Social determinants of health are associated with physical therapy use: a systematic review

Abstract

ObjectiveThe purpose of this systematic review is to identify and summarise the social determinants of health (SDH) cited in the literature and evaluate their association with individuals using physical therapy services.DesignA systematic review using qualitatively synthesised information to describe the association between SDH and physical therapy use.Data sourcesThe electronic databases Medline, Embase and Scopus were searched from inception to February 2021, identifying observational and qualitative studies.Eligibility criteriaPublished studies included all adults, aged 18 or older, who independently sought to use physical therapy, in all practice settings from all geographical locations.ResultsOf the 9248 studies screened, 36 met the inclusion criteria for the review. The participants represented 8 countries and totaled 2 699 437. The majority of the papers reported moderate strength of association for each SDH. Female gender, non-Hispanic white race/ethnicity, increased education attainment, urban environment, access to transportation, employment, high socioeconomic status and private insurance were associated with higher likelihood of physical therapy use.ConclusionThis systematic review identifies predisposing and enabling factors impacting physical therapy usage among adults in different countries and across physical therapy settings. The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.

Physical Therapy Utilization Among Hospitalized Patients With Pediatric Acute Lymphoblastic Leukemia

“…Future studies exploring other variations in care between patients with ALL treated by a hematology/oncology attending versus other physicians may help improve the quality of care for children with ALL. 36 We also found that PT utilization had minimal variation by geographic region. In unadjusted analyses, we found that patients who received PT were more likely to be treated in hospitals in the West than those who did not receive PT, similar to a national study of PT utilization among adult patients with vestibular disorders that found PT was more frequently provided to patients in the West.…”

Telehealth Physical Therapy for Sports Medicine Rehabilitation: What Is Its Role in the Postpandemic Era?

“…The highest proportion of visits were covered under private insurance, in concordance with data illustrating a higher likelihood of PT use for private insurance holders. 3 Interestingly, a subanalysis of telehealth utilization before and after official reopening of the PT center revealed similar differences in patient characteristics with those identified between in-person and telehealth visits. That is, after September 2020 (reopening date) compared with before, telehealth users were more often female, lived farther away and in nonurban postal codes, had lower income, and more frequently carried Medicaid or Medicare health insurance.…”

“…The highest proportion of visits were covered under private insurance, in concordance with data illustrating a higher likelihood of PT use for private insurance holders. 3 …”

Resistance Training in Individuals With Hip and Knee Osteoarthritis: A Clinical Commentary With Practical Applications

“…Over the past 5 years, a growing emphasis has been placed on the biopsychosocial model of health care, aiming to assess the psychosocial aspects of health alongside the more well-accepted biological factors associated with disease, injury, or pathology, to develop a plan of care that considers the whole person. A recent systematic review highlighted predisposing factors as they relate to social determinants of health that impact the use of physical therapy services (8). This research can cautiously be extrapolated to other areas of wellness, prevention, and exercise rehabilitation, suggesting that health care professionals should consider marketing and engagement strategies that promote exercise and resistance training to individuals in rural areas, with lower levels of education, or in a lower socioeconomic class, as these are more likely to be a barrier to care.…”