Cross-Sectional Examination of Patient and Therapist Factors Affecting Participation in Physical Therapy in Acute Care Hospital Settings

Young, Daniel L.; Moonie, Sheniz; Bungum, Timothy J.

doi:10.2522/ptj.20150591

Cited by 10 publications

(33 citation statements)

References 38 publications

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“…While constrained PT practice in the acute care setting is beyond this article's scope, hospitals must have the resources to provide all patients the skilled services indicated in their care. 22,24,26 Discharge to skilled nursing significantly increases the cost of every episode of care and the risk of early hospital readmission. 41,44,45 The alarming relationship between hospital readmission and increased risk of 1-year mortality for those discharged to a skilled nursing facility is a red flag that must be addressed.…”

Section: Discussionmentioning

confidence: 99%

Physical Therapy and Discharge Disposition Following Acute Hospitalization for UTI in Community-Dwelling Older Adults

Miller¹,

Moore²,

Stikeleather³

2021

Journal of Acute Care Physical Therapy

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Background: Bed rest during acute hospitalization is associated with new-onset mobility impairments in community-dwelling older adults, resulting in discharge to skilled nursing facilities rather than home. Purpose: The purpose of this retrospective study is to determine whether the number of physical therapy (PT) visits is related to discharge disposition following an acute hospitalization for urinary tract infection (UTI) in the older adult population. Methods: Medical records over a 3-year period of 523 community-dwelling older adults (65 years and older) admitted from home functionally independent were reviewed. Demographic and patient characteristics, including age, gender, living status, length of stay (LOS), discharge disposition, and the number of PT visits, were collected. Multinomial regression was conducted to determine predictors of disposition. Results:The multinomial logistic regression model was statistically significant, χ 2 (2) = 6.90, P = .032. Older age, longer LOS with fewer PT visits during acute hospitalization, and a higher comorbidity score were significant predictors of hospital discharge to subacute rehabilitation facilities than those who were able to return home with home health PT. These variables were not predictors of the disposition for younger patients with fewer comorbidities. Limitations: Due to the retrospective nature of this study, assessment of potential preexisting levels of frailty, standardized delivery of PT, and level of activity outside of PT could not be performed. Conclusions: Reduced frequency of physical therapist intervention for older adults hospitalized with UTI was associated with discharge to rehabilitation in a skilled nursing facility compared with those of similar age with increased PT intervention frequency.Multimorbidity, which is a common occurrence with aging, significantly increases the risk of mobility impairments. 7,8 For the older adult, staying in bed for as little as half a day represents an increased risk of developing a new-onset disability. 9 With nearly 70% of older adults being discharged from hospitals below their prior level of function, researchers forecast exponential growth in disability, compounding the rate of health care spending for the senior population over the next decade. [10][11][12] Immobility during a hospital stay accounts for approximately 50% of previously independent community-dwelling older adults discharging to a skilled nursing facility rather than returning home. This postacute care disposition increases the cost of each episode of care for both patients and payers. 5,[13][14][15] When older adults are discharged from acute care hospitals to skilled nursing facilities, they are less likely to recover preadmission levels of function and are at risk of being permanently institutionalized. 15,16 Even more alarming is the high 1-year mortality rate following the hospitalization of older adults. 17 Baztan et al 17 reported that 32.6% of community-dwelling older adults died within 1 year of hospitalization due to acute illne...

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Section: Discussionmentioning

confidence: 99%

Physical Therapy and Discharge Disposition Following Acute Hospitalization for UTI in Community-Dwelling Older Adults

Miller¹,

Moore²,

Stikeleather³

2021

Journal of Acute Care Physical Therapy

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“…This provides a standardized metric representing PT service intensity, simultaneously accounting for the variability in both length of stay and the number of completed visits. The latter can be influenced by therapists’ practice patterns and patients’ appropriateness for therapy, willingness to participate, and availability 6,29. Visit frequency was standardized to a 7-day period to be interpreted as a weekly frequency, which is the most common mode of planning and evaluating physical therapy frequency in the hospitals, and was categorized: ≤2, >2–4, >4–7, and >7 visits/week.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2022

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“…Patient data included sex, age, medical diagnosis, scheduled physical therapist, and day of the week treatment was scheduled. Patient diagnoses were grouped into categories (ie, musculoskeletal, wound, renal, pulmonary, neurological, cardiovascular, gastrointestinal, cancer, and other) according to previously published work 11,13. If the primary diagnosis was not certain, it was categorized as “unknown.”…”

Section: Methodsmentioning

confidence: 99%

“…To realize these benefits, patients must be active participants in treatment sessions. Scheduled therapy sessions that do not result in treatment can be called nontreatment 11. The proportion of hospital nontreatment is known to range from 15% to 26% and has been associated with patient diagnosis and hospital staffing 4,11–13…”

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confidence: 99%

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Missed Physical Therapy Treatments in the Acute Hospital: Toward a More Complete Understanding

Shan

Johnson

Fertitta

et al. 2020

Journal of Acute Care Physical Therapy

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Introduction: Therapy sessions that do not result in treatment (nontreatment) occur in 15% to 26% of scheduled sessions. The relationship between therapist personality and nontreatment is unknown. Objective: To determine the relationship between physical therapist personality and nontreatment events in the acute hospital. Methods: The relationship between physical therapist personality (Big Five Inventory) and nontreatment was statistically modeled adjusting for other therapist and patient factors. Results: There were 522 patients and 34 physical therapists with 918 scheduled physical therapy sessions included. The average age of patients was 71 (SD = 16, range = 17-99) and 41 (SD = 7, range 27-54) for therapists. Therapists with higher openness had lower nontreatment, odds ratio 0.93; 95% confidence interval 0.87 to 0.99; P = .045. Conclusions: The positive effect of physical therapy is minimized when scheduled treatment does not occur. Lower nontreatment is associated with more trait openness. Attributes related to openness (eg, inquisitiveness and problem-solving) should be cultivated. More research is needed to understand nontreatment and guide therapists in hospital patient care.

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Cross-Sectional Examination of Patient and Therapist Factors Affecting Participation in Physical Therapy in Acute Care Hospital Settings

Cited by 10 publications

References 38 publications

Physical Therapy and Discharge Disposition Following Acute Hospitalization for UTI in Community-Dwelling Older Adults

Physical Therapy and Discharge Disposition Following Acute Hospitalization for UTI in Community-Dwelling Older Adults

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

Missed Physical Therapy Treatments in the Acute Hospital: Toward a More Complete Understanding

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