1
|
Yu BXB, Liu Y, Chan KCC, Chen CW. EGCN++: A New Fusion Strategy for Ensemble Learning in Skeleton-Based Rehabilitation Exercise Assessment. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2024; 46:6471-6485. [PMID: 38502632 DOI: 10.1109/tpami.2024.3378753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Skeleton-based exercise assessment focuses on evaluating the correctness or quality of an exercise performed by a subject. Skeleton data provide two groups of features (i.e., position and orientation), which existing methods have not fully harnessed. We previously proposed an ensemble-based graph convolutional network (EGCN) that considers both position and orientation features to construct a model-based approach. Integrating these types of features achieved better performance than available methods. However, EGCN lacked a fusion strategy across the data, feature, decision, and model levels. In this paper, we present an advanced framework, EGCN++, for rehabilitation exercise assessment. Based on EGCN, a new fusion strategy called MLE-PO is proposed for EGCN++; this technique considers fusion at the data and model levels. We conduct extensive cross-validation experiments and investigate the consistency between machine and human evaluations on three datasets: UI-PRMD, KIMORE, and EHE. Results demonstrate that MLE-PO outperforms other EGCN ensemble strategies and representative baselines. Furthermore, the MLE-PO's model evaluation scores are more quantitatively consistent with clinical evaluations than other ensemble strategies.
Collapse
|
2
|
Beneciuk JM, Michener LA, Sigman E, Harrison T, Buzzanca-Fried KE, Lu X, Shan G, Hill JC. Validation of the Keele STarT MSK Tool for Patients With Musculoskeletal Pain in United States-based Outpatient Physical Therapy Settings. THE JOURNAL OF PAIN 2024; 25:104475. [PMID: 38242334 DOI: 10.1016/j.jpain.2024.01.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
The STarT MSK tool was developed to enable risk stratification of patients with common musculoskeletal (MSK) pain conditions and help identify individuals who may require more targeted interventions or closer monitoring in primary care settings, however, its validity in U.S.-based outpatient physical therapy settings has not been investigated. The 10-item Keele STarT MSK risk stratification tool was tested for construct (convergent and discriminant) and predictive validity using a multicenter, prospective cohort study design. Participants (n = 141) receiving physical therapy for MSK pain of the back, neck, shoulder, hip, knee, or multisite regions completed intake questionnaires including the Keele STarT MSK tool, Functional Comorbidity Index (FCI), Optimal Screening for Prediction of Referral and Outcome Review-of-Systems and Optimal Screening for Prediction of Referral and Outcome Yellow Flag tools. Pain intensity, pain interference, and health-related quality of life (Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) physical [PCS] and mental [MCS] component summary scores) were measured at 2- and 6-month follow-up. Participants were classified as STarT MSK tool low (44%), medium (39%), and high (17%) risk. Follow-up rates were 70.2% (2 months) and 49.6% (6 months). For convergent validity, fair relationships were observed between the STarT MSK tool and FCI and SF-8 MCS (r = .35-.37) while moderate-to-good relationships (r = .51-.72) were observed for 7 other clinical measures. For discriminant validity, STarT MSK tool risk-dependent relationships were observed for Optimal Screening for Prediction of Referral and Outcome Review-of-Systems, Optimal Screening for Prediction of Referral and Outcome Yellow Flag, pain interference, and SF-8 PCS (low < medium < high; P < .01) and FCI, pain intensity, and SF-8 MCS (low < medium-or-high; P < .01). For predictive validity, intake STarT MSK tool scores explained additional variability in pain intensity (11.2%, 20.0%), pain interference (7.5%, 14.1%), and SF-8 PCS (8.2%, 12.8%) scores at 2 and 6 months, respectively. This study contributes to the existing literature by providing additional evidence of STarT MSK tool cross-sectional construct validity and longitudinal predictive validity. PERSPECTIVE: This study presents STarT MSK risk stratification tool validity findings from a U.S. outpatient physical therapy sample. The STarT MSK tool has the potential to help physical therapists identify individuals presenting with the most common MSK pain conditions who may require more targeted interventions or closer monitoring.
Collapse
Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida; Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Erica Sigman
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Trent Harrison
- Brooks Institute of Higher Learning, Brooks Rehabilitation, Jacksonville, Florida
| | - Katherine E Buzzanca-Fried
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida; Rehabilitation Science Doctoral Program, College of Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Xinlin Lu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Jonathan C Hill
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| |
Collapse
|
3
|
McCurdy MA, Narayanan R, Trenchfield D, Lee Y, Khanna A, Ebrahimi M, Kurd M, Kaye ID, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler C. The Impact of Outpatient Physical Therapy on Patient-Reported Outcomes After Lumbar Fusion: Perspective from A Bundled Care Dataset. World Neurosurg 2024:S1878-8750(24)00969-0. [PMID: 38866235 DOI: 10.1016/j.wneu.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE/BACKGROUND As value-based care grows in popularity across the United States, more payers have turned toward bundled payment models for surgical procedures. Though episode costs in spine are highly variable, physical therapy (PT) has been identified as a driver of 90-day cost. The goal of this study is to assess the impact of postoperative PT on patient-reported outcomes and cost after lumbar fusion surgery using bundled insurance data. METHODS Bundled payment information of lumbar fusion episodes-of-care (EOC) from 2019 to 2021 was reviewed at a single, urban, tertiary care center. EOC comprised a 210-day period surrounding the date of the procedure, beginning 30 days preoperatively and ending 180 days postoperatively. Patients were grouped into physical therapy (PT) and no physical therapy (no PT) groups based on the presence of PT claims. RESULTS Bivariate analysis of surgical outcomes revealed similar overall complication rates (P = 0.413), 30-day readmissions (P = 0.366), and 90-day readmissions (P = 0.774). Patients who did not participate in postoperative PT had significantly better preoperative physical component score (PCS) (P = 0.003), 6-month postoperative PCS (P = 0.001), and 6-month ΔPCS (P = 0.026) compared with patients who participated in postoperative PT. At 1-year follow-up, patients who did not participate in PT had less leg pain (P = 0.041) than those who did participate in PT. CONCLUSIONS Our study finds that PT after lumbar fusion is not associated with significant improvement in Oswestry Disability Index, PCS, mental component score, or visual analog scale pain scores. Additionally, the number of PT sessions a patient attends has no correlation with improvement in these outcomes.
Collapse
Affiliation(s)
- Michael A McCurdy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| | - Delano Trenchfield
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Akshay Khanna
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mina Ebrahimi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - I David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Christopher Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Pritchard KT, Baillargeon J, Lee WC, Doulatram G, Raji MA, Kuo YF. Inequitable access to nonpharmacologic pain treatment providers among cancer-free U.S. adults. Prev Med 2024; 178:107809. [PMID: 38072313 PMCID: PMC10872296 DOI: 10.1016/j.ypmed.2023.107809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE Using evidence-based nonpharmacologic pain treatments may prevent opioid overuse and associated adverse outcomes. There is limited data on the impact of access-promoting social determinants of health (SDoH: education, income, transportation) on use of nonpharmacologic pain treatments. Our objective was to examine the relationship between SDoH and use of nonpharmacologic pain treatment providers. Our goal was to understand policy-actionable factors contributing to inequity in pain treatment. METHODS Based on Andersen's Health Utilization Model, this cross-sectional analysis of 2016-2019 Medical Expenditure Panel Survey data evaluated whether use of outpatient nonpharmacologic pain treatment providers is driven by enabling (i.e., advantageous socioeconomic resources) or need (i.e., perceived disability and diagnosed disease) factors. The study sample (unweighted n = 28,188) represented a weighted N = 81,912,730 noninstitutionalized, cancer-free, U.S. adults with pain interference. The primary outcome measured use of nonpharmacologic providers relative to exclusive prescription opioid use or no treatment (i.e., neither opioids nor nonpharmacologic). To quantify equitable access, we compared the variance-between access-promoting enabling factors versus medical need factors-that explained utilization. RESULTS Compared to enabling factors, need factors explained twice the variance predicting pain treatment utilization. Still, the adjusted odds of using nonpharmacologic providers instead of opioids alone were 39% lower among respondents identifying as Black (95% Confidence Interval [CI], 0.49-0.76) and respondents residing in the U.S. South (95% CI, 0.51-0.74). Higher education (95% CI, 1.72-2.79) and income (95% CI, 1.68-2.42) both facilitated using nonpharmacologic providers instead of opioids. CONCLUSIONS These findings highlight the substantial influence access-promoting SDoH have on pain treatment utilization.
Collapse
Affiliation(s)
- Kevin T Pritchard
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jacques Baillargeon
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | - Wei-Chen Lee
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Gulshan Doulatram
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| |
Collapse
|
5
|
Yao L, Lei Q, Zhang H, Du J, Gao S. A Contrastive Learning Network for Performance Metric and Assessment of Physical Rehabilitation Exercises. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3790-3802. [PMID: 37729572 DOI: 10.1109/tnsre.2023.3317411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Human activity analysis in the legal monitoring environment plays an important role in the physical rehabilitation field, as it helps patients with physical injuries improve their postoperative conditions and reduce their medical costs. Recently, several deep learning-based action quality assessment (AQA) frameworks have been proposed to evaluate physical rehabilitation exercises. However, most of them treat this problem as a simple regression task, which requires both the action instance and its score label as input. This approach is limited by the fact that the annotations in this field usually consist of healthy or unhealthy labels rather than quality scores provided by professional physicians. Additionally, most of these methods cannot provide informative feedback on a patient's motion defects, which weakens their practical application. To address these problems, we propose a multi-task contrastive learning framework to learn subtle and critical differences from skeleton sequences to deal with the performance metric and AQA problems of physical rehabilitation exercises. Specifically, we propose a performance metric network that takes triplets of training samples as input for score generation. For the AQA task, the same contrast learning strategy is used, but pairwise training samples are fed into the action quality assessment network for score prediction. Notably, we propose quantifying the deviation of the joint attention matrix between different skeleton sequences and introducing it into the loss function of our learning network. It is proven that considering both score prediction loss and joint attention deviation loss improves physical exercises AQA performance. Furthermore, it helps to obtain informative feedback for patients to improve their motion defects by visualizing the joint attention matrix's difference. The proposed method is verified on the UI-PRMD and KIMORE datasets. Experimental results show that the proposed method achieves state-of-the-art performance.
Collapse
|
6
|
Latreche A, Kelaiaia R, Chemori A, Kerboua A. A New Home-Based Upper- and Lower-Limb Telerehabilitation Platform with Experimental Validation. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2023; 48:1-16. [PMID: 37361467 PMCID: PMC10039343 DOI: 10.1007/s13369-023-07720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/15/2023] [Indexed: 03/28/2023]
Abstract
The world is witnessing interesting challenges in several fields, including medicine. Solutions to many of these challenges are being developed in the field of artificial intelligence. As a result, artificial intelligence techniques can be used in telerehabilitation to facilitate the work of doctors and to find methods that can be used to better treat methods that can be used to better treat patients. Motion rehabilitation is an essential procedure for elderly people and patients undergoing physiotherapy after physical procedures such as surgery for the anterior cruciate ligament (ACL), a frozen shoulder. To regain normal motion, the patient must participate in rehabilitation sessions. Furthermore, telerehabilitation has become a significant trend in research studies because of the COVID-19 pandemic, which is continuing to affect the world through the delta and the omicron variants, and other epidemics. In addition, because of other special issues like the vastness of the desert area in Algeria and the lack of facilities, it is ideal to avoid requiring patients to travel for all of their rehabilitation sessions; patients should be able to perform their rehabilitation exercises at home. Thus, telerehabilitation could lead to promising developments in this field. Therefore, our project's goal is to develop a website for telerehabilitation that can be used to facilitate rehabilitation from a distance. We also want to track the progress of patients' range of motion (ROM) in real time using artificial intelligence techniques, by controlling the angles of the motion of a limbs about a joint.
Collapse
Affiliation(s)
- Ameur Latreche
- LGMM, 20 August 1955-Skikda University, BP 26. Road El Hadaiek, 21000 Skikda, Algeria
- LIRMM, University of Montpellier, CNRS, Montpellier, France
| | - Ridha Kelaiaia
- LGMM, 20 August 1955-Skikda University, BP 26. Road El Hadaiek, 21000 Skikda, Algeria
| | - Ahmed Chemori
- LIRMM, University of Montpellier, CNRS, Montpellier, France
| | - Adlen Kerboua
- LGMM, 20 August 1955-Skikda University, BP 26. Road El Hadaiek, 21000 Skikda, Algeria
| |
Collapse
|
7
|
Richter RR, Chrusciel T, Salsich G, Austin T, Scherrer JF. Disparities Exist in Physical Therapy Utilization and Time to Utilization Between Black and White Patients With Musculoskeletal Pain. Phys Ther 2022; 102:6649124. [PMID: 35871435 DOI: 10.1093/ptj/pzac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/24/2022] [Accepted: 04/05/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Black patients are less likely than White patients to receive physical therapy for musculoskeletal pain conditions. Current evidence, however, is limited to self-reported conditions and health services use. The purpose of this study was to use a large electronic health record database to determine whether a race disparity existed in use of physical therapy within 90 days of a new musculoskeletal diagnosis. METHODS Eligible patients (n = 52,384) were sampled from an Optum deidentified electronic health record database of 5 million adults distributed throughout the United States. In this database, patients were designated as "Black" and "White." Patients were eligible if they had a new diagnosis for musculoskeletal neck, shoulder, back, or knee pain between January 1, 2012, and December 31, 2017. Logistic regression and Cox proportional hazard models were computed before and after adjusting for covariates to estimate the association between race and receipt of physical therapy services within 90 days of musculoskeletal pain diagnoses. RESULTS Patients were on average 47.5 (SD = 14.9) years of age, 12.8% were Black, 87.2% were White, and 52.7% were female. Ten percent of Black patients and 15.5% of White patients received physical therapy services within 90 days of musculoskeletal pain diagnoses. After adjusting for covariates, White patients were 57% more likely (odds ratio = 1.57; 95% CI = 1.44-1.71) to receive physical therapy compared with Black patients and had significantly shorter time to physical therapy than Black patients (hazard ratio = 1.53; 95% CI = 1.42-1.66). CONCLUSIONS In a nationally distributed cohort, Black patients were less likely than White patients to utilize physical therapy and had a longer time to utilization of physical therapy for musculoskeletal pain. IMPACT These findings highlight the need to determine the mechanisms underlying the observed disparities and how these disparities influence health outcomes.
Collapse
Affiliation(s)
- Randy R Richter
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Timothy Chrusciel
- Department of Health and Clinical Outcomes Research, Salus Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Gretchen Salsich
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Tricia Austin
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
8
|
Chevan J, Barrett M, Nowakowski K, Pappas K, Murphy H, Erck E, Weisner S. Responding to stakeholder needs to engage rehabilitation professionals in the delivery of evidence-based health programming for adults with osteoarthritis. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:907477. [PMID: 36188917 PMCID: PMC9397695 DOI: 10.3389/fresc.2022.907477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
Although there are many evidence-based programs that promote healthy lifestyles and symptom modification for people with osteoarthritis, their delivery in rehabilitation clinical settings in the United States is limited. These programs can be a primary component of treatment or a discharge option to facilitate long-term mobility and pain management. The purpose of this perspective article is to describe a delivery model that brings one arthritis-appropriate, evidence-based intervention, the Arthritis Foundation's Walk With Ease program, to older adults seeking physical therapy related to their osteoarthritis. We embedded program delivery into a Doctor of Physical Therapy curriculum using a student health coaching approach and partnering with physical therapy clinics and other community agencies for participant referrals. This model of delivery is cost-effective, sustainable, and provides outcomes that meet goals of the national agenda for osteoarthritis. The model provides benefits for students in health professions education programs, community organizations and rehabilitation clinics, and adults living with osteoarthritis.
Collapse
Affiliation(s)
- Julia Chevan
- Department of Physical Therapy, Springfield College, Springfield, MA, United States
- *Correspondence: Julia Chevan
| | - Maureen Barrett
- Department of Physical Therapy, Springfield College, Springfield, MA, United States
| | - Kimberly Nowakowski
- Department of Physical Therapy, Springfield College, Springfield, MA, United States
| | - Kathleen Pappas
- Department of Physical Therapy, Springfield College, Springfield, MA, United States
| | - Heather Murphy
- National Association of Chronic Disease Directors, Decatur, GA, United States
| | - Elizabeth Erck
- National Association of Chronic Disease Directors, Decatur, GA, United States
| | - Serena Weisner
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
9
|
Masaracchio M, Kirker K. Resistance Training in Individuals With Hip and Knee Osteoarthritis: A Clinical Commentary With Practical Applications. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
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]
|
11
|
Rethorn ZD, Covington JK, Cook CE, Bezner JR. Physical Therapists' Knowledge, Skills, Beliefs, and Organizations Impact Physical Activity Promotion: A Systematic Review and Meta-Analysis. Phys Ther 2022; 102:6481178. [PMID: 34972862 DOI: 10.1093/ptj/pzab291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize factors that influence physical therapists' physical activity (PA) promotion practices and map these factors to the Theoretical Domains Framework (TDF) to inform future implementation efforts. METHODS Six databases (MEDLINE, EMBASE, Scopus, CINAHL, PsychInfo, and Web of Science) were searched from inception to March 11, 2021. Studies were included if they reported physical therapists' PA promotion practices and factors influencing these practices. Study quality was assessed with a modified Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme checklist. Studies were excluded if they did not separate physical therapist PA promotion practices and influencing factors from other health professionals. RESULTS The search yielded 12,835 references and 27 included studies. Twenty studies were included in a meta-analysis of proportions, whereas 15 studies were included in a meta-analysis of correlations. Very-low to moderate-quality evidence suggests that factors at the individual and organizational levels have very small to moderate associations with PA promotion practices. CONCLUSION Efforts to improve PA promotion by physical therapists should consider incorporating combinations of individual and organizational factors. Limitations to the body of evidence highlight the need for future research. IMPACT With PA projected to decrease in the general population by an additional 20% by 2050, PA promotion is urgently needed to maximize physical therapists' impact on the health of society. This study identifies factors that may prove useful for guiding the development of strategies to encourage greater engagement in PA promotion by physical therapists.
Collapse
Affiliation(s)
- Zachary D Rethorn
- Rocky Mountain University of Health Professions, Provo, Utah, USA.,Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - J Kyle Covington
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, Round Rock, Texas, USA
| |
Collapse
|
12
|
Du C, Graham S, Depp C, Nguyen T. Assessing Physical Rehabilitation Exercises using Graph Convolutional Network with Self-supervised regularization. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:281-285. [PMID: 34891291 DOI: 10.1109/embc46164.2021.9629569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Computer-vision techniques provide a way to conduct low-cost, portable, and real-time evaluations of exercises performed as a part of physical rehabilitation. Recent data-driven methods have explored using deep learning on 3D body-landmark sequences for automatic assessment of physical rehabilitation exercises. However, existing deep learning methods using convolutional neural networks (CNN) fail to utilize the spatial connection information of the human body, which limits the accuracy of these assessments. To overcome these limitations and provide a more accurate method to assess physical rehabilitation exercises, we propose a deep learning framework using a graph convolutional network (GCN) with self-supervised regularization. The experimental results on an existing benchmark dataset validate that the proposed method achieves state-of-the-art performance with lower error than other CNN methods, and the self-supervised learning improves the prediction accuracy.Clinical relevance-This work established a supervised learning method to automatically assess physical rehabilitation exercises in the home environment using computer vision. This low-cost, portable, and real-time evaluation may provide clinicians with a way to provide feedback to patients about their exercise performance without having to provide in-person supervision.
Collapse
|
13
|
Whitford AS, Kim E, Halilaj E, Enseki K, Popchak A, Hodgins J. Sensor-Based Evaluation of Physical Therapy Exercises . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7556-7561. [PMID: 34892839 DOI: 10.1109/embc46164.2021.9629773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Physical therapy is important for the treatment and prevention of musculoskeletal injuries, as well as recovery from surgery. In this paper, we explore techniques for automatically determining whether an exercise was performed correctly or not, based on camera images and wearable sensors. Classifiers were tested on data collected from 30 patients during normally-scheduled physical therapy appointments. We considered two lower limb exercises, and asked how well classifiers could generalize to the assessment of individuals for whom no prior data were available. We found that our classifiers performed well relative to several metrics (mean accuracy: 0.76, specificity: 0.90), but often returned low sensitivity (mean: 0.34). For one of the two exercises considered, these classifiers compared favorably with human performance.
Collapse
|
14
|
Huang Z, Tang G, Kumar A, Mahmoud S, Ge P, Fang Q. A Kinematic Data Based Lower Limb Motor Function Evaluation Method for Post-Stroke Rehabilitation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7288-7291. [PMID: 34892781 DOI: 10.1109/embc46164.2021.9629887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Recent studies have demonstrated that home-based rehabilitation for stroke patients has excellent potential in reducing the cost and enhancing rehabilitation efficiency. Nonetheless, a timely and accurate rehabilitation assessment is required to attain efficacy and provide feedback to both clinicians and patients. In this paper, a lower limb motor function assessment approach based on limb kinematic data has been presented. The kinematic characteristics of lower limbs were quantified into specific evaluation parameters, which were calculated during a set of selected rehabilitation exercises. A body area network composed of two triaxial accelerometers was used to acquire the limb kinematic data of twenty stroke patients and six healthy subjects. While a referenced template was developed using the data from healthy subjects, an empirical score was obtained to evaluate the lower-limb motor function of stroke patients from the calculated parameters. The results have demonstrated that the scoring has a statistically significant strong correlation with the Brunnstrom stage classification, which provides a practical quantitative evaluation approach for home-based rehabilitation for lower limbs of stroke patients.Clinical Relevance- The proposed quality assessment method provides practical technical support for performing early support discharge rehabilitation.
Collapse
|
15
|
Gulbrandsen MT, Lara N, Beauchamp JA, Chung A, Chang M, Crandall D. Early Gender Differences in Pain and Functional Recovery Following Thoracolumbar Spinal Arthrodesis. J Clin Med 2021; 10:jcm10163654. [PMID: 34441952 PMCID: PMC8397048 DOI: 10.3390/jcm10163654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background: To analyze gender differences regarding the recovery experience (pain, function, complications) after spinal arthrodesis surgery. Methods: Pre-operative and post-operative gender-based differences in patient-reported outcomes for open posterior spinal arthrodesis at 6 weeks, 3 months, 6 months, and 1 year were studied, including age, comorbidities, body mass index (BMI), diagnosis, number of vertebrae fused, type of surgery, primary vs. revision surgery, and complications. Statistical analysis included the use of Student’s t-test, Chi square, linear regression, Mann–Whitney U test, and Spearman’s rho. Results: Primary or revision posterior arthrodesis was performed on 1931 consecutive adults (1219 females, 712 males) for deformity and degenerative pathologies. At surgery, females were older than males (61.7 years vs. 59.7 years, p < 0.01), had slightly more comorbidities (1.75 vs. 1.5, p < 0.01), and were more likely to undergo deformity correction (38% vs. 22%, p < 0.01). Females described more pre-op pain (female VAS = 6.54 vs. male VAS = 6.41, p < 0.01) and lower pre-op function (female ODI = 49.73 vs. male ODI = 46.52, p < 0.01). By 3 months post-op, there was no significant gender difference in VAS or ODI scores. Similar pain and function scores between males and females continued through 6 months and 12 months. Conclusion: Although females have more pain and dysfunction before undergoing spinal surgery, the differences in these values do not reach the Minimum Clinically Important Difference (MCID). Post-operatively, there is no difference in pain and function scores among males and females at 3, 6, and 12 months.
Collapse
Affiliation(s)
- Matthew T. Gulbrandsen
- Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA 92354, USA
- Correspondence:
| | - Nina Lara
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA; (N.L.); (M.C.); (D.C.)
| | - James A. Beauchamp
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA;
| | | | - Michael Chang
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA; (N.L.); (M.C.); (D.C.)
- Sonoran Spine Center, Tempe, AZ 85281, USA;
| | - Dennis Crandall
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA; (N.L.); (M.C.); (D.C.)
- Sonoran Spine Center, Tempe, AZ 85281, USA;
| |
Collapse
|
16
|
Rethorn ZD, Covington JK, Cook CE, Bezner JR. Physical Activity Promotion Attitudes and Practices Among Outpatient Physical Therapists: Results of a National Survey. J Geriatr Phys Ther 2021; 44:25-34. [PMID: 33347041 DOI: 10.1519/jpt.0000000000000289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Physical activity (PA) promotion delivered by physical therapists is effective. However, little is known about how much PA promotion is integrated into outpatient US physical therapist practice. The purpose of this study was to determine the current PA promotion practices and factors that influence those practices among outpatient US physical therapists. METHODS A sample of outpatient US physical therapists from the Academy of Orthopaedic Physical Therapy and American Physical Therapy Association (APTA) Geriatrics completed an adaptive online survey that included questions related to PA promotion practices and factors that influence those practices. We dichotomized levels of PA promotion as regular and irregular. Multivariable logistic regression was used to determine what factors predicted regular PA promotion. RESULTS AND DISCUSSION A total of 522 individuals participated and 393 surveys were included in the analyses (75.3%). Most participants (58.5%) irregularly promoted PA and few reported always screening for patients' PA levels (12.7%). The strongest predictor of regularly promoting PA was screening for baseline PA (odds ratio = 5.07, 95% confidence interval = 2.23, 11.57). Physical therapists' own PA levels compared favorably to the US adult population and other health professionals and predicted PA promotion. Other factors related to capability, opportunity, and environment were predictors of PA promotion. Perceived lack of financial support from insurance companies, lack of support from clinical employers, and a perception of competing priorities were barriers to PA promotion. Despite being a public health priority, the majority of physical therapists surveyed infrequently screen for baseline PA and irregularly promote PA. Perceived financial barriers, lack of organizational support, and prioritizing other patient problems hinder PA promotion in the outpatient setting. CONCLUSION Despite guidance from national and international governing bodies, US outpatient physical therapists do not regularly promote PA to patients and perceive financial constraints and competing priorities as key barriers. Professional and patient stakeholders should be involved in designing pathways to improve PA promotion practices among outpatient US physical therapists.
Collapse
Affiliation(s)
- Zachary D Rethorn
- Rocky Mountain University of Health Professions, Provo, Utah
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
| | - J Kyle Covington
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, Round Rock
| |
Collapse
|
17
|
Braaten AD, Hanebuth C, McPherson H, Smallwood D, Kaplan S, Basirico D, Clewley D, Rethorn Z. Social determinants of health are associated with physical therapy use: a systematic review. Br J Sports Med 2021; 55:1293-1300. [PMID: 34083223 DOI: 10.1136/bjsports-2020-103475] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to identify and summarise the social determinants of health (SDH) cited in the literature and evaluate their association with individuals using physical therapy services. DESIGN A systematic review using qualitatively synthesised information to describe the association between SDH and physical therapy use. DATA SOURCES The electronic databases Medline, Embase and Scopus were searched from inception to February 2021, identifying observational and qualitative studies. ELIGIBILITY CRITERIA Published studies included all adults, aged 18 or older, who independently sought to use physical therapy, in all practice settings from all geographical locations. RESULTS Of the 9248 studies screened, 36 met the inclusion criteria for the review. The participants represented 8 countries and totaled 2 699 437. The majority of the papers reported moderate strength of association for each SDH. Female gender, non-Hispanic white race/ethnicity, increased education attainment, urban environment, access to transportation, employment, high socioeconomic status and private insurance were associated with higher likelihood of physical therapy use. CONCLUSION This systematic review identifies predisposing and enabling factors impacting physical therapy usage among adults in different countries and across physical therapy settings. The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.
Collapse
Affiliation(s)
- Amanda Day Braaten
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Cannon Hanebuth
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Holt McPherson
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Dashae Smallwood
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University, Durham, North Carolina, USA
| | - David Basirico
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Derek Clewley
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Zachary Rethorn
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| |
Collapse
|
18
|
Orozco T, Laliberté M, Mazer B, Hunt M, Williams-Jones B, Feldman DE. Making Decisions about Service Provision for Clients with Low Back Pain: Perspectives of Canadian Physiotherapy Professionals. Physiother Can 2021; 73:47-55. [DOI: 10.3138/ptc-2019-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study identified the individuals responsible for making decisions about physiotherapy (PT) wait time, frequency of treatment, and treatment duration for persons with low back pain and determined which factors guided these decisions. Method: A cross-sectional survey was sent to Canadian PT professionals treating adult patients with musculoskeletal problems. It included a clinical vignette describing a patient with low back pain. Respondents were asked who made decisions about wait time, treatment frequency, and treatment duration as well as on which factors they based these decisions. Results: Clinicians were most often responsible for making decisions about treatment frequency and duration. Although clinicians and managers or coordinators were mainly responsible for making decisions about wait time, there was more variability depending on sector of care: in the private sector, administrative assistants played a much larger role. Clinical judgment, clinical guidelines, and patients’ demands were the predominant factors influencing wait time and frequency decisions. Treatment duration was related to patients’ goals, clinical progression, patients’ motivation, and patients’ return to work. Conclusions: Decisions about service provision for wait times are made by a range of stakeholders, and a wide variety of factors guide Canadian PT professionals’ decision making. Identifying these factors is essential for informing a discussion of decisions about evidence-based and equitable service delivery so that the actors involved can reach a consensus.
Collapse
Affiliation(s)
| | - Maude Laliberté
- École de réadaptation, Faculté de médecine
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain
| | - Barbara Mazer
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain
- School of Physical and Occupational Therapy, McGill University, Montreal, Que
| | - Matthew Hunt
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain
- School of Physical and Occupational Therapy, McGill University, Montreal, Que
| | | | | |
Collapse
|
19
|
Abstract
The challenge of overuse raises important questions for those in the business of musculoskeletal health care. What is the right number of physical therapy visits for a given condition? Can a practice provide "less" but still be profitable? In this, the editorial on overcoming overuse of musculoskeletal health care, we consider the economic drivers of overuse in the private sector. We propose actions that could support small business leaders to overcome overuse and build profitable, high-quality services. J Orthop Sports Phys Ther 2021;51(1):1-4. doi:10.2519/jospt.2021.0101.
Collapse
|
20
|
Dolot J, Hyland M, Shi Q, Kim HY, Viola D, Hoekstra C. Factors Impacting Physical Therapy Utilization for Patients With Nonspecific Low Back Pain: Retrospective Analysis of a Clinical Data Set. Phys Ther 2020; 100:1502-1515. [PMID: 32386221 DOI: 10.1093/ptj/pzaa082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Factors predicting physical therapy utilization for lower back pain (LBP) remain unclear, limiting the development of value-based initiatives. The purpose of this study was to identify important factors that impact the number of physical therapist visits per episode of care for US adults with nonspecific LBP. METHODS This study was a retrospective observational cohort study of a clinical dataset derived from 80 clinics of a single physical therapy provider organization. Research variables were categorized at the individual (patient) level and the organization (therapist, clinic) level. A hierarchical regression model was designed to identify factors influencing the number of physical therapist visits per episode of care. RESULTS Higher out-of-pocket payments per visit, receipt of "active" physical therapy, longer average visit length, earlier use of physical therapy, and sex of the therapist (male) were found to predict fewer visits per episode of care. Percent change of function, prior receipt of physical therapy by the same provider organization, self-discharge from physical therapy, level of starting function, and therapist certification were found to predict more visits. Of the variance in number of visits, 8.0% was attributable to the health care organization. CONCLUSIONS Individual factors, such as higher out-of-pocket payment, have a significant impact on reducing visits per episode of care and should be considered when developing value-based initiatives to optimize clinical and utilization outcomes. IMPACT Payers use consumer-directed healthcare to reduce costs by discouraging utilization of low value services and encouraging use of low-cost providers. LBP is a costly condition for which physical therapy is a high-value treatment. This study shows that non-need factors predict the number of physical therapy visits per episode of care for patients with nonspecific LBP. Insurance benefit plans with lower out-of-pocket payments for physical therapy and higher reimbursement for active physical therapist interventions may facilitate appropriate utilization of high-value treatment for LBP.
Collapse
Affiliation(s)
- Janet Dolot
- Department of Physical Therapy, School of Health Sciences and Practice, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595 (USA)
| | - Matthew Hyland
- Department of Physical Therapy, Mercy College, Dobbs Ferry, New York
| | - Qiuhu Shi
- Department of Public Health, School of Health Sciences and Practice, New York Medical College
| | - Hae-Young Kim
- Department of Public Health, School of Health Sciences and Practice, New York Medical College
| | - Deborah Viola
- Department of Data Management and Analytics, Westchester Medical Center Health Network, Valhalla, New York
| | - Christopher Hoekstra
- Department of Physical Therapy, Therapeutic Associates Inc, Tualatin, Oregon. Dr Hoekstra is a board-certified clinical specialist in orthopedic physical therapy and a Fellow of the American Academy of Orthopedic Manual Physical Therapists
| |
Collapse
|
21
|
Liao Y, Vakanski A, Xian M, Paul D, Baker R. A review of computational approaches for evaluation of rehabilitation exercises. Comput Biol Med 2020; 119:103687. [PMID: 32339122 PMCID: PMC7189627 DOI: 10.1016/j.compbiomed.2020.103687] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/27/2022]
Abstract
Recent advances in data analytics and computer-aided diagnostics stimulate the vision of patient-centric precision healthcare, where treatment plans are customized based on the health records and needs of every patient. In physical rehabilitation, the progress in machine learning and the advent of affordable and reliable motion capture sensors have been conducive to the development of approaches for automated assessment of patient performance and progress toward functional recovery. The presented study reviews computational approaches for evaluating patient performance in rehabilitation programs using motion capture systems. Such approaches will play an important role in supplementing traditional rehabilitation assessment performed by trained clinicians, and in assisting patients participating in home-based rehabilitation. The reviewed computational methods for exercise evaluation are grouped into three main categories: discrete movement score, rule-based, and template-based approaches. The review places an emphasis on the application of machine learning methods for movement evaluation in rehabilitation. Related work in the literature on data representation, feature engineering, movement segmentation, and scoring functions is presented. The study also reviews existing sensors for capturing rehabilitation movements and provides an informative listing of pertinent benchmark datasets. The significance of this paper is in being the first to provide a comprehensive review of computational methods for evaluation of patient performance in rehabilitation programs.
Collapse
Affiliation(s)
- Yalin Liao
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | | | - Min Xian
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | - David Paul
- Department of Movement Sciences, University of Idaho, Moscow, USA
| | - Russell Baker
- Department of Movement Sciences, University of Idaho, Moscow, USA
| |
Collapse
|
22
|
Liao Y, Vakanski A, Xian M. A Deep Learning Framework for Assessing Physical Rehabilitation Exercises. IEEE Trans Neural Syst Rehabil Eng 2020; 28:468-477. [PMID: 31940544 PMCID: PMC7032994 DOI: 10.1109/tnsre.2020.2966249] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Computer-aided assessment of physical rehabilitation entails evaluation of patient performance in completing prescribed rehabilitation exercises, based on processing movement data captured with a sensory system. Despite the essential role of rehabilitation assessment toward improved patient outcomes and reduced healthcare costs, existing approaches lack versatility, robustness, and practical relevance. In this paper, we propose a deep learning-based framework for automated assessment of the quality of physical rehabilitation exercises. The main components of the framework are metrics for quantifying movement performance, scoring functions for mapping the performance metrics into numerical scores of movement quality, and deep neural network models for generating quality scores of input movements via supervised learning. The proposed performance metric is defined based on the log-likelihood of a Gaussian mixture model, and encodes low-dimensional data representation obtained with a deep autoencoder network. The proposed deep spatio-temporal neural network arranges data into temporal pyramids, and exploits the spatial characteristics of human movements by using sub-networks to process joint displacements of individual body parts. The presented framework is validated using a dataset of ten rehabilitation exercises. The significance of this work is that it is the first that implements deep neural networks for assessment of rehabilitation performance.
Collapse
|
23
|
Sandstrom R. Increased Utilization of Ambulatory Occupational Therapy and Physical Therapy After Medicaid Expansion. Arch Phys Med Rehabil 2019; 100:1587-1591. [DOI: 10.1016/j.apmr.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 11/25/2022]
|
24
|
Pardasaney PK, Pope GC, Amico P, Deutsch A, Kline T, Dever J, Silver B, Scheffler S, Meadow A, West P. Medicare Outpatient Physical Therapy Expenditures Vary by Diagnosis and Functional Mobility. Phys Ther 2019; 99:526-539. [PMID: 30801639 DOI: 10.1093/ptj/pzz023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/02/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clinical characteristics driving variations in Medicare outpatient physical therapy expenditures are inadequately understood. OBJECTIVE The objectives of this study were to examine variations in annual outpatient physical therapy expenditures of Medicare fee-for-service beneficiaries by primary diagnosis and baseline functional mobility, and to assess whether case mix groups based on primary diagnosis and functional mobility scores would be useful for expenditure differentiation. DESIGN This was an observational, longitudinal study. METHODS Volunteer providers in community settings participated in data collection with Continuity Assessment Record and Evaluation-Community (CARE-C) assessments for Medicare fee-for-service beneficiaries. Annual outpatient physical therapy expenditures were calculated using allowed charges on Medicare claims; primary diagnosis and baseline functional mobility were obtained from CARE-C assessments. Whether annual expenditures varied significantly across primary diagnosis groups and within diagnosis groups by functional mobility was examined. RESULTS Data for 4210 patients (mean [SD] age = 72.9 [9.9] years; 64.6% women) from 127 providers were included. Mean expenditures differed significantly across 12 primary diagnosis groups created from CARE-C clinician-reported diagnoses (F = 12.73; df = 11). Twenty-five pairwise differences in 66 pairwise diagnosis group comparisons were statistically significant. Within 8 diagnosis groups, expenditures were significantly higher for low-mobility subgroups than for high-mobility subgroups; borderline significance was achieved for 1 diagnosis group. LIMITATIONS The small convenience sample limited the statistical power and the generalizability of the results. CONCLUSIONS Significant variations in physical therapy expenditures based on primary diagnosis and baseline functional mobility support the use of these variables in predicting outpatient physical therapy expenditures. Although Medicare's annual therapy spending cap was repealed effective January 2018, the data from this study provide an initial foundation to inform any future policy efforts, such as targeted medical review, risk-adjusted therapy payments, or case mix groups as potential payment alternatives. Additional research with larger samples is needed to further develop and test case mix groups and improve generalizability to the national population. Refined case mix groups could also help providers prognosticate physical therapy expenditures based on patient profiles.
Collapse
Affiliation(s)
- Poonam K Pardasaney
- RTI International, 230 West Monroe Street, Suite 2100, Chicago, IL 60606 (USA)
| | | | | | - Anne Deutsch
- RTI International, Chicago; Shirley Ryan AbilityLab, Chicago; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | | | - Ann Meadow
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | | |
Collapse
|
25
|
Tammany JE, O'Connell JK, Allen BS, Brismée JM. Are Productivity Goals in Rehabilitation Practice Associated With Unethical Behaviors? Arch Rehabil Res Clin Transl 2019; 1:100002. [PMID: 33543042 PMCID: PMC7853351 DOI: 10.1016/j.arrct.2019.100002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives To evaluate the presence of productivity goals among licensed rehabilitation clinicians and their relationship with observed unethical behavior. Design Exploratory, cross-sectional survey. Setting Online. Participants Licensed physical therapy clinicians (N=3446). Intervention Not applicable. Main Outcome Measure Participants completed an electronic survey regarding use of clinical productivity goals. They rated the frequency in which they observed 6 unethical behaviors on a 7-point Likert scale in their practice setting from 1=never to 7=always. An overall observed unethical behavior score was calculated by summing these scales. Results The response rate was 12.8% (N=3446), with analyses showing low risk of nonresponse bias. Many respondents (73.9%) had a formal productivity goal. Most (89.4%) reported observing some form of unethical behavior, but many (68.6%) reported it occurred “rarely” or “never.” Those in skilled nursing facility (SNF) settings reported higher frequencies of observance and were 4.1 times more likely to report more unethical behavior than the median compared with all other settings. A positive correlation existed between expected productivity rate and rate of unethical behaviors observed (ρ=0.225; P<.0001). Amounts of organizational emphases on ethical practice (ρ=−0.509; P<.0001) and evidence-based practice (ρ=−0.492; P<.0001) were negatively correlated with total observed unethical behavior. Conclusions Use of productivity goals in rehabilitation practice is significantly related with rate of unethical behavior observed. Frequency of observed unethical behavior in rehabilitation practice was very low overall. Organizational culture appears to be a greater predictor of observed unethical behavior than any individual clinician-related characteristics. The SNF setting displays the greatest areas of ethical concern.
Collapse
Affiliation(s)
- Justin E Tammany
- Department of Physical Therapy, Holland School of Sciences and Mathematics, Hardin-Simmons University, Abilene, Texas, United States
| | - Janelle K O'Connell
- Department of Physical Therapy, Holland School of Sciences and Mathematics, Hardin-Simmons University, Abilene, Texas, United States
| | - Brad S Allen
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| |
Collapse
|
26
|
Warren M, Shireman TI. Geographic Variability in Discharge Setting and Outpatient Postacute Physical Therapy After Total Knee Arthroplasty: A Retrospective Cohort Study. Phys Ther 2018; 98:855-864. [PMID: 29945184 DOI: 10.1093/ptj/pzy077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/11/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Despite the frequency of total knee arthroplasty (TKA) in the Medicare population, little is known about the use of postacute physical therapy among those discharged to home. OBJECTIVE The objectives of this study were to explore factors associated with geographic variability in discharge disposition and outpatient physical therapy utilization for Medicare patients after TKA discharged to home/self-care. DESIGN The design of the study was a retrospective cohort study. METHODS Medicare patients with TKA discharged alive from July 1, 2010, to June 30, 2011, with discharge disposition to home/self-care (HSC), home health agency (HHA), inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF) were selected. Geography was measured with Census region. Outpatient physical therapy utilization was calculated from Medicare Part B claims. Odds ratios for discharge disposition and adjusted means for physical therapy utilization variables by Census region were calculated, accounting for county-clustered data and adjusting for demographics, clinical, and environmental characteristics. RESULTS There was significant variation with discharge destination by Census region among 18,278 patients. With discharge disposition analysis, the patients from the West region who were discharged home were the referent group. The patients from the South and Northeast regions had higher odds for discharge to HHAs (adjusted odds ratio [95% CI = 1.80 [1.48-2.19] and 2.20 [1.70-2.84]), SNFs (1.34 [1.08-1.66] and 4.42 [3.38-5.79]), and IRFs (2.36 [1.80-3.09] and 8.83 [6.41-12.18]). For those discharged to HSC, 40.4% received outpatient physical therapy within 4 weeks. Significant differences were found with time to first physical therapy visit (Midwest <South <[West = Northeast]) and length of therapy episode, but not with the number of therapy visits by geographic region. CONCLUSIONS Geographic region was associated with discharge setting, postacute physical therapy, and outpatient therapy utilization in Medicare beneficiaries after TKA. Differences in outcomes of outpatient therapy should be assessed to better describe the impact of geographic variation in care.
Collapse
Affiliation(s)
- Meghan Warren
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ 86011 (USA)
| | - Theresa I Shireman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| |
Collapse
|
27
|
Beneciuk JM, Lentz TA, He Y, Wu SS, George SZ. Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study. Phys Ther 2018; 98:290-301. [PMID: 29669081 PMCID: PMC6256953 DOI: 10.1093/ptj/pzy021] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 02/06/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Musculoskeletal pain is a societal epidemic because it is highly prevalent and a leading contributor to disability; however, physical therapists are still challenged when predicting which patients are at high risk for persistent symptoms. OBJECTIVE The objectives of this study were to identify patient characteristics predictive of persistent musculoskeletal pain 12 months following physical therapist care and to determine the influence of anatomical region. DESIGN The design included a secondary analysis of a cohort study. METHODS Participants ranged in age from 18 to 65 years, had a primary report of knee, shoulder, back, or neck pain, were receiving physical therapy, and were enrolled in the Orthopedic Physical Therapy Investigative Network (OPT-IN) Optimal Screening for Prediction of Referral and Outcome (OSPRO) validation cohort study. Candidate predictor variables included demographic and clinical characteristics, comorbidities, and OSPRO Review of Systems (OSPRO-ROS) and OSPRO Yellow Flag (OSPRO-YF) tool scores. Persistent musculoskeletal pain was assessed by self-report responses to questions on the duration of pain and activity limitation. Logistic regression was used for completed cases to identify predictors of persistent pain at 12 months in full and parsimonious models. RESULTS Follow-up assessment at 12 months was performed for 63.4% of participants (279/440). Participants with persistent pain at 12 months (n = 101; 36.2%) had more comorbidities, higher numerical pain rating scale scores, and higher OSPRO-ROS and OSPRO-YF tool scores at baseline than those without persistent pain, and the findings were independent of anatomical region. The number of comorbidities (odds ratio [OR] range = 0.30-0.46), numerical pain rating scale scores (OR at baseline = 1.44-1.75; OR at 4 weeks = 1.37-1.39), and OSPRO-ROS (plus additional items) scores (OR = 1.33-1.54) were predictors in full and parsimonious models. LIMITATIONS Convenience sampling was used, with a follow-up rate at 12 months (63.4%) that was lower than anticipated, and an operational definition for chronic low back pain was applied to persistent musculoskeletal pain in other body regions. CONCLUSIONS The OSPRO-ROS tool may be used to improve the prediction of persistent musculoskeletal pain at 12 months in conjunction with comorbidities and pain intensity (baseline and 4 weeks). These are potentially important findings because persistent pain was not commonly evaluated in previous screening studies; however, it is a relevant outcome in an era of front-line nonpharmacological pain management.
Collapse
Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, Florida, and Brooks Rehabilitation Clinical Research Center, 3901 University Blvd S, Ste 103, Jacksonville, FL 32216 (USA),Address all correspondence to Dr Beneciuk at:
| | - Trevor A Lentz
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ying He
- Department of Mathematics, Clarkson University, Potsdam, New York
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| |
Collapse
|
28
|
Laliberté M. Facteurs influençant la multiplication de traitements en physiothérapie : une analyse thématique de la jurisprudence québécoise. BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044610ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
La physiothérapie est touchée par un problème de multiplication de traitements; la fréquence des traitements ou leur durée peuvent être inappropriées ou disproportionnées face aux besoins du patient. La multiplication de traitements peut avoir des conséquences financières, physiques, psychologiques et sociales. Pour explorer les facteurs influençant la fréquence et la durée des traitements dans les situations de multiplication de traitements, une analyse thématique de la jurisprudence a été réalisée. Certains facteurs cliniques et non cliniques influençant la fréquence et la durée des traitements ont pu être identifiés par cette analyse thématique de la jurisprudence. Les facteurs cliniques impliquent que l’allocation des ressources soit guidée par la condition et l’évolution du patient. Les facteurs non cliniques peuvent inclure la pression des employeurs, les demandes des autres professionnels de la santé ou les conflits d’intérêts de type financier. Cette analyse thématique de la jurisprudence est une première étape pour comprendre ce qui motive les décisions cliniques d’allocation des ressources des professionnels de la physiothérapie. Cette démarche est essentielle pour mettre en place des politiques et des normes de pratique soucieuses du contexte de pratique et des normes éthiques, déontologiques et légales qui animent la profession.
Collapse
Affiliation(s)
- Maude Laliberté
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Canada
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal
- Membre étudiant de l’Institut de recherche en santé publique de l’Université de Montréal (IRSPUM)
- Membre étudiant du Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR)
| |
Collapse
|
29
|
Bove AM, Gough ST, Hausmann LRM. Providing no-cost transport to patients in an underserved area: Impact on access to physical therapy. Physiother Theory Pract 2018; 35:645-650. [PMID: 29601223 DOI: 10.1080/09593985.2018.1457115] [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: 10/17/2022]
Abstract
Background: Barriers to accessing outpatient health care services are common and contribute to poor health outcomes. We describe the efforts of a private practice physical therapy (PT) clinic to reduce these barriers by offering a door-to-door van service at no cost to patients. Methods: Clinic records and national census databases were retrospectively reviewed to explore the impact of offering no-cost van rides to patients attending outpatient PT appointments. We used descriptive statistics and linear regression to describe volume of utilization of the van service over a 40-month period. Paired t-tests compared PT clinic attendance rates (percentage of scheduled visits that were attended) before and after implementation of the van service. Results: Use of the van service increased significantly over time, from a mean of 83 riders per month in 2010 to 205 riders per month in 2013 (p < 0.001). Overall clinic attendance rate increased from 80.1% to 84.1% after implementation of the service (p = 0.002). Following introduction of the van service, 48% of patients using the van, compared to 25% of clinic patients overall, were uninsured or insured by Medicaid. Conclusion: Use of the van service increased over time, and availability of no-cost van transportation was associated with increased visit attendance for patients at an outpatient PT clinic.
Collapse
Affiliation(s)
- Allyn M Bove
- a Department of Physical Therapy , University of Pittsburgh School of Health and Rehabilitation Sciences , Pittsburgh , PA , USA
| | | | - Leslie R M Hausmann
- c Veterans Affairs Pittsburgh Healthcare System , Center for Health Equity Research and Promotion , Pittsburgh , PA , USA.,d Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| |
Collapse
|
30
|
Utilization and out of pocket (OOP) payment for physiotherapy services in public hospitals of Shahid Beheshti University of Medical Sciences. Med J Islam Repub Iran 2018; 32:19. [PMID: 30159270 PMCID: PMC6108256 DOI: 10.14196/mjiri.32.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Physiotherapy services constitute a principle part of health care systems, and interest in their use has increased in the recent decades. This study was conducted to investigate the utilization and OOP payment for physiotherapy services in public hospitals of Shahid Beheshti University of Medical Sciences in Tehran, Iran.
Methods: This cross-sectional study was conducted using the data of physiotherapy department of three public hospitals. The study sample included 6528 patients who had received 7257 episodes of care. Data were extracted through hospital information systems and analyzed using multivariate regression analysis by SPSS17.
Results: The average episode per patient was 1.11 and 12.6 session per episode. The average cost of each episode and treatment session was 1 784 660 IRR (USD 59) and 142 023 IRR (USD 4.7), respectively. The OOP payment share for physiotherapy was 31%. Age, OOP amount, having insurance coverage, insurance type, and service type significantly affected physiotherapy utilization. Number of treatment sessions, having insurance coverage, type of insurance coverage, and gender were related to OOP payment.
Conclusion: There is a large variety in utilization and OOP payment in the insurance funds, which could restrict the accessibility and utilization of services by patients, leading to inequalities in utilization. Therefore, policymakers should conduct an overall review on the tariffs and service packages of insurer organizations to provide better conditions for the elderly, unhealthy, and vulnerable population to mitigate inequality in service utilization and decrease OOP payment.
Collapse
|
31
|
Abstract
The article presents University of Idaho - Physical Rehabilitation Movement Data (UI-PRMD) - a publically available data set of movements related to common exercises performed by patients in physical rehabilitation programs. For the data collection, 10 healthy subjects performed 10 repetitions of different physical therapy movements, with a Vicon optical tracker and a Microsoft Kinect sensor used for the motion capturing. The data are in a format that includes positions and angles of full-body joints. The objective of the data set is to provide a basis for mathematical modeling of therapy movements, as well as for establishing performance metrics for evaluation of patient consistency in executing the prescribed rehabilitation exercises.
Collapse
Affiliation(s)
- Aleksandar Vakanski
- University of Idaho, Industrial Technology, 1776 Science Center Drive, Idaho Falls, ID 83402, USA
| | - Hyung-pil Jun
- University of Idaho, Department of Movement Sciences, 875 Perimeter Drive, Moscow, ID 83844, USA
| | - David Paul
- University of Idaho, Department of Movement Sciences, 875 Perimeter Drive, Moscow, ID 83844, USA
| | - Russell Baker
- University of Idaho, Department of Movement Sciences, 875 Perimeter Drive, Moscow, ID 83844, USA
| |
Collapse
|
32
|
Brooks G, Dolphin M, Rufa A. Variation in perceived providers of ambulatory physical therapy in the United States, 2009-2012: An analysis using data from the Medical Expenditure Panel Survey. Physiother Theory Pract 2018; 35:229-242. [PMID: 29485316 DOI: 10.1080/09593985.2018.1441933] [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: 10/17/2022]
Abstract
Introduction: Little is known about public perception of physical therapy (PT) delivery by type of provider in the United States (US). Purpose: This study aimed to describe differences in ambulatory PT visits and expenditures according to perceived provider type, and to determine if visits and expenditures varied by provider type. Methods: This study employed the Medical Expenditure Panel Survey (MEPS), which is a nationally representative survey of US households that used a complex, stratified, cluster sample design. Data from cross-sectional samples over 4 years of the MEPS Household Component were used to study adults with musculoskeletal conditions who reported receiving ambulatory PT. National-level, average annual estimates of numbers of visits, and reported total expenditures by perceived provider type were computed. Associations between perceived provider type and visits and expenditures were determined by linear regression, accounting for the sample design, and adjusting for demographic and clinical covariates. Results: Estimated annual perceived PT visits were 60.00 million with physical therapists, 39.66 million with non-physical therapist providers, and 20.66 million with multiple providers. Estimated annual expenditures for PT were $9.37 billion with physical therapists, $4.62 billion with non-physical therapist providers, and $3.09 billion with multiple providers. Compared with non-physical therapist providers, physical therapist provider status and multiple provider status were associated with higher numbers of visits and expenditures. Conclusion: Non-physical therapist providers are responsible for a substantial amount of PT delivery in the US. Numbers of visits and total expenditures varied by the type of provider delivering PT.
Collapse
Affiliation(s)
- Gary Brooks
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Michelle Dolphin
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Adam Rufa
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
33
|
The Influence of Patient Choice of First Provider on Costs and Outcomes: Analysis From a Physical Therapy Patient Registry. J Orthop Sports Phys Ther 2018; 48:63-71. [PMID: 29073842 DOI: 10.2519/jospt.2018.7423] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Retrospective study. Background Alternative models of care that allow patients to choose direct access to physical therapy have shown promise in terms of cost reduction for neck and back pain. However, real-world exploration within the US health care system is notably limited. Objectives To compare total claims paid and patient outcomes for patients with neck and back pain who received physical therapy intervention via direct access versus medical referral. Methods Data were accessed for patients seeking care for neck or back pain (n = 603) between 2012 and 2014, who chose to begin care either through traditional medical referral or direct access to a physical therapy- led spine management program. All patients received a standardized, pragmatic physical therapy approach, with patient-reported measures of pain and disability assessed before and after treatment. Patient demographics and outcomes data were obtained from the medical center patient registry and combined with total claims paid calculated for the year after the index claim. Linear mixed-effects modeling was used to analyze group differences in pain and disability, visits/time, and annualized costs. Results Patients who chose to enter care via the direct-access physical therapy-led spine management program displayed significantly lower total costs (mean difference, $1543; 95% confidence interval: $51, $3028; P = .04) than those who chose traditional medical referral. Patients in both groups showed clinically important improvements in pain and disability, which were similar between groups (P>.05). Conclusion The initial patient choice to begin care with a physical therapist for back or neck pain resulted in lower cost of care over the next year, while resulting in similar improvements in patient outcomes at discharge from physical therapy. These findings add to the emerging literature suggesting that patients' choice to access physical therapy through direct access may be associated with lower health care expenditures for patients with neck and back pain. Level of Evidence Economic and decision analyses, level 4. J Orthop Sports Phys Ther 2018;48(2):63-71. Epub 26 Oct 2017. doi:10.2519/jospt.2018.7423.
Collapse
|
34
|
Marshall TF, Groves JR, Holan GP, Lacamera J, Choudhary S, Pietrucha RJ, Tjokro M. The Feasibility of Community-Based, Supervised Exercise Programs to Engage and Monitor Patients in a Postrehabilitation Setting. Am J Lifestyle Med 2018; 14:443-461. [PMID: 33281525 DOI: 10.1177/1559827617750385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective. To evaluate the feasibility of disease-specific, community-based supervised exercise programs (CSEPs) to improve biometric and functional outcomes among persons with a variety of chronic medical conditions. Design. Feasibility, cohort study. Subjects were recruited through community placed flyers and provider offices. Exercise programs consisted of aerobic and resistance training that adhered to American College of Sports Medicine guidelines. A Wilcoxon signed rank test was used to assess program outcomes. Setting. Ten, community-based, medical fitness centers. Subjects. A total of 382 total participants. The number of participants in each CSEP ranged from 38 to 119. Individuals were 18 years of age or older and treated for various chronic medical conditions. Results. Varied by cohort, but generally consisted of (a) favorable changes in body composition ( P < .05), (b) significant improvements in submaximal exercise tolerance and functional outcome measures ( P < .05), and (3) significant increase in self-reported exercise behaviors ( P < .05). Conclusion. CSEPs improve outcomes in patients with chronic medical conditions and may be relevant within the continuum of care in outpatient rehabilitation medicine, particularly among bundled or value-based payment models. Further research is needed to evaluate outcomes from CSEPs versus controls.
Collapse
Affiliation(s)
- Timothy F Marshall
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Jay R Groves
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - George P Holan
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Jonathan Lacamera
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Shaloo Choudhary
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Ronald J Pietrucha
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Moorissa Tjokro
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| |
Collapse
|
35
|
Keeney T, Jette AM, Freedman VA, Cabral H. Racial Differences in Patterns of Use of Rehabilitation Services for Adults Aged 65 and Older. J Am Geriatr Soc 2017; 65:2707-2712. [PMID: 29114848 DOI: 10.1111/jgs.15136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services. DESIGN Secondary analysis of the 2016 National Health and Aging Trends Study (NHATS). SETTING Standardized in-person home interviews. PARTICIPANTS Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months. MEASUREMENTS Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services. RESULTS Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial differences in improvement in function. CONCLUSION Strategies are needed to identify possible barriers to use of rehabilitation services for vulnerable groups of aging individuals who need rehabilitation services, particularly older blacks.
Collapse
Affiliation(s)
- Tamra Keeney
- Institute of Health Professiowns, Massachusetts General Hospital, Boston, Massachusetts
| | - Alan M Jette
- Institute of Health Professiowns, Massachusetts General Hospital, Boston, Massachusetts
| | - Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Howard Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| |
Collapse
|
36
|
Laliberté M, Mazer B, Orozco T, Chilingaryan G, Williams-Jones B, Hunt M, Feldman DE. Low Back Pain: Investigation of Biases in Outpatient Canadian Physical Therapy. Phys Ther 2017; 97:985-997. [PMID: 29029551 DOI: 10.1093/ptj/pzx055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 05/12/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Previous research suggested that physical therapy services can be influenced by patient characteristics (age, sex, socioeconomic status) or insurance status rather than their clinical need. OBJECTIVE The aim of this study was to determine whether patient-related factors (age, sex, SES) and the source of reimbursement for physical therapy services (insurance status) influence wait time for, frequency of, and duration of physical therapy for low back pain. DESIGN This study was an empirical cross-sectional online survey of Canadian physical therapy professionals (defined as including physical therapists and physical rehabilitation specialists). METHODS A total of 846 physical therapy professionals received 1 of 24 different (and randomly selected) clinical vignettes (ie, patient case scenarios) and completed a 40-item questionnaire about how they would treat the fictional patient in the vignette as well as their professional clinical practice. Each vignette described a patient with low back pain but with variations in patient characteristics (age, sex, socioeconomic status) and insurance status (no insurance, private insurance, Workers' Compensation Board insurance). RESULTS The age, sex, and socioeconomic status of the fictional vignette patients did not affect how participants would provide service. However, vignette patients with Workers' Compensation Board insurance would be seen more frequently than those with private insurance or no insurance. When asked explicitly, study participants stated that insurance status, age, and chronicity of the condition were not factors associated with wait time for, frequency of, or duration of treatment. LIMITATIONS This study used a standardized vignette patient and may not accurately represent physical therapy professionals' actual clinical practice. CONCLUSIONS There appears to be an implicit professional bias in relation to patients' insurance status; the resulting inequity in service provision highlights the need for further research as a basis for national guidelines to promote equity in access to and provision of quality physical therapy services.
Collapse
Affiliation(s)
- Maude Laliberté
- École de Réadaptation, Faculté de Médecine, Université de Montréal, C.P. 6128 Succursale Centre-ville, Montréal, Québec, Canada H3C 3J7; and Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montréal, Québec, Canada
| | - Barbara Mazer
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada; and CRIR
| | - Tatiana Orozco
- École de Réadaptation, Faculté de Médecine, Université de Montréal
| | - Gevorg Chilingaryan
- Centre Intégré de Santé et de Services Sociaux de Laval, Hôpital Juif de Réadaptation, Laval, Québec, Canada; School of Physical and Occupational Therapy, McGill University; and CRIR
| | - Bryn Williams-Jones
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada; and CRIR
| | - Debbie Ehrmann Feldman
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada; and CRIR
| |
Collapse
|
37
|
Sabbahi A, Arena R, Woldt J, Wax B, Mauk S, Wolner F, Phillips SA. Improvements in cardiometabolic risk markers, aerobic fitness, and functional performance following a physical therapy weight loss program. Physiother Theory Pract 2017; 34:13-21. [PMID: 28862533 DOI: 10.1080/09593985.2017.1368757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objectives of this study were to determine the efficacy of a current physical therapy and weight loss program model on exercise performance, physical function, and cardiometabolic risk factors in obese patients. DESIGN Retrospective pre-post design. SUBJECTS A total of 192 patients who previously underwent testing of anthropometric measurements, cardiovascular biomarkers, and lower extremity function scale (LEFS) were included. RESULTS There was a significant reduction in body weight [5.91 ± 3.47 (95% CI, 5.4 to 6.4) kg; p < 0.001; n = 187] and waist circumference [7.1 ± 5 (95% CI, 6.3 to 7.9) cm; p < 0.001; n = 187]. Submaximal exercise capacity (VO2ex) increased by [5.29 ± 4.74 (95% CI, 4.38 to 6.19) ml/kg/min; p < 0.001; n = 107], and lower extremity functional scale (LEFS) improved by [9 ± 11 (95% CI, 7 to 12) scale points; p < 0.001; n = 75]. Both systolic (pre SBP: 125.7 ± 15 vs. post SBP: 118.4 ± 12 mmHg; p < 0.001; n = 150) and diastolic (pre DBP: 78.5 ± 10 vs. post DBP: 74 ± 8.5 mmHg; p < 0.001; n = 150) blood pressures as well as fasting blood glucose (pre FBG: 112.8 ± 37 vs. post FBG: 99 ± 18 mg/dL; p < 0.001; n = 132) were significantly reduced. CONCLUSIONS This study indicates the importance and significance of weight loss in improving physical function and cardiometabolic risk profiles across a cohort of outpatient physical therapy patients. Our study also suggests that weight loss can be achieved in a comprehensive exercise intensive physical therapy program for obese patients.
Collapse
Affiliation(s)
- Ahmad Sabbahi
- a Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences , University of Illinois at Chicago , Chicago , IL, USA
| | - Ross Arena
- a Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences , University of Illinois at Chicago , Chicago , IL, USA
| | - Joel Woldt
- b Revolution Physical Therapy and Weight Loss , Chicago , IL, USA
| | - Ben Wax
- b Revolution Physical Therapy and Weight Loss , Chicago , IL, USA
| | - Steven Mauk
- b Revolution Physical Therapy and Weight Loss , Chicago , IL, USA
| | - Frederic Wolner
- b Revolution Physical Therapy and Weight Loss , Chicago , IL, USA
| | - Shane A Phillips
- a Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences , University of Illinois at Chicago , Chicago , IL, USA
| |
Collapse
|
38
|
Vyas A, Babcock Z, Kogut S. Impact of depression treatment on health-related quality of life among adults with cancer and depression: a population-level analysis. J Cancer Surviv 2017; 11:624-633. [PMID: 28799098 DOI: 10.1007/s11764-017-0635-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/27/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Cancer diagnosis in adults is often accompanied by negative impacts, which increase the risk of depression thereby lowering health-related quality of life (HRQoL). We examined the association between depression treatment and HRQoL among US adults with cancer and depression. METHODS Patients age 18 and above, with self-reported cancer and depression diagnoses were identified from Medical Expenditure Panel Survey database for 2006-2013. Baseline depression treatment was categorized as antidepressants only, psychotherapy with or without antidepressant use, and no reported use of antidepressants or psychotherapy. HRQoL was measured using SF-12 physical component summary (PCS) and mental component summary (MCS) scores. Adjusted ordinary least squares regressions estimated the association between type of depression treatment and HRQoL. RESULTS Out of 450 (weighted per calendar year: 2.1 million) cancer adults included in the study, 51% received antidepressants only, while 16% received psychotherapy with or without antidepressants. In bivariate analyses, the mean MCS score was lowest among those who received psychotherapy with or without antidepressants compared to those receiving antidepressants only and those with no reported use of either modality, p < 0.05. In multivariate analyses, there was no significant difference in HRQoL by type of depression treatment. CONCLUSION Despite treatment for depression, HRQoL did not improve during the measurement timeframe. Quality of life is a priority health outcome in cancer treatment, yet our findings suggest that current clinical approaches to ameliorate depression in cancer patients appear to be suboptimal. IMPLICATIONS FOR CANCER SURVIVORS Adults with cancer and comorbid depression should receive appropriate depression care in order to improve their HRQoL.
Collapse
Affiliation(s)
- Ami Vyas
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA.
| | - Zachary Babcock
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
| | - Stephen Kogut
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
| |
Collapse
|
39
|
Masaracchio M, Hanney WJ, Liu X, Kolber M, Kirker K. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS One 2017; 12:e0178295. [PMID: 28575058 PMCID: PMC5456061 DOI: 10.1371/journal.pone.0178295] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/10/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the role of early initiation of rehabilitation on length of stay (LOS) and cost following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty. DATA SOURCES Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, and the Cochrane Library were searched in July 2016. Five additional trials were identified through reference list scanning. STUDY SELECTION Eligible studies were published in English language peer-reviewed journals; included participants that had undergone total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty reported clearly defined timing of rehabilitation onset for at least two groups; and reported at least one measure of LOS or cost. Inclusion criteria were applied by 2 independent authors, with disagreements being determined by a third author. Searching identified 1,029 potential articles, of which 17 studies with 26,614 participants met the inclusion criteria. DATA EXTRACTION Data was extracted independently by 2 authors, with disagreements being determined by a third author. Methodological quality of each study was evaluated independently by 2 authors using the Downs and Black checklist. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate standardized mean differences (SMD) and 95% confidence intervals for LOS. DATA SYNTHESIS When compared with standard care, early initiation of physical therapy demonstrated a decrease in length of stay for the 4 randomized clinical trials (SMD = -1.90; 95% CI -2.76 to -1.05; I2 = 93%) and for the quasi-experimental and 5 prospective studies (SMD = -1.47; 95% CI -1.85 to -1.10; I2 = 88%). CONCLUSION Early initiation of rehabilitation following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty is associated with a shorter LOS, a lower overall cost, with no evidence of an increased number of adverse reactions. Additional high quality studies with standardized methodology are needed to further examine the impact of early initiation of physical therapy among patients with joint replacement procedures.
Collapse
MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/rehabilitation
- Humans
- Length of Stay/economics
- Physical Therapy Modalities/economics
- Treatment Outcome
Collapse
Affiliation(s)
- Michael Masaracchio
- Department of Physical Therapy, Long Island University, Brooklyn, New York, United States of America
| | - William J. Hanney
- Department of Health Professions, University of Central Florida, Orlando, Florida, United States of America
| | - Xinliang Liu
- Department of Health Management and Informatics, University of Central Florida, Orlando, Florida, United States of America
| | - Morey Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Kaitlin Kirker
- Department of Physical Therapy, Long Island University, Brooklyn, New York, United States of America
| |
Collapse
|
40
|
Rommel A, Kroll LE. Individual and Regional Determinants for Physical Therapy Utilization in Germany: Multilevel Analysis of National Survey Data. Phys Ther 2017; 97:512-523. [PMID: 28340149 DOI: 10.1093/ptj/pzx022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 03/07/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Physical therapy is included in many clinical guidelines and is a commonly used health service. However, access to its benefits should not strongly depend on social or demographic factors. OBJECTIVE The present study used the Andersen model to explain to what extent physical therapy utilization in Germany depends on factors beyond medical need. METHODS The German Health Interview and Examination Survey for Adults (DEGS, 2008-2011; target population, 18-79 years) is part of the German health-monitoring system. Two-stage stratified cluster sampling resulted in a sample of 8152 participants. Data were matched with district-related information on social structures and service supply. Following Andersen's Behavioral Model of Health Services Use, this study identified predisposing, enabling, and need factors for physical therapy utilization using multilevel logistic regression analyses. RESULTS Physical therapy was used by 23.4% (95% CI: 22.0-24.8) of the German population within one year, with a higher proportion of females (26.8%; 95% CI: 25.1-28.6) than males (19.9%; 95% CI: 18.1-21.8) and an increase with age. Beyond medical need, physical therapy utilization depended on higher education, migrant background, nonsmoking (predisposing), social support, higher income, private health insurance, and gatekeeping service contact (enabling). Variation among districts partly reflected regional supply. LIMITATIONS Because the present study was cross-sectional, its findings provide representative information on physical therapy use but do not establish final causal links or identify whether utilization or supply in certain districts or population groups is adequate. CONCLUSIONS Whether certain regions are under- or overserved and whether further regulations are needed is of political interest. Physicians and therapists should develop strategies to improve both adherence of hard-to-reach groups and supply in low-supply regions.
Collapse
Affiliation(s)
- Alexander Rommel
- Department 2: Epidemiology and Health Monitoring, Robert Koch Institute, POB 65 02 61, D-13302 Berlin, Germany
| | - Lars Eric Kroll
- Department 2: Epidemiology and Health Monitoring, Robert Koch Institute
| |
Collapse
|
41
|
Pignataro RM. Tobacco cessation counseling within physical therapist practice: Results of a statewide survey of Florida physical therapists. Physiother Theory Pract 2017; 33:131-137. [DOI: 10.1080/09593985.2016.1266719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rose M. Pignataro
- Department of Rehabilitation Sciences, College of Health Professions and Social Work, Florida Gulf Coast University, Fort Myers, FL, USA
| |
Collapse
|
42
|
Finding the "Right-Size" Physical Therapy Workforce: International Perspective Across 4 Countries. Phys Ther 2016; 96:1597-1609. [PMID: 27149960 DOI: 10.2522/ptj.20160014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/28/2016] [Indexed: 02/09/2023]
Abstract
Finding the "right-size" physical therapy workforce is an increasingly important issue, but it has had limited study, particularly across nations. This perspective article provides a comprehensive examination of physical therapy workforce issues across 4 countries (United States, Singapore, Portugal, and Bangladesh), which were deliberately selected to allow consideration of key contextual factors. This investigation provides a theoretical model uniquely adapted to focus on variables most likely to affect physical therapy workforce needs. This theoretical model was used to guide acquisition of public domain data across the respective countries. The data then were used to provide a contextualized interpretation about the physical therapy workforce supply (ie, physical therapists per capita) across the 4 countries in light of the following factors: indicators of physical therapy need, financial and administrative barriers affecting physical therapy access and demand, the proportion of physical therapy graduates (with varying trends over time across the countries), and the role of emigration/immigration in supply inequalities among countries of lower and higher income. In addition, both the physical therapy workforce supply and scope of practice were analyzed in the context of other related professions across the 4 countries. This international comparison indicated that there may not be a "one-size-fits-all" recommendation for physical therapy workforce supply across countries or an ideal formula for its determination. The optimal, country-specific physical therapy workforce supply appears to be affected by discipline-specific health care and contextual factors that may vary across countries, and even within the same country. This article provides a conceptual framework and basis for such contextualized evaluations of the physical therapy workforce.
Collapse
|
43
|
Abstract
This paper discusses the user research and design process of the PTCane: a smart cane for physical therapy. The goal of the research process is to identify limitations in current home exercise programs, and the goal of the design process is to provide a device, the PTCane, to overcome these limitations and augment home exercise programs. User research included a general survey, physical therapy observations, and expert interviews. From our user research, we identified that the technology needs to overcome barriers to physical therapy, inform patients of their exercise accuracy, and decrease helplessness during recovery. The final proposed cane design includes reminders, an accuracy feedback system, a pain and progress survey, and a system to provide information about progress in therapy to both patients and therapists.
Collapse
Affiliation(s)
| | - Tengwen Hu
- North Carolina State University, Raleigh, NC, 27606
| | | | - John Muth
- North Carolina State University, Raleigh, NC, 27606
| |
Collapse
|
44
|
Sandstrom R, Bruns A. Disparities in Access to Outpatient Rehabilitation Therapy for African Americans with Arthritis. J Racial Ethn Health Disparities 2016; 4:599-606. [DOI: 10.1007/s40615-016-0263-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 11/28/2022]
|
45
|
Utilization and Payments of Office-Based Physical Rehabilitation Services Among Individuals With Commercial Insurance in New York State. Phys Ther 2016; 96:202-11. [PMID: 26658150 DOI: 10.2522/ptj.20150060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 12/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited research exists on the utilization and payments of physical rehabilitation services, especially among individuals with commercial insurance. OBJECTIVE This study aimed to characterize the utilization and payments of office-based physical rehabilitation services among nonelderly individuals with commercial insurance from New York State. DESIGN This was a retrospective descriptive study with a cross-sectional design. METHODS A cohort of 1.8 million individuals in the 2012 Truven Health MarketScan Research Database was constructed for review. A total of 109,821 unique patients who received any type of physical rehabilitation provided by physical therapists, chiropractors, and physicians in the office setting were included for analyses. RESULTS Physical therapists provided the largest proportion of physical rehabilitation services (54.5%), followed by chiropractors (27.5%) and physicians (18.0%). Six out of 100 individuals used physical rehabilitation services in 2012. The mean annual payment of physical rehabilitation per patient was $820 (median=$323). Women and older individuals were more likely to use rehabilitation services and have higher annual utilization and payments. For the 5 most common physical rehabilitation services, payment rates for chiropractors were the highest and those for physical therapists were the lowest, with payment rates for physicians in between. LIMITATIONS This study was based on commercial insurance claims data from one state. CONCLUSIONS Findings from this study recognize that rehabilitation services are delivered by various types of health care professionals and the payment rates vary across provider specialties in New York State. Of particular interest is that although physical therapists provide the largest proportion of services, their payment rates are lower than the rates for chiropractors and physicians. Future research should assess regional variations and explore interprovider cost-effectiveness in delivering these interventions.
Collapse
|
46
|
Impact of Out-of-Pocket Expenditure on Physical Therapy Utilization for Nonspecific Low Back Pain: Secondary Analysis of the Medical Expenditure Panel Survey Data. Phys Ther 2016; 96:212-21. [PMID: 26608328 DOI: 10.2522/ptj.20150028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 11/18/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical therapy decreases low back pain, improves function, and may lead to decreased use of medical services. However, factors predicting physical therapy utilization for patients with low back pain are not well understood. OBJECTIVES The purpose of this study was to identify the impact of out-of-pocket expenditure on physical therapy utilization for US adults with nonspecific low back pain. DESIGN This study was a secondary analysis of retrospective Medical Expenditure Panel Survey data. METHODS The participants were US adults with nonspecific low back pain. The outcome variable was the number of visits per episode of care. The research variable was out-of-pocket expenditure. Covariate variables were Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) component scores. Descriptive statistics and multiple linear regression analyses were performed. RESULTS Three hundred fourteen adults met the inclusion criteria and submitted SF-12 scores, representing nearly 4 million adults. Out-of-pocket expenditure, physical component score, and the age-insurance category "18-64 years with public coverage only for all of the year or uninsured all of the year" negatively predicted visits per episode of care in the final regression model. LIMITATIONS Limitations of the study included use of a nonexperimental design, lack of information about symptom severity and content of physical therapy, and SF-12 scores were not taken coincidental with the episode of care. CONCLUSIONS Out-of-pocket expenditure negatively predicts physical therapy utilization. More research is needed to identify all factors influencing physical therapy utilization so that effective health policies may be developed.
Collapse
|
47
|
Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review. J Orthop Sports Phys Ther 2016; 46:56-70. [PMID: 26755406 DOI: 10.2519/jospt.2016.6138] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic review. BACKGROUND Current US practice guidelines suggest an initial "wait-and-see" approach following onset of musculoskeletal pain, particularly for spinal pain. Several studies suggest that early, compared with delayed, initiation of physical therapy for musculoskeletal conditions may decrease health costs and improve outcomes. OBJECTIVE To compare early and delayed initiation of physical therapy for individuals with musculoskeletal conditions and to assess effects on patient-important outcomes and cost. METHODS MEDLINE (Ovid), CINAHL (EBSCO), Web of Science, and PEDro were the data sources. We included studies that compared early and delayed initiation of physical therapy for patients with musculoskeletal disorders. Studies in which early and delayed interventions differed were excluded. Two independent reviewers extracted study characteristics and outcomes, and determined eligibility and quality through consensus with a third reviewer. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in summary conclusions. Standardized effect sizes (d) and odds ratios were calculated to assess the effect strength of early versus delayed physical therapy for each included study. RESULTS Of the 3855 articles initially screened, 14 studies were included. The majority of articles studied low back pain (only 2 articles studied cervical pain). For spinal pain, there was low-quality evidence that early versus delayed physical therapy was associated with decreased cost and decreased frequency of opioid prescriptions, advanced imaging, and surgeries without compromising patient-important outcomes. One subgroup analyzed showed improved function/disability with early physical therapy in an occupational health setting. CONCLUSION Although there were consistent results across studies favoring early physical therapy for decreased cost and medical utilization, quality was limited. Preliminary evidence suggests that early physical therapy may decrease cost without compromising outcomes. The primary limitation of the current research on this topic is in study design. Additional high-quality research involving prospective randomized designs and economic impact analyses is required to further investigate the outcomes associated with early initiation of physical therapy. LEVEL OF EVIDENCE Therapy, level 1a.
Collapse
|
48
|
Refinements of the Medicare Outpatient Therapy Annual Expenditure Limit Policy. Phys Ther 2015; 95:1638-49. [PMID: 26089039 DOI: 10.2522/ptj.20140423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 06/08/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND A Medicare beneficiary's annual outpatient therapy expenditures that exceed congressionally established caps are subject to extra documentation and review requirements. In 2011, these caps were $1,870 for physical therapy and speech-language pathology combined and $1,870 for occupational therapy separately. OBJECTIVE This article considers the distributional effects of replacing current cap policy with equal caps by therapy discipline (physical therapy, occupational therapy, and speech-language pathology) or a single combined cap, and risk adjusting the physical therapy cap using beneficiary characteristics and functional status. METHODS Alternative therapy cap policies are simulated with 100% Medicare claims for 2011 therapy users (N=4.9 million). A risk-adjusted cap for annual physical therapy expenditures is calculated from a quantile regression estimated on a sample of physical therapy users with diagnoses and clinician assessments of functional ability merged to their claims (n=4,210). RESULTS Equal discipline-specific caps of $1,710 each for physical therapy, occupational therapy, and speech-language pathology result in the same aggregate Medicare expenditures above the caps as 2011 cap policy. A single combined-disciplines cap of $2,485 also results in the same aggregate expenditures above the cap. Risk adjustment varies the physical therapy cap by as much as 5 to 1 across beneficiaries and equalizes the probability of exceeding the physical therapy cap across diagnosis and functional status groups. LIMITATIONS One limitation of the study was the assumption of no behavioral response on the part of beneficiaries or providers to a change in cap policy. Additionally, analysis of risk adjusting the therapy caps was limited by sample size. CONCLUSIONS Equal discipline-specific caps for physical therapy, occupational therapy, and speech-language pathology are more equitable to high users of both physical therapy and speech-language pathology than current cap policy. Separating the physical therapy and speech-language pathology caps is a change that policy makers could consider. Risk adjustment of the therapy caps is a first step in incorporating beneficiary need for services into Medicare outpatient therapy payment policy.
Collapse
|
49
|
Out-of-Pocket Spending for Ambulatory Physical Therapy Services From 2008 to 2012: National Panel Survey. Phys Ther 2015; 95:1680-91. [PMID: 26112257 DOI: 10.2522/ptj.20150018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Out-of-pocket (OOP) expenditures are incurred as insurers and employers shift some of the burden of health care costs onto consumers. As cost-sharing increases, OOP expenditures could be a barrier to physical therapy care. OBJECTIVE The purposes of this study were: (1) to identify factors associated with any OOP physical therapy spending and (2) to identify factors associated with higher spending among individuals incurring OOP costs. DESIGN The study was a retrospective analysis using the 4 most recently available panels of data from the Medical Expenditure Panel Survey (MEPS) encompassing 2008-2012. METHODS A data file containing episodes of physical therapy care for 2,189 people was created. Logistic regression was used to identify factors related to having an OOP expenditure. A multivariable generalized linear model was used to identify factors related to mean OOP expenditures. RESULTS On average, an episode of care encompassed 9.9 visits, with mean total expenditures of $1,708 (median: $792). Fifty-four percent of episodes of care had an OOP expenditure. For individuals with OOP expenditures, the mean OOP expenditure for an episode of care was $351 (median: $144). Being female or non-Hispanic and having a higher income were associated with higher odds of incurring an OOP expenditure, whereas being in worse general health, >65 years of age, or nonwhite and having public funding were associated with lower odds of incurring an OOP expenditure. Amounts of OOP spending were higher in urban areas and in all census geographic regions relative to the Northeast region. LIMITATIONS Estimates are based on household-reported survey data, limited to ambulatory care, and do not include institutionalized individuals. CONCLUSIONS At 54%, the proportion of individuals with OOP expenditures for physical therapy is lower than for general medical care. Several predictors were found of having OOP expenditures and of the magnitude of those expenditures.
Collapse
|
50
|
Alenzi EO, Sambamoorthi U. Depression treatment and health-related quality of life among adults with diabetes and depression. Qual Life Res 2015; 25:1517-25. [PMID: 26590839 DOI: 10.1007/s11136-015-1189-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous findings regarding depression treatment and its consequences on health-related quality of life (HRQoL) of adults with diabetes were inconsistent and targeted certain groups of population. Therefore, there is a critical need to conduct a population-based study that focuses on a general population with diabetes and depression. OBJECTIVE The primary aim of this study was to examine the physical and mental HRQoL associated with depression treatment during the follow-up year. METHODS We adopted a longitudinal design using multiple panels (2005-2011) of the Medical Expenditure Panel Survey to create a baseline year and follow-up year. We included adults with diabetes and depression. We categorized the baseline depression treatment into: (1) antidepressant use only; (2) psychotherapy with or without antidepressants; and (3) no treatment. HRQOL was measured using SF-12 version 2 physical component summary (PCS) and SF-12 mental component summary (MCS) scores during both baseline year and follow-up year. Ordinary least squares (OLS) were used to estimate the association between depression treatment and the HRQoL measures. The OLS regression controlled for predisposing, enabling, need, external environment factors, personal health practices, and baseline HRQoL measures. RESULTS After controlling for all the independent variables and the baseline PCS, individuals who received psychotherapy with or without antidepressants had higher PCS scores as compared to those without any treatment for depression (beta = 1.28, p < 0.001). Individuals who reported using only antidepressants had lower PCS scores (beta = -0.54, p < 0.001) as compared to those without depression treatment. On the contrary, individuals who reported receiving psychotherapy with or without antidepressants had lower MCS scores as compared to those without depression treatment (beta = -1.43, p < 0.001). Those using only antidepressants had higher MCS scores as compared to those without depression treatment (beta = 0.56, p < 0.001). CONCLUSION The associations between depression treatment and the HRQoL varied by the type of depression treatment and the component of the HRQoL measures.
Collapse
Affiliation(s)
- Ebtihag O Alenzi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26506, USA.
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26506, USA
| |
Collapse
|