, Spain
- Correspondence: ; Tel.: +34-958-248033
| | | | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, University of Extremadura, 06006 Badajoz, Spain;
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26
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Babatunde OO, Bishop A, Cottrell E, Jordan JL, Corp N, Humphries K, Hadley-Barrows T, Huntley AL, van der Windt DA. A systematic review and evidence synthesis of non-medical triage, self-referral and direct access services for patients with musculoskeletal pain. PLoS One 2020; 15:e0235364. [PMID: 32628696 PMCID: PMC7337346 DOI: 10.1371/journal.pone.0235364] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction The demand for musculoskeletal (MSK) care is rising, and is a growing challenge for general practice. Direct access to physiotherapy and other healthcare services may offer appropriate care for MSK pain patients but there is uncertainty regarding the effectiveness or efficiency of this approach in practice. This study aimed to review the evidence regarding characteristics, outcomes, barriers and facilitators of MSK triage and direct access services. Methods A comprehensive search of eight databases (including MEDLINE, EMBASE, and Cochrane library) up to February 2018 was conducted to identify studies (trials, cohorts and qualitative evidence) on direct access services for MSK in primary care settings. Using predefined inclusion and exclusion criteria, titles, abstracts, and subsequent full texts were independently screened by reviewers. Methodological quality of eligible studies was assessed using the mixed methods appraisal tool, and extracted data regarding study characteristics and results were independently reviewed. A narrative synthesis and grading of evidence was undertaken. Approaches to MSK triage and direct access were profiled along with their respective outcomes of care relating to patient-oriented and socioeconomic outcomes. Barriers and facilitators of each model of direct access services were also highlighted. Results 9010 unique citations were screened, of which 26 studies were eligible. Three approaches (open access, combination and service pathway models) to MSK triage and direct access shared similar goals but were heterogeneous in application. MSK patients using direct access showed largely similar characteristics (age, sex and duration of symptoms) compared to GP-led care, although they were often younger, slightly more educated and with better socio-economic status than patients seen through GP-led care. Although many studies showed limitations in design or methods, outcomes of care (patient oriented outcomes of pain, and disability) did not show large differences between direct access and GP-led care. In most studies direct access patients were reported to have lower healthcare utilisation (fewer physiotherapy or GP consultations, analgesics or muscle relaxants prescriptions, or imaging procedures) and less time off work compared to GP-led care. Discussion This study provides insight into the current state of evidence regarding MSK triage and direct access services and highlights potential implications for future research, healthcare services planning, resource utilisation and organising care for MSK patients in primary care. There is consistent, although limited, evidence to suggest that MSK triage and direct access services lead to comparable clinical outcomes with lower healthcare consumption, and can help to manage GP workload. However, due to the paucity of strong empirical data from methodologically robust studies, a scale up and widespread roll out of direct access services cannot as yet be assumed to result in long term health and socio-economic gains. PROSPERO-ID: CRD42018085978.
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Affiliation(s)
- Opeyemi O. Babatunde
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
- * E-mail:
| | - Annette Bishop
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Elizabeth Cottrell
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Nadia Corp
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Katrina Humphries
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Tina Hadley-Barrows
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
| | - Alyson L. Huntley
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Danielle A. van der Windt
- Arthritis Research UK Primary Care Centre, School of Primary, Community & Social Care, Keele University, Keele, United Kingdom
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Garcia AN, Cook C, Lutz A, Thigpen CA. Concurrent validity of the single assessment numerical evaluation and patient-reported functional measures in patients with musculoskeletal disorders: An observational study. Musculoskelet Sci Pract 2019; 44:102057. [PMID: 31542682 DOI: 10.1016/j.msksp.2019.102057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/15/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION As patient-reported outcome measures (PROMs) continue to evolve as vital measures of patient status, it may be useful to identify efficiently, Single Assessment Numeric Evaluation (SANE) scores that are valid and related to the patient's specific functional needs. OBJECTIVE To evaluate the concurrent validity between SANE scores and commonly used body region-specific functional PROMs, functional percentage change scores, and total visits in patients with musculoskeletal (MSK) disorders. METHODS 479 patients completed the SANE and one of the following PROMs at physical therapy discharge: Modified Low Back Pain Disability Questionnaire [MDQ], Neck Disability Index [NDI], Penn Shoulder Score [PSS], International Knee Documentation Committee [IKDC], Lower Extremity Functional Scale [LEFS]. Pearson correlation coefficients were used to assess the relationship between SANE and the aforementioned outcomes and total visits. RESULTS The SANE was moderately negatively correlated with the MDQ and NDI at discharge. There were high positive correlations between SANE and PSS and IKDC and moderate positive correlation between SANE and LEFS. The SANE and MDQ and IKDQ demonstrated low positive correlation for functional percentage change scores, and the SANE and NDI demonstrated moderate positive correlation for functional percentage change scores. For total visits outcome, there was a negligible negative correlation between SANE and MDQ and NDI at discharge. CONCLUSION The SANE exhibits acceptable concurrent validity across all investigated PROMs at physical therapy discharge. However, inconsistent relationships across body regions for functional percentage change and total visits suggest differences in these values as compared to raw discharge scores.
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Affiliation(s)
- Alessandra N Garcia
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, 311 Trent Drive, Durham, NC, 27710, USA.
| | - Chad Cook
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Duke Clinical Research Institute, Duke University, 311 Trent Drive, Durham, NC, 27710, USA
| | - Adam Lutz
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia SC, Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia SC, Clinical Excellence, ATI Physical Therapy, Greenville SC, 200 Patewood Dr Ste 150C, Greenville, SC, 29615, USA
| | - Charles A Thigpen
- Sr. Director of Practice Innovation & Analytics, ATI Physical Therapy, Program in Observational Clinical Research in Orthopedics, Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Greenville, SC, 29681, USA
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28
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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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29
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Luth C, Bartell D, Bish M, Yudd A, Palaima M, Cleland JA. The effectiveness of vestibular rehabilitation therapy vs conservative treatment on dizziness: a systematic review and meta-analysis. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1670395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Carl Luth
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Desiree Bartell
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Michaela Bish
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Andrew Yudd
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Mary Palaima
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Joshua A. Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
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Garcia AN, Cook C, Rhon D. Which patients do not seek additional medical care after a self-management class for low back pain? An observational cohort. Clin Rehabil 2019; 33:1831-1842. [PMID: 31353943 DOI: 10.1177/0269215519865013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES (1) To identify baseline variables associated with patients that sought no additional care during the 12 months following a single self-management education session for low back pain (LBP), and (2) in those who sought care, to determine whether the same variables were associated with low versus high downstream LBP-related healthcare utilization. DESIGN An observational cohort. SETTING Single large military hospital. PARTICIPANTS A total of 733 patients with LBP. INTERVENTION Single self-management education session. MAIN OUTCOMES Eleven variables were explored in two distinct logistic regression models: (1) no additional care versus additional care, and (2) low versus high number of additional visits in the additional care group. RESULTS In the first model, not being on active duty service (odds ratio (OR) = 1.98, 95% confidence interval (CI) = 1.37-2.86), low baseline disability (OR = 1.02, 95% CI = 1.00-1.04), low baseline fear-avoidance related to work (OR = 1.02, 95% CI = 1.00-1.03), and, in the last year, no opioid prescriptions (OR = 1.44, 95% CI = 1.00-2.07), physical therapy (OR = 1.63, 95% CI = 1.00-2.65), or sleep disorder diagnosis (OR = 1.62, 95% CI = 1.05-2.51) significantly increased the odds that patients would not seek any additional care. In the second model, not being on active duty service (OR = 2.18, 95% CI = 1.38-3.46), low baseline disability (OR = 1.04, 95% CI = 1.02-1.06), and no opioid prescriptions in the prior year (OR = 2.19, 95% CI = 1.42-3.37) increased the odds that patients would have less visits (⩽2 visits). CONCLUSION Our study found several variables that helped determine whether patients would seek little or no additional care during the 12 months following a self-management education class for LBP.
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Affiliation(s)
| | - Chad Cook
- Duke University Division of Physical Therapy, Duke Department of Orthopaedic Surgery, Duke Clinical Research Institute, Durham, NC, USA
| | - Daniel Rhon
- Duke University Division of Physical Therapy, Duke Department of Orthopaedic Surgery, Duke Clinical Research Institute, Durham, NC, USA.,Physical Performance Service Line, Army Office of the Surgeon General, Falls Church, VA, USA
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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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32
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Horn ME, Fritz JM. Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort. BMC Health Serv Res 2018; 18:887. [PMID: 30477480 PMCID: PMC6258489 DOI: 10.1186/s12913-018-3699-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/08/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients seek care from physical therapists for neck pain but it is unclear what the association of the timing of physical therapy (PT) consultation is on 1-year healthcare utilization and costs. The purpose of this study was to compare the 1-year healthcare utilization and costs between three PT timing groups: patients who consulted a physical therapist (PT) for neck pain within 14 days (early PT consultation), between 15 and 90 days (delayed PT consultation) or between 91 and 364 days (late PT consultation). METHODS A retrospective cohort of 308 patients (69.2% female, ages 48.7[±14.5] years) were categorized into PT timing groups. Descriptive statistics were calculated for each group. In adjusted regression models, 1-year healthcare utilization of injections, imaging, opioids and costs were compared between groups. RESULTS Compared to early PT consultation, the odds of receiving an opioid prescription (aOR = 2.79, 95%CI: 1.35-5.79), spinal injection (aOR = 4.36, 95%CI:2.26-8.45), undergoing an MRI (aOR = 4.68, 95%CI:2.25-9.74), X-ray (aOR = 2.97, 95%CI:1.61-5.47) or CT scan (aOR = 3.36, 95%CI: 1.14-9.97) were increased in patients in the late PT consultation group. Similar increases in risk were found in the delayed group (except CT and Opioids). Compared to the early PT consultation group, mean costs were $2172 ($557, $3786) higher in the late PT contact group and $1063 (95%CI: $ 138 - $1988) higher in the delayed PT consultation group. DISCUSSION There was an association with the timing of physical therapy consultation on healthcare utilization and costs, where later consultation was associated with increases costs and healthcare utilization. This study examined the association of timing of physical therapy consultation on costs and healthcare utilization, but not the association of increased access to physical therapy consultation. Therefore, the findings warrant further investigation to explore the effects of increased access to physical therapy consultation on healthcare utilization and costs in a prospective study.
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Affiliation(s)
- Maggie E Horn
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division, Duke University, Box 104002, Durham, NC, 27708, USA.
| | - Julie M Fritz
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
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