Power JD, Cott CA, Badley EM, Hawker GA. Physical therapy services
for older adults with at least moderately severe hip or knee
arthritis in two Ontario counties. J Rheumatol. 2005 Jan;32(1):123-9.
[Pub
Med ID 15630737]
Objective
Physical therapy (PT) is a recommended treatment for the management of
arthritis. We investigated factors related to referral to PT services
in people with hip or knee arthritis and describe characteristics
of treatment received.
[more…]
Physical therapy is considered an important component of the overall
episode of care surrounding total joint replacement, as it helps
individuals to maximize their function.
Methods
As part of a longitudinal study of the population aged ≥ 55 years
with at least moderately severe hip or knee arthritis in 2 Ontario
counties (n = 1350), participants were surveyed in the third year of follow-up
about use of PT. Participants were categorized as to whether they
had total joint replacement surgery in the past year (TJR group, n
= 52) or did not (non-TJR group, n = 1298). Multivariate logistic
regression was used to identify determinants of referral to PT considering
sociodemographic characteristics, comorbidity, use of prescribed arthritis
medication, and arthritis severity (WOMAC summary score).
[more…]
The study is being conducted in 3 phases in 2 counties in Ontario where
the current rates for TJR were shown to be disparate: Oxford
County (rural, high rates) and East York (urban, low rates).
Results
Overall, 18.7% of the cohort was referred to PT in the past year: 65.4%
of the TJR group and 16.8% of the non-TJR group. The only significant
predictor of PT in the TJR group was current use of prescribed
arthritis medication. Greater arthritis severity, current use of
prescribed arthritis medication, and greater comorbidity were significant
independent predictors of referral to PT for the non-TJR group in multivariate
logistic regression. The Ontario Health Insurance Plan paid for the majority
of PT received.
[more…]
No statistically significant associations were found between various
sociodemographic characteristics, WOMAC summary scores, or number
of comorbid conditions and referral to PT in the past year for
the TJR group. However, those currently taking a prescribed
arthritis medication were referred in a higher proportion that
those not taking such medications (47.4% vs 75.8%; p=0.038).
The small size of the TJR group prohibited multivariate analyses.
In the non-TJR group, the percentage of women referred was significantly
higher than the percentage of men (p=0.028). There were also
significant trends for higher referral rates with increasing
WOMAC summary scores (p trend ‹0.001) and greater number of comorbid
conditions (p trend = 0.004). Although not statistically significant,
individuals with greater education in both TR groups were more likely
to have been referred than those with less education. See Table 4 for
the multivariate results.
Conclusions
Low rates of referral to PT in the previous year suggest possible underutilization.
Further research is needed to examine patterns of use of PT throughout
the course of the arthritis disease process and to examine barriers
to PT access.
[more…]
Although the majority of PT provided to the participants of our study
was funded by the Ontario Health Insurance Plan, the publicly
funded fee-for-service system that covers the cost of medical
and hospital care, this does not reflect the balance of public
and private funding for PT in Ontario. There has been a shift
in the provision of PT in Ontario over the last decade towards
an increase in the number of privately funded clinics located both inside
and outside hospitals, with the result that the majority of PT is now
provided in the private sector. Currently only about 14% of physical therapists
in the province work in an OHIP funded clinic. Individuals with extended
health care benefits, for example through their place of employment,
can have PT services in private, non-OHIP clinics paid for by these plans.
Individuals not covered by an extended health insurance plan
must pay of the cost of their services in a private clinic themselves.
It may be that physicians refer patients to PT on the basis of their
health care coverage. The low proportion of participants receiving
PT in our study may be a reflection of financial barriers to
PT when publicly funded clinics are unavailable. Such financial
barriers are likely to be of particular significance for older
individuals, like the participants in this study, many of whom
are retired.
List of Tables and Figures (in the publication)
- Table 1. Comparison of baseline (Phase 2) characteristics of
respondents and nonrespondents.
- Table 2. Comparison of characteristics of TJR and non-TJR groups.
- Table 3. Descriptive statistics for referral to physical therapy
in the past year stratified by TJR status.
- Table 4. Odds ratios for referral to physical therapy in the
past year for the non-TJR group.
- Table 5. Location of physical therapy, payment methods, and additional costs.
- No figures for this paper.
Selected Tables from the Publication (with interpretation)
Characteristics of the TJR and non-TJR groups are listed in Table 2. Subjects
in the TJR group were more likely to be male, and younger than
those in the non-TJR group.
In multivariate logistic regression for the non-TJR group, sociodemographic
characteristics were not related to referral to PT in the past
year (see Table 4). For every 10 point increase in the WOMAC summary
score, the odds of referral to PT increased by a factor of 1.15
(95% CI 1.04-1.27P. Individuals with greater comorbidity were more
likely to be referred (OR 1.24, 95% CI 1.07-1.44), and for those taking
a prescribed arthritis medication, the odds of referral to PT were 1.63
times greater (95% CI 1.16-2.29) than for those not currently taking such
medications.
Supplementary Tables (with interpretation)
No supplementary information is available for this paper.
