Exercise Rehabilitation Services Provided by Physiotherapy Departments in Cancer Care in Ireland

Aims This study aimed to identify the physiotherapy exercise rehabilitation services available to patients with cancer in Ireland and to identify barriers to the provision of services. Methods Physiotherapy department managers in specialised cancer centres, public and private hospitals and palliative care settings were surveyed to establish the availability of exercise rehabilitation services for patients with cancer. Results Of 40 managers contacted, 24 responded providing information about 26 services. Ten services employed a dedicated oncology physiotherapist. Exercise classes were offered to patients with cancer by five services, primarily within the palliative care setting. In the 17 hospitals which provided surgery, ten provided oncology specific post-operative exercise rehabilitation and one offered a prehabilitation programme. Limited human and physical resources and absence of established physiotherapy pathways were cited barriers to service provision. Conclusion Exercise rehabilitation is not an element of standard care for patients with cancer in Ireland.

Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study.

OBJECTIVE: To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. DESIGN: Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. SETTING: Retrospective cohort study. PARTICIPANTS: Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. RESULTS: Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age <45y; adjusted HR, 3.62), being a man (adjusted HR, 1.49), having ischemic stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI score<10; adjusted HR, 2.68), and comorbidity (Charlson-Deyo Comorbidity Index [CCI] score≥3, compared with CCI score=0; adjusted HR, 4.23). CONCLUSIONS: First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation.

[Comparison of the effects of rehabilitation in stroke patients rehabilitated in stationary conditions and the home]. / Porównanie efektów rehabilitacji u chorych po Udarze mózgu usprawnianych w warunkach stacjonarnych i warunkach domowych.

UNLABELLED: Rehabilitation after stroke is to help the patient recover optimal physical condition, psychosocial and vocational. Standard of care is to ensure comprehensiveness and continuity of the rehabilitation process. THE AIM OF THE STUDY: Was to compare the effects of rehabilitation in stroke patients rehabilitated in the hospital and at home. MATERIAL AND METHODS: The 90 patients after ischemic stroke were examined. The first examined group (45 people) consisted ofpatients rehabilitated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital in Lodz. The second examined group number (45 people) consisted of patients waiting for admission to the Department of Rehabilitation, who were rehabilitated in environmental conditions. The patients were examined twice: first before the rehabilitation (study I) and then at the end of rehabilitation program (study II). Functional status was examined with the Barthel ADL Index and the Brunnstrom scale. RESULTS: Both individuals after stroke rehabilitated in hospital and those rehabilitated in environmental conditions achieved a significant improvement in functional of paretic limbs and improving independence in activities of daily living. However, the improvement observed in the hospital group was significantly higher. Better positive effects in patients included hospital rehabilitation is achieved through the implementation of comprehensive treatment of the involvement in the therapeutic process the entire interdisciplinary team. CONCLUSIONS: The comprehensive stationary rehabilitation significantly affected on improving the functional ability of stroke compared to those rehabilitated in environmental conditions. Rehabilitation at home, even though it is associated with certain restrictions is an important element in the overall process of rehabilitation.

Users' experiences of physiotherapy treatment in a semi-urban public hospital in Kenya.

INTRODUCTION: Physiotherapy practice in Africa faces a number of challenges, one of which is the limited number of therapists in most public hospitals. In Africa, physiotherapy is still mainly institution based with very little community-based practice, leading to lack of access to services for a large part of the population. This study explores users' perceptions of physiotherapy, challenges faced by users, possible options for management, and determines whether current physiotherapy practice in a rural Kilifi District general hospital in Kenya facilitates future self-management of chronic conditions. METHODS: Eight in-depth interviews, 3 focus groups discussions and 4 participant observations were conducted for data collection. All interviews and focus group discussions were recorded using a digital recorder, transcribed into the Swahili language and then translated into English. The transcriptions were imported to NVivo 9 (www.qsrinternational.com) for management and storage. Inductive data analysis was used to generate themes from the rich-text data of the transcriptions. RESULTS: Many of the users perceived physiotherapy as being effective. Challenges included distance from health facilities, negative experiences with some therapists, and lack of staff and equipment. Rehabilitation options included community- and home-based programs fostering self-management of chronic conditions. Current hospital practice lacks emphasis on self-management skills for patients with chronic conditions who can do their physiotherapy at home. CONCLUSIONS: Users' experiences of physiotherapy treatment in this rural hospital indicate that a host of challenges exist. In the face of these challenges, the needs of the users seemed to be compromised, especially those with chronic conditions. Rehabilitation services that are accessible and affordable would be better options in rural and low-resource settings. There is therefore need for community-based services that place emphasis on self-management of chronic conditions for fostering better health outcomes in rural communities.

Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database.

BACKGROUND: Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients' functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. METHODS: Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. RESULTS: The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). CONCLUSIONS: In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet.

Physical therapy services utilization and length of stay for obese patients following traumatic leg fracture.

BACKGROUND: Obesity is an increasing epidemic that can complicate the treatment of simple injuries and can increase health care costs. The purpose of the present study was to determine whether obesity is a factor in the utilization of inpatient physical therapy services and length of stay following a traumatic lower leg fracture. METHODS: A retrospective study of patients admitted to the hospital in 2005 and 2006 with a primary discharge diagnosis of lower leg or ankle fracture was conducted. Inclusion criteria were age > or = 18 years, only 1 involved lower extremity, and nonweight-bearing on the affected extremity per physician orders. Patients were excluded from the study if they had a fibular fracture only, pathological fractures, multiple trauma, severe cardiac or vascular comorbidities, or cognitive impairments. Data were compiled into 3 categories on the basis of body mass index (BMI): < 30, 30-35, > 35. Physical therapy services were measured in 15-minute units of time. These data were analyzed by within-group and between-group comparisons and with regression analysis. RESULTS: A total of 181 patients with a primary discharge diagnosis of distal lower extremity or ankle fracture were included in the study. Patients with a BMI >35 used more physical therapy services (mean services, 9.8 units) than did patients with a BMI of 30-35 (mean services, 6.2 units) or a BMI <30 (mean services, 5.6 units) (P = .001). Length of stay was also highest among patients with a BMI >35. LIMITATIONS: Factors other than BMI may be associated with length of stay and physical therapy use and may confound the association. CONCLUSION: Previous studies have shown that there is an increase in health care utilization among the bariatric population. The present study demonstrates similar findings for physical therapy services. Increased length of stay and physical therapy utilization among the bariatric population also result in increased staff utilization and equipment costs.

Patient dissatisfaction with acute stroke care.

BACKGROUND AND PURPOSE: Riks-Stroke, the Swedish Stroke Register, was used to explore patient characteristics and stroke services as determinants of patient dissatisfaction with acute in-hospital care. METHODS: All 79 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. During 2001 to 2007, 104,876 patients (87% of survivors) responded to a follow-up questionnaire 3 months after acute stroke; this included questions on satisfaction with various aspects of stroke care. RESULTS: The majority (>90%) were satisfied with acute in-hospital stroke care. Dissatisfaction was closely associated with outcome at 3 months. Patient who were dependent regarding activities of daily living, felt depressed, or had poor self-perceived general health were more likely to be dissatisfied. Dissatisfaction with global acute stroke care was linked to dissatisfaction with other aspects of care, including rehabilitation and support by community services. Patients treated in stroke units were less often dissatisfied than patients in general wards, as were patients who had been treated in a small hospital (vs medium or large hospitals) and patient who had participated in discharge planning. In multivariate analyses, the strongest predictor of dissatisfaction with acute care was poor outcome (dependency regarding activities of daily living, depressed mood, poor self-perceived health). CONCLUSIONS: Dissatisfaction with in-hospital acute stroke care is part of a more extensive complex comprising poor functional outcome, depressive mood, poor self-perceived general health, and dissatisfaction not only with acute care but also with health care and social services at large. Several aspects of stroke care organization are associated with a lower risk of dissatisfaction.

[Use of rehabilitation services by technology-dependent children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil]. / Utilização de serviços de reabilitação pelas crianças e adolescentes dependentes de tecnologia de um hospital materno-infantil no Rio de Janeiro, Brasil.

The objective of this study was to describe the dependence on technology and use of rehabilitation services by children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil. Using a cross-sectional design, the following variables were analyzed: gender and age of the children and adolescents, socioeconomic characteristics of the family, technology dependence, and use of rehabilitation services. The majority of the study population consisted of preschoolers (56.3%), boys (58.3%), residing in Greater Metropolitan Rio de Janeiro (89.3%), from low-income families (70.9%), and cared for mainly by their mothers (93.8%), who in turn have low schooling (54.2%) and are unemployed (89.6%). Of the entire study population, 22.9% were dependent on more than three different technologies, with medication as the most prevalent. Government and nonprofit institutions fund the rehabilitation, and physical therapists are the most widely used health professionals during treatment (60.4%). The target hospital provides all of the specialized medical treatment and most of the rehabilitation.

Is waiting for rehabilitation services associated with changes in function and quality of life in children with physical disabilities?

OBJECTIVES: To determine whether longer waiting times for rehabilitation were associated with deterioration in child functional status and/or quality of life. METHODS: Parents of 124 children (mean age 45 months) with physical disabilities (e.g., cerebral palsy, global developmental delay, spina bifida) who were referred to pediatric rehabilitation centers were interviewed every three months, from referral until admission into the rehabilitation program. Information from parental interviews included socio-demographics, parental empowerment (Family Empowerment Scale), function (WeeFIM: Functional Independence Measure for Children), and quality of life (PedsQL). Data on date of referral, age, gender, and diagnosis were obtained from hospital databases. RESULTS: Half of the sample waited more than 9.1 months (95% confidence interval: 6.5-16.1) for admission to a public rehabilitation program. A total of 42% paid for some private services while waiting. Over the waiting period, there was statistically significant improvement in WeeFIM cognition and total scores but not in mobility scores. PedsQL psychosocial summary score declined over the waiting period (p< .05). CONCLUSION: Longer wait times for rehabilitation were associated with declining psychosocial quality of life. Reducing waiting times for rehabilitation services may allow rehabilitation specialists to address psychosocial problems for these children.

Use of physical therapy in patients hospitalized with a diagnosis of generalized weakness: a retrospective study.

In a retrospective analysis of data from a national database, we observed and compared the presence of complications, lengths of stay, inflation-adjusted charges, and discharge statuses of two groups of patients hospitalized with a primary diagnosis of generalized weakness who did or did not receive physical therapy (PT) services. From a sample of patients (n = 38,991 cumulative from 1988 through 2003) from the Nationwide Inpatient Sample (NIS), 2.3% of patients admitted to the hospital with generalized weakness received PT intervention. Patients hospitalized with a primary diagnosis of generalized weakness who received PT services were sicker, had more selected secondary complications, and were demographically and socioeconomically dissimilar from patients who did not receive PT services. Quantitative analyses indicate that PT patients had longer inpatient hospital stays, more nonroutine discharges, and higher inflation-adjusted charges. The results are consistent with the interpretation that outcomes such as those examined here (nonroutine discharge, length of stay, and charges at discharge) are related to referral patterns in which only the most serious comorbidities qualify patients for referral for PT intervention services.

A Saturday physiotherapy service may decrease length of stay in patients undergoing rehabilitation in hospital: a randomised controlled trial.

QUESTION: Is additional Saturday physiotherapy intervention beneficial for inpatients undergoing rehabilitation? DESIGN: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Two hundred and sixty-two inpatients undergoing rehabilitation in an Australian metropolitan hospital. INTERVENTION: The experimental group received physiotherapy intervention from Monday to Saturday and the control group from Monday to Friday. OUTCOME MEASURES: Primary outcomes were hospital and physiotherapy length of stay. Secondary measures were collected to reflect patient outcomes (health state, independence, activity, flexibility and strength) and burden of care (discharge destination, adverse events, and follow-up physiotherapy intervention). RESULTS: There was a 3.2 day reduction for the experimental group (95% CI -0.5 to 6.9) in hospital length of stay and a 2.5 day reduction (95% CI -0.9 to 5.9) in physiotherapy length of stay. There was no significant between-group difference in change from admission to discharge for most of the secondary patient outcomes (health state, independence, activity, flexibility). The risk of the experimental group being categorised as strong relative to the control group was 1.2 (95% CI 0.99 to 1.50). The risk of not being discharged home, of having an adverse event, or requiring follow-up physiotherapy intervention was no greater for the experimental group than the control group. CONCLUSION: The provision of additional Saturday physiotherapy intervention resulted in a trend to shorter hospital and physiotherapy length of stay without affecting patient outcome unfavourably or increasing burden of care, suggesting that a larger multicentre trial is warranted.

Use of time by physiotherapists and occupational therapists in a stroke rehabilitation unit: a comparison between four European rehabilitation centres.

PURPOSE: The aim of this study was to compare the time allocated to therapeutic activities (TA) and non-therapeutic activities (NTA) of physiotherapists (PT) and occupational therapists (OT) in stroke rehabilitation units in four European countries. METHOD: Therapists documented their activities in 15-min periods for two weeks. They recorded: activity, number of patients, number of stroke patients, involvement of other people, location and frequency of each activity. Kruskal-Wallis tests and negative binomial regression models were used to compare activities between professional groups and between units. RESULTS: The average proportion of TA per day ranged between 32.9% and 66.1% and was higher for PT than for OT in each unit. For OT, significant differences emerged between the units in the proportion of time allocated to TA compared to NTA with British OTs spending significantly less time in TA. In the Belgian unit, three times less time was spent on patient-related co-ordination activities (e.g., administration, ward rounds) compared to the British and Swiss units. CONCLUSIONS: Time allocation differed between PT and OT and between units, affecting the time available for TA. Further investigation is necessary to study the effect of work organization in stroke rehabilitation units on the efficiency of rehabilitation regimes.

The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review.

Provision of out of regular business hours (OBH) physiotherapy to hospital inpatients is widespread in the hospital setting. This systematic review evaluated the effect of additional OBH physiotherapy services on patient length of stay (LOS), pulmonary complications, discharge destination, discharge mobility status, quality of life, cost saving, adverse events, and mortality compared with physiotherapy only within regular business hours. A literature search was completed on databases with citation tracking using key words. Two reviewers completed data extraction and quality assessment independently by using modified scales for historical cohorts and case control studies as well as the PEDro scale for randomized controlled trials and quasi-randomised controlled trials. This search identified nine articles of low to medium quality. Four reported a significant reduction in LOS associated with additional OBH physiotherapy, with two articles reporting overall significance and two reporting only for specific subgroups. Two studies reported significant reduction in pulmonary complications for two different patient groups in an intensive care unit (ICU) with additional OBH physiotherapy. Three studies accounted for discharge destination and/or discharge mobility status with no significant difference reported. Quality of life, adverse events, and mortality were not reported in any studies. Cost savings were considered in three studies, with two reporting a cost saving. This systematic review was unable to conclude that the provision of additional OBH physiotherapy made significant improvement to patient outcomes for all subgroups of inpatients. One study in critical care reported that overnight physiotherapy decreased LOS and reduced pulmonary complications of patients in the ICU. However, the studies in the area of orthopaedics, neurology, postcardiac surgery, and rheumatology, which all considered additional daytime weekend physiotherapy intervention, did not provide strong evidence to indicate effective reduction in patient LOS or improving patient discharge mobility status or discharge destination. Investigation should continue in this area, but future trials should ensure factors such as random allocation, groups equal at baseline, blinded investigators, and proven intervention are included in the study design.

Associations between hospital-based rehabilitation for hip fracture and two-year outcomes for mortality and independent living: An Australian database study of 1,724 elderly community-dwelling patients.

OBJECTIVE: To compare rates of mortality, hospital readmissions and independent living status for 2 years following hip fracture in community-dwelling patients with and without hospital-based rehabilitation. DESIGN: Retrospective cohort study. METHODS: Administrative data-sets were linked for hospital treatment, residential aged care admissions, selected community services and date of death for community-dwelling hip fracture patients. Mortality, readmissions, residency within aged care facilities and independent living status at intervals up to 2 years were compared in multivariate logistic regression for patients with and without hospital-based rehabilitation. RESULTS: Age, sex and comorbidity distributions were similar for 1,050 patients who received rehabilitation and 674 patients who did not. Rehabilitation added 11 days to total hospital stay and $AUD 12,000 to hospital costs. Mortality at 90 days after hip fracture was 4.7% for rehabilitation patients vs 10.7% for others (p < 0.001), and 26.2% vs 37.2% (p < 0.001) at 2 years. Beyond 90 days there was no significant association between receipt of rehabilitation and the proportion of patients meeting criteria for independent living. Hospital readmissions in the year following the index fracture were not significantly different. CONCLUSION: In-hospital rehabilitation substantially increases total hospital costs. It is associated with improved early and late survival, but not with the likelihood of living independently for up to 2 years after hip fracture.

Effects of race and poverty on the process and outcome of inpatient rehabilitation services among stroke patients.

BACKGROUND AND PURPOSE: The greater mortality and residual physical impairments among black stroke patients may be attributable to differential utilization of rehabilitation services. This report examines, within an equal-access healthcare system, racial differences in time to initiation of stroke rehabilitation services and in the trajectory of physical function recovery. METHODS: This study was a secondary analysis of data from an inception cohort of 1073 stroke patients hospitalized between April 1995 and March 1997 and followed up for up to 1 year. Inpatient data came from medical record reviews; follow-up data came from telephone interviews at 1, 6, and 12 months after stroke. The study included consecutive acute ischemic or intracerebral hemorrhagic stroke patients from 9 VA medical centers. The main outcome measures were time to initiation of inpatient rehabilitation services and ability to perform activities of daily living. RESULTS: There were no racial differences in receipt of inpatient rehabilitation services (blacks, 76%; whites, 70%) or in the proportion of patients referred within 3 days of admission (blacks, 43.5%; whites, 42.0%). Among patients who experienced delay in initiation of rehabilitation, only low-income blacks experienced worse functional recovery over 12 months. CONCLUSIONS: Low-income black stroke patients who experience delay in initiation of inpatient rehabilitation have a worse trajectory of functional recovery in the first year after stroke. Poverty-associated factors in the postdischarge setting may explain this phenomenon.

Randomized controlled trial of an early discharge rehabilitation service: the Belfast Community Stroke Trial.

BACKGROUND AND PURPOSE: To compare a community-based multidisciplinary stroke team (CST) approach with hospital-based rehabilitation in terms of hospital stay, functioning, quality of life, and service use and costs. METHODS: Stroke patients who met pre-agreed criteria were allocated randomly to the CST service (n=59) or to usual inpatient rehabilitation and follow-up care (n=54). Assessments were completed at randomization and 12 months later. Caregiver strain and satisfaction (n=55) were also assessed. Cost data were collected for a subsample of 38 patients. RESULTS: Almost 80% of surviving patients (n=691) were discharged home and a small number (n=55) were readmitted. Approximately 17% (113/649) were randomized. There were no statistically significant differences in hospital duration, costs, or outcome measures at baseline and 12 months except for higher satisfaction reported by CST patients. Overall, both groups recorded improvement in most domains over time. Carers reported a high level of satisfaction although the level of strain among carers is cause for concern. The community group (n=18) cost less than the hospital group (n=20). CONCLUSIONS: A mixed model of hospital-based and community-based rehabilitation services is likely to lead to increased patient choice and satisfaction and a potential reduction in bed pressures for less severe stroke patients.

Asymptomatic carriage of Klebsiella pneumoniae producing extended-spectrum beta-lactamase by patients in a neurological early rehabilitation unit: management of an outbreak.

During 11 months 58 extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) isolates were grown from 10 patients on a neurological early rehabilitation unit. The patients had no signs of infection but were colonized in the nose and trachea, and unusually only one had colonization in the gut. A single clone of ESBL-Kp was identified by pulse field gel electrophoresis. Strong hygienic precautions similar to those for Methicillin-resistant Staphylococcus aureus patients prevented spread of the bacteria to other wards. However, rehabilitation for patients with severe neurological failures made it very difficult to follow hygienic requirements. Disinfection of mucous membranes was difficult. Eventually the application of a nasal spray containing povidone-iodine proved to be successful.

Three perspectives on physical therapist managerial work.

BACKGROUND AND PURPOSE: The nature of managerial work in the commercial sector has not been studied since the 1970s, and little is known about the work of managers in the health care sector. In this study, the perceived importance of managerial role and skill categories among 3 groups of physical therapists were studied to better understand the work priorities of physical therapist managers. SUBJECTS: Two groups of subjects were physical therapist managers in hospitals or private practices. A third group consisted of faculty members in professional physical therapist education programs. METHODS: Respondents (n=343) rated the importance of 75 managerial activities. Responses related to 16 predetermined work categories were placed in rank order by group. A multivariate analysis of variance (MANOVA) was used to identify differences among groups. RESULTS: All groups identified communication, financial control, entrepreneur, resource allocator, and leader as the 5 most important categories and rated technical expert and figurehead as least important. The MANOVA showed differences between faculty members and private practice managers in 15 work categories, between hospital-based managers and private practice managers in 9 categories, and between faculty members and hospital-based managers in 8 categories. DISCUSSION AND CONCLUSION: Work setting appears to have an impact on level of importance placed on managerial work categories. The strongest candidates for "universal" physical therapist managerial work categories were communication, financial control, and resource allocator.

Physical therapy episodes of care for patients with low back pain.

BACKGROUND AND PURPOSE: Although individuals with low back pain frequently receive treatment from a physical therapist, few published studies exist that describe who sees a physical therapist for their low back pain nor is much known about physical therapy episodes of care for this condition. Secondary analysis of data from the American Physical Therapy Association's Survey of Physical Therapy Outpatient Practice provides new descriptive data on services provided to a national, representative sample of patients discharged from hospital-based and private outpatient practices. In addition, specific hypotheses were tested on clinical and background factors believed to influence low back pain episodes of care. SUBJECTS: Patients with low back pain represented over 25% of all outpatient discharges from physical therapy practices. METHODS: A mail survey was conducted with representatives of a national probability sample of facilities that provided outpatient physical therapy services. Data were provided on each facility and on a discharge sample of patients treated at each facility. RESULTS: On average, episodes of care extended over 5 weeks and consisted of 11 therapy visits, for an average charge of $766.70. Duration and charge for low back episodes of care did not differ, on average, in private versus hospital-based practices. Certain aspects of care, however, did vary across regions of the country. Episodes of care charged to workers' compensation were costlier than those charged to other insurance carriers, and whites were charged less, on average, than nonwhites. Duration of back symptoms was related to intensity, duration, and charges incurred for the episode of care. CONCLUSION AND DISCUSSION: Further research is needed to understand the reasons for the relationships observed in this study, as well as studies that relate care provided by physical therapists to specific patient outcomes. Further research is also needed to compare outcomes achieved across different health professions.

Perceptions of acute care physical therapy practice: issues for physical therapist preparation.

BACKGROUND AND PURPOSE: Acute care physical therapists have experienced the effects of dramatic changes in health care reimbursement systems and population demographics. Acute care hospitals now serve a patient population of much older, chronically ill patients who are hospitalized for shorter periods of time in a practice environment in which physical therapy staffing resources are often inadequate. The purposes of this study were to document common experiences in the practice of acute care physical therapy and to identify differences in the perceptions of physical therapists with varying levels of experience and in various sizes of acute care facilities. SUBJECTS AND METHODS: A survey questionnaire was mailed to 500 randomly selected physical therapists employed in acute care facilities. The therapists answered questions regarding the frequency of various physical therapy evaluation and treatment practices, problems encountered in delivering physical therapy services, coordination of the discharge planning process, and perceptions of staffing trends in the acute care setting. The responses of 188 physical therapists who completed the survey were compared by their experience levels and the size of the institutions in which they practiced. RESULTS: Subjects reported that patient factors, such as medical complications and cooperation; organizational factors, such as staffing shortages and large caseloads; and health care system constraints, such as difficulty changing orders and limited time in which to work with the patient interfered with patients reaching physical therapy goals. CONCLUSION AND DISCUSSION: Inadequate skills for successful acute care practice and maladaptive therapist beliefs about acute care career possibilities may adversely affect physical therapist career longevity in the acute care setting.