Physical Therapy最新文献

The increasing prevalence of accelerated Doctor of Physical Therapy (DPT) programs, which condense the conventional 3-year curriculum into a 2-year format, has emerged with limited national discussion and debate and without substantive educational research support. This novel approach challenges the traditional 3-year DPT educational framework. This perspective draws historical parallels between the challenges and unintended consequences that arose from the acceleration of anterior cruciate ligament reconstruction rehabilitation protocols with early return-to-play and the current shift toward accelerated DPT education. While advocates argue that accelerated programs offer advantages over traditional 3-year DPT curricula, there is insufficient evidence to support these claims or to determine whether these benefits outweigh potential drawbacks. Using Rogers' Diffusion of Innovation framework, this perspective explores key questions and potential concerns regarding accelerated DPT programs. This perspective critically examines the potential impact of reducing the duration of DPT education on program and graduate outcomes, including National Physical Therapy Exam pass rates, clinical readiness, and broader educational experiences. It also raises questions about the potential effects on student well-being and mental health. The perspective emphasizes the need for rigorous, data-driven educational inquiry and recommends comprehensive data collection to evaluate the effects of accelerated DPT programs on a wide range of important variables. This perspective emphasizes the importance of prioritizing student learning and development by exploring potential unforeseen risks associated with accelerated DPT curricula. It advocates for a student-centered approach to educational research, ensuring that any changes to program length support both the depth and quality of learning. Through systematic investigation, the profession can determine whether safeguards are necessary to maintain the integrity of DPT education, ensuring that students receive the comprehensive training they need without compromising educational excellence in the pursuit of speed.

Objective: The objectives of this study were to evaluate the differences in medical costs and health care utilization between patients receiving virtual physical therapy (V-PT) care and patients receiving in-person physical therapy (IP-PT) care (controls) over 6 and 12 months.

Methods: This study used claims data from July 2019 to May 2023. The index date was defined as the initial video (V-PT) or in-person (IP-PT) (controls) physical therapist evaluation date. Patients receiving V-PT (n = 342) were 1:3 propensity score matched to controls receiving IP-PT (n = 1026). Median difference-in-difference per-member-per-month (PMPM) estimates, differences in median postindex costs between groups, and return on investment at 6 and 12 months were estimated. Utilization was evaluated as the postindex mean difference in encounter counts.

Results: There were significant gross PMPM savings among patients in V-PT versus those in IP-PT at 6 and 12 months in total costs (-$104.70 vs - $64.10) and musculoskeletal (MSK) condition-related total costs (-$99.56 vs - $49.80). After inclusion of the cost of virtual care, patients receiving V-PT experienced significant net PMPM savings in 6-month MSK condition-related total costs (-$21.20) and 6- and 12-month physical therapy costs (-$25.05 vs - $8.22). These patients experienced significantly lower 6- and 12-month gross MSK condition-related postindex costs than patients receiving IP-PT (-$1059 vs - $1049) which translates to a 1.8-times return on investment at both time points. Patients in V-PT utilized significantly fewer total health care services, MSK condition-related total services, and physical therapist services than patients in IP-PT at 6 and 12 months.

Conclusions: V-PT care may be a meaningful driver of MSK condition-related cost savings by providing a cost-effective and accessible alternative to IP-PT care.

Impact: V-PT care provides an accessible platform for clinically appropriate patients to engage in physical therapy in a cost-effective way. Increasing awareness and utilization of V-PT care may reduce medical costs related to MSK conditions.

Lay summary: To the author's knowledge, this is the first real-world health care claims analysis to evaluate costs and utilization of V-PT care compared to IP-PT care in treating musculoskeletal conditions. This study suggested that V-PT care was associated with cost savings and lower utilization for total medical care and musculoskeletal condition-specific care compared to IP-PT, with reductions driven by physical therapy costs and encounters.

Importance: This study aims to enhance the care provided for patients with musculoskeletal disorders (MSKDs).

Objective: The objective of this study is to compare first-contact physical therapy (FCPT) and usual primary care (UPC) for societal and clinical outcomes of patients with MSKDs.

Design: The design was a systematic review and meta-analysis of randomized controlled trials.

Setting: The study took a global perspective on FCPT compared to UPC for societal and clinical outcomes of patients with MSKDs.

Participants: The study included patients presenting with MSKDs.

Intervention(s) or exposure(s): FCPT was compared to UPC for patients with MSKDs.

Main outcomes and measures: Societal outcomes including clinical imaging rates, prescription medication rates, cost, and clinical outcomes including pain, disability, and health-related quality of life (HRQoL) were assessed.

Results: Ten randomized controlled trials were included with a sample size of 2081 patients. Very low to moderate quality of evidence showed patients achieved similar to superior societal and clinical outcomes with FCPT compared to UPC. Lower clinical imaging rates (risk ratio [RR] = 0.55; 95% CI, 0.45-0.68) and prescription medication rates (RR = 0.29; 95% CI, 0.16-0.53) were associated with FCPT. All effects favored FCPT, including a small effect for cost (mean difference = -309.79; 95% CI, -678.69 to 59.12), a medium effect for pain (standardized mean difference [SMD] = -0.75; 95% CI, -1.57 to 0.06), and negligible effects for disability (SMD = -0.15; 95% CI, -0.32 to 0.03) and HRQoL (SMD = -0.03; 95% CI, -0.17 to 0.11).

Conclusions: When compared to UPC, FCPT is likely to reduce clinical imaging rates and may result in a reduction of prescription medication rates. FCPT may result in little to no difference in disability and HRQoL. Evidence is very uncertain about the effect of FCPT on pain and cost. All conclusions can be interpreted for the medium term.

Relevance: Health care organizations treating patients with MSKDs should consider integrating FCPTs to support primary care.

Importance: Understanding the long-term impact of long COVID on physical function and health-related quality of life (HRQoL) is essential to guide clinical care and rehabilitation.

Objective: The objective of this study was to compare physical capacity over time among adults in 3 groups: those without COVID-19 (control group [CG]), those who recovered from COVID without persistent symptoms (short COVID group [SCG]), and those with long COVID (long COVID group [LCG]). A secondary objective was to identify baseline predictors of 6-month HRQoL in the LCG.

Design: This study was a prospective longitudinal cohort study.

Setting: In-laboratory assessments were conducted at baseline, 3 months, and 6 months, at either the Center for Interdisciplinary Research in Rehabilitation and Social Integration (Quebec City) or the Orthopedic Clinical Research Unit (Montreal).

Participants: A total of 360 age- and sex-matched adults (n = 120 per group), including individuals without a history of COVID-19 (CG), those with short COVID (symptom resolution within 4 weeks, SCG), and those with persistent symptoms ≥12 weeks (LCG) participated in the study.

Intervention/exposure: Participants were categorized based on their COVID-19 history and symptom duration and no intervention or exposure was applied.

Main outcomes and measures: Self-reported outcomes measuring HRQoL, comorbidities, sleep quality, pain, and fatigue, along with objective measures such as grip strength, Short Physical Performance Battery (SPPB), 6-min walk test (6MWT), and perceived exertion (Modified Borg Scale) during the 6MWT, were collected. Daily averages for resting heart rate, step count, and minutes of intensive activity were recorded over 7 days using a fitness tracker watch. Generalized estimating equations were used for longitudinal comparisons, and recursive partitioning analysis for predicting HRQoL factors.

Results: Significant time × group interactions were observed for HRQoL, sleep quality, pain, fatigue, SPPB, and 6MWT. Although the LCG showed significant improvements across these outcomes, only the reduction in fatigue reached a clinically meaningful level, whereas the other groups remained stable. A group effect was detected for all outcomes, except for heart rate and minutes of intensive activity, with the LCG consistently showing lower scores across all follow-ups. Recursive partitioning analysis identified 2 baseline predictors of HRQoL at 6 months in the LCG: self-reported fatigue and daily step count.

Conclusions and relevance: These findings highlight the persistent impairments in adults with long COVID and emphasize early HRQoL predictor identification to anticipate long-term needs and adjust treatment plans accordingly.

Importance: Chronic low back pain (CLBP) is a global health problem with significant clinical, social, and economic challenges. Over 80% of CLBP cases are non-specific (CNLBP), causing the highest number of years lived with disability. People with CNLBP often have comorbidities such as overweight or obesity, which negatively impact symptoms and treatment outcomes.

Objective: The objective is to evaluate whether a lifestyle intervention combining diet, physical activity, and evidence-based physical therapy can reduce pain in individuals with CNLBP and comorbid overweight or obesity.

Design: This is an international multicenter triple-blinded randomized controlled trial (RCT).

Setting: The trial will be conducted in Belgium and Switzerland, with interventions delivered in hospitals (ambulatory care) and outpatient private practices.

Participants: In total, 252 adults will be included and randomly assigned to 1 of 2 treatment arms.

Interventions: The control intervention includes Pain Neuroscience Education and Cognition-Targeted Exercise Therapy. The experimental group receives the same intervention supplemented with a Behavioral Weight Reduction Program.

Main outcomes and measures: The primary outcome is pain intensity (assessed using the Brief Pain Inventory). Secondary outcomes include other pain-related outcomes, body composition measures, energy balance related behavior, medical consumption, indirect health-related costs, and quality of life. Assessments will occur at baseline, post-intervention, and at 3-, 6-, 9-, and 12-months follow-up.

Conclusion: This study is the first international multicenter RCT integrating a lifestyle approach into evidence-based physical therapy for people with CNLBP and comorbid overweight or obesity. It will assess whether addressing comorbid overweight or obesity enhances pain reduction and other health outcomes in this population.

Relevance: The results will push the field forward, leading to new knowledge about the (cost-)effectiveness of this approach, which will provide key insights for different stakeholders, help optimizing therapy guidelines and individualized care for people with CNLBP and comorbid overweight or obesity.

Importance: Clinical practice guidelines recommend individuals with subacromial pain syndrome (SAPS) exhaust conservative care, with an emphasis on therapeutic exercise, prior to undergoing subacromial decompression (SAD) surgery. To date, there are no studies that describe the care individuals with SAPS receive prior to undergoing SAD in a large health care system.

Objective: The objective of this study was to characterize care received by patients undergoing SAD in the year before surgery with a focus on shoulder exercise visits.

Design: This was a retrospective, longitudinal database study.

Setting: This study included records from the Military Health System.

Participants: Participants were United States active-duty service members (n = 5917).

Exposure: This study included patients who underwent SAD in a military treatment facility between 2015 through 2019.

Main outcomes and measures: Medical imaging, shoulder injections, medications, and rehabilitation encounters were categorized using Current Procedural Terminology codes. Rehabilitation encounters were further categorized as exercise, manual therapy, and/or passive therapy visits. A multivariable negative binomial regression model was performed to identify factors associated with the number of exercise visits attended in the year preceding surgery.

Results: Overall, 2171 (36.7%) service members did not attend any exercise visits in the year before surgery. Significant predictors of attending more exercise visits included undergoing at least 1 magnetic resonance imaging study, receiving a shoulder injection, and younger age (<25 years). Most patients (94.6%) underwent at least 1 shoulder-related imaging procedure. The most common therapeutic class of medication prescribed was nonsteroidal anti-inflammatory drugs (NSAIDs; 81.0%), followed by muscle relaxers (29.3%), opioids (27.3%), and analgesics that were not NSAIDs (24.4%).

Conclusions: Therapeutic exercise was underutilized in our cohort, which may contribute to the overutilization of SAD in individuals with SAPS. Before considering SAD, providers should ensure patients with SAPS complete a course of evidence-based nonoperative care, to include supervised therapeutic exercise.

Relevance: Increasing awareness of care patterns prior to SAD may help improve care pathways for individuals with SAPS.

Importance: Identifying patients most likely to benefit from physical therapy in the hospital could aid physical therapists in optimizing treatment allocation for the purpose of increasing discharge to home.

Objective: The aims of this study were to develop and externally validate a predictive model for discharge to home on the basis of physical therapy frequency for patients who were hospitalized.

Design: A predictive model was developed using retrospective cohort data collected between April 2017 and August 2022, with external validation conducted in a separate sample.

Setting: The setting was a large health system.

Participants: Participants were adult patients who were hospitalized and received physical therapy.

Main outcome and measures: Predictors were extracted from the electronic health record and included demographics, clinical characteristics, and therapist-entered variables such as home set-up and prehospital level of function. Physical therapy frequency was quantified as once daily, defined as ≥5 times per week. The outcome was discharge to home. Variables were included in the final multivariable logistic regression model on the basis of associations with physical therapy frequency and/or outcome and clinical relevance. Calibration and discrimination of the models were assessed.

Results: The development sample included 205,659 adult patient (average age = 72.2 [SD = 14.3] years; 55.3% female) hospitalizations, with 52.5% of patients receiving physical therapy daily and an overall proportion of 67.1% being discharged to home. The final multivariable model included 8 variables, with good calibration and discrimination. Internal validity was established with an optimism-corrected concordance statistic of 0.874 (95% CI = 0.872-0.875). The external sample included 102,311 patient (average age = 67.7 [SD = 16.5] years; 50.9% female) admissions, with 64.5% of patients receiving physical therapy daily and 77.8% being discharged to home. Predictive performance was high (calibration slope = 0.908), and discrimination was good (concordance statistic = 0.851).

Conclusions and relevance: This study developed and externally validated the underlying prediction model for a clinical decision support tool, termed Physical Therapy Frequency Clinical Decision Support Tool (PT-PENCIL), to identify patients most likely to benefit from daily physical therapy to discharge to home. Future work will evaluate the implementation of PT-PENCIL to determine its effect on patient-centered outcomes.