Association of Physical Therapy Treatment Frequency in the Acute Care Hospital With Improving Functional Status and Discharging Home

Johnson, Joyce M.; Rothberg, Michael B.; Adams, Kellie; Lapin, Brittany; Keeney, Tamra; Stilphen, Mary; Béthoux, François; Freburger, Janet K.

doi:10.1097/mlr.0000000000001708

Cited by 10 publications

(9 citation statements)

References 48 publications

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“…One hospital system estimated that 42% of all patients had at least one PT visit during their admission. 9 Emerging evidence suggests that PT improves physical function, [9][10][11][12] discharge to home, 9,11 and risk for readmission. 13,14 For patients with pneumonia, in-hospital PT is associated with reduced hospital length of stay (LOS), readmission, and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Physical therapy provision for patients with pneumonia in US hospitals

Johnson,

Young,

Guo

et al. 2023

Journal of Hospital Medicine

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BackgroundPhysical therapy (PT) appears beneficial for hospitalized patients. Little is known about PT practice patterns and costs across hospitals.ObjectiveTo examine whether receiving PT is associated with specific patient and hospital characteristics for patients with pneumonia. We also explored the variability in PT service provision and costs between hospitals.MethodsWe included administrative claims from 2010 to 2015 in the Premier Healthcare Database, inclusive of 644 US hospitals. We examined associations between receiving at least one PT visit and patient (age, race, insurance, intensive care utilization, comorbidity status, and length of stay) and hospital (academic status, rurality, size, and location) characteristics. Exploratory measures included timing and proportion of days with PT visits, and per‐visit and per‐admission costs.ResultsOf 768,010 patients, 49% had PT. After adjustment, older age most significantly increased the probability of receiving PT (+38.0% if >80 vs. ≤50 years). Higher comorbidity burden, longer length of stay, and hospitalization in an urban setting were also associated with higher probability. Hospitalization in the South most significantly decreased the probability (−9.1% vs. Midwest). Patients without Medicare and Non‐White patients also had lower probability. Median (interquartile range) days to first visit was 2 (1–4). Mean proportion of days with a visit was 35% ± 20%. Median per‐visit cost was $88.90 [$56.70–$130.90] and per‐admission was $224.00 [$137.80–$369.20].ConclusionBoth clinical (intensive care utilization and comorbidity status) and non‐clinical (age, race, rurality, location) factors were associated with receiving PT. Within and between hospitals, there was high variability in the number and frequency of visits, and costs.

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Section: Introductionmentioning

confidence: 99%

“…Understanding physical therapy (PT) utilization has important implications for patient outcomes and hospital costs, but the frequency of PT consultation is not well documented. One hospital system estimated that 42% of all patients had at least one PT visit during their admission 9 …”

Section: Introductionmentioning

confidence: 99%

Physical therapy provision for patients with pneumonia in US hospitals

Johnson,

Young,

Guo

et al. 2023

Journal of Hospital Medicine

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“…Physical therapists are an important part of the hospital care team assessing and treating patients with these functional limitations 10–12 . There is strong evidence that early and ongoing physical therapy reduces and helps to restore lost physical function for patients with critical illness, 13 stroke, 14 and orthopedic surgery, 15 and that it may reduce inpatient postacute care need 16,17 . However, evidence informing the visit frequency of physical therapists among hospitalized patients is lacking 2,18 …”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] There is strong evidence that early and ongoing physical therapy reduces and helps to restore lost physical function for patients with critical illness, 13 stroke, 14 and orthopedic surgery, 15 and that it may reduce inpatient postacute care need. 16,17 However, evidence informing the visit frequency of physical therapists among hospitalized patients is lacking. 2,18 The prevalence of patients hospitalized with pneumonia combined with their risk for functional decline makes them an important population for studies on the potential benefits of physical therapy.…”

Section: Introductionmentioning

confidence: 99%

Association between physical therapy frequency and postacute care for a national cohort of patients hospitalized with pneumonia

Young,

Johnson,

Guo

et al. 2023

Journal of Hospital Medicine

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BackgroundAnnually more than 300,000 patients hospitalized for pneumonia need postacute care. Patients and systems prefer home discharge, but physical limitations often necessitate postacute care. It is unknown whether frequency of physical therapy in the hospital affects postacute care discharges.ObjectiveExamine the relationship between physical therapy visit frequency and disposition among a national sample of patients hospitalized with pneumonia.DesignsObservational cohort study.SettingAcute care hospital.ParticipantsAdult patients with primary diagnosis of pneumonia in the Premier Data Set who received physical therapy in the hospital during a 5‐day window, with therapy on at least days 1 and 5.InterventionPhysical therapy visit frequency.Main Outcome and MeasuresDischarge disposition (home or postacute care).ResultsWe included 18,886 patients from 595 hospitals. Just over half were discharged home (n = 9638; 51.0%) and 558 (2.95%) died. Patients getting more frequent therapy were older, non‐Hispanic white, treated in small non‐teaching rural hospitals in the West, Midwest, or South, and had fewer severe illness indicators. In adjusted models, patients who received physical therapy on 100% of days were 7% [(95% confidence interval, 4.3–9.7), p < .0001] more likely to go home than patients who received physical therapy on 40% of days. As a falsification test, we found that there was no relationship between physical therapy frequency and all‐cause mortality. Physical therapy visit frequency was positively associated with discharge to home. Increasing visit frequency of physical therapy in hospitals might reduce the need for postacute care, but randomized controlled trials are needed to confirm the effect.

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“…Physical therapist's role in acute care hospitals, including early mobility practices aimed at maintaining and regaining strength, is widely recognized as beneficial to reducing mortality, hospital length of stay (LOS), use of post–acute hospital resources, and disability 9,13–15. Physical therapist's are also uniquely educated to use training principles to promote a return to function, including the function of respiratory musculature 16.…”

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confidence: 99%