Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services

Martinez, Maylyn; Cerasale, Matthew; Baig, Mahnoor; Dugan, Claire; Robinson, Marla; Sweis, Meghan; Prochaska, Micah T.; Schram, A. W.; Meltzer, David O.; Arora, Vineet M.

doi:10.12788/jhm.3673

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…However, why the most mobile patients have more physiotherapy remains questionable. As previously described, overuse of physiotherapy in patients who would not benefit from it could be an explanation [42].…”

Section: The Most Mobile Patients Have More Physiotherapy Prescriptionsmentioning

confidence: 88%

Steps parameters of elderly patients hospitalised for an acute medical illness in a Swiss University Hospital: an observational pilot study

Tommasini¹,

Marques‐Vidal²,

Kayser³

et al. 2022

Swiss Med Wkly

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BACKGROUND: Objective mobility goals for elderly hospitalised medical patients remain debated. We therefore studied steps parameters of elderly patients hospitalised for an acute illness, to determine goals for future interventional trials and medical practice. METHODS: Observational study conducted from February to November 2018 in a medical ward of the Lausanne University Hospital, Switzerland. We measured the step parameters of consecutive medical patients aged ≥65 years admitted for an acute medical illness using a wrist accelerometer (Geneactiv). We also collected demographic, somatic and functional factors. RESULTS: Overall, 187 inpatients had their step parameters (daily step count, walking cadence and bout duration) measured with accelerometers worn for a mean of 3.6 days (standard deviation [SD] 3.2). Elderly inpatients (81.5 years, SD 8.5) walked a median of 603 steps daily (interquartile range [IQR] 456–809), at a median cadence of 100 steps/minute (IQR 99–101) with median walking bouts of 33 seconds (IQR 27–37) and with 70% of the walking bouts lasting less than 30 seconds. Patients walking ≥600 steps were younger (80.4 years, SD 8.9 vs 82.8 years,SD 7.9, p = 0.050) and had a longer length of stay (7.8 days, SD 5.1 vs 6.1 days, SD 4.1, p = 0.011) than those walking <600 steps. Patients at high risk of bed sores walked less (564 steps, IQR 394–814 vs 626, IQR 526–840) than those with a lower risk of sores. CONCLUSION: During a hospitalisation for an acute medical illness, patients aged ≥65 years walk a mere 603 steps daily and most of the time for periods of less than 30 seconds. This information should be used to build up future interventional trials or to set mobility goals for patients hospitalised in Swiss hospitals.

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Section: The Most Mobile Patients Have More Physiotherapy Prescriptionsmentioning

confidence: 88%

Steps parameters of elderly patients hospitalised for an acute medical illness in a Swiss University Hospital: an observational pilot study

Tommasini¹,

Marques‐Vidal²,

Kayser³

et al. 2022

Swiss Med Wkly

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“…Difficulty identifying which patients will benefit the most from physical therapy obfuscates the value rendered to the system. A recent publication makes this point by suggesting that overutilization of physical therapists for general mobilization may be commonplace 36…”

Section: Complexity Science Applied To Acute Care Physical Therapy An...mentioning

confidence: 99%

Describing the Value of Physical Therapy in a Complex System Using the Socio-Ecological Model

Crick¹,

Alain²,

Quatman³

et al. 2022

Journal of Acute Care Physical Therapy

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A system is a collection of entities (ie, widgets, molecules, people, businesses) that interact in such a way that their resulting collective behavior is not immediately apparent by viewing the collected items separately. Hospital-based health care meets the definition of a system, but further specification is helpful to describe the value of components in the system. Complexity science offers a chance to reconceptualize our understanding of health care to an environment of connected parts operating together and adapting on the basis of inputs and outputs. The purpose of this conceptual article is to apply complexity science principles to acute care physical therapy in order to provide perspective on the value of the physical therapist in the hospital environment and on the contextual factors that influence the profession's value. We present a model, the Socio-Ecological Model for Acute Care, and apply this model to physical therapy in order to describe the interrelated factors influencing the profession's value to individual patients, to the hospital units on which they practice, to the hospital system as a whole, and how they contribute to policy discussions. Yet, this value is difficult to distinguish due to the multifarious inputs into the system. Providing a clear description of the value of physical therapy in hospital settings is essential in our current health care environment that is increasingly cost-conscious. We provide perspective for clinicians and health care leaders while suggesting needs for future research.

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Section: If Not Now Then When?mentioning

confidence: 99%

“…In fact, PT referrals occur for hospitalized patients with no need for skilled therapy as much as 38% of the time. 24 But given they are a constrained resource in most hospital settings, like other consultants, their services should be reserved for the appropriate patients. Targeting allocation of skilled therapy to vulnerable patients is key for treating and preventing HAD and physical deconditioning in hospitalized patients but cannot be achieved with the current standards of practice.…”

Section: If Not Now Then When?mentioning

confidence: 99%

“…Their dual responsibility as therapists administering treatment and experts providing recommendations for safe discharge levels of care means therapists are frequently saddled with triaging, diagnosing, and treating mobility issues regardless of a patient's functional status. In fact, PT referrals occur for hospitalized patients with no need for skilled therapy as much as 38% of the time 24 . But given they are a constrained resource in most hospital settings, like other consultants, their services should be reserved for the appropriate patients.…”

Section: If Not Now Then When?mentioning

confidence: 99%

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Deconditioned, disabled, or debilitated? Formalizing management of functional mobility impairments in the medical inpatient setting

Martinez

Cifu

2022

Journal of Hospital Medicine

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Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services

Cited by 14 publications

References 13 publications

Steps parameters of elderly patients hospitalised for an acute medical illness in a Swiss University Hospital: an observational pilot study

Steps parameters of elderly patients hospitalised for an acute medical illness in a Swiss University Hospital: an observational pilot study

Describing the Value of Physical Therapy in a Complex System Using the Socio-Ecological Model

Deconditioned, disabled, or debilitated? Formalizing management of functional mobility impairments in the medical inpatient setting

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