Improved functional outcomes as a function of utilization of physical therapy services in patients with fractures of the pelvis and femur

Studies to assess the relationships between health outcomes and utilization of specific health services are critical to policy analysis and future decision-making pertaining to the delivery of health care. No published studies have addressed the direct relationship between functional outcomes of patients with fractures of the pelvis and the femur and the utilization of physical therapy services.

This study presents single equation models to describe the relationships between the dependent variable functional scores and independent variables inclusive of patient demographics, patient medical characteristics, and physical therapy services. The sample population consisted of 340 inpatients in one large medical center teaching hospital. These patients received a mean of 6.46 physical therapy visits for a total average of 3.43 hours of treatment.

The results that are consistent with previous studies are the inverse (negative) relationships between functional outcomes and age, female gender, the number of preexisting conditions and complications, and the hospital length of stay. In this study, functional score was expected to decrease by 16.5% for each additional complication and by 2.6% with a 10% increment in hospital length of stay.

Using the full model single equation, including both PT minutes and visits, there was a positive nonsignificant effect of physical therapy (PT) utilization on functional scores. A 10% increase in the number of PT visits yielded a 1.3% increase in scores, whereas a 3.2% increase in scores was expected with a 10% increase in the number of PT minutes. Using reduced models including only PT visits or PT minutes resulted in positive and statistically significant associations (p $<$.0001) between the PT variable and increased functional scores. The utilization of PT was positively associated, although statistically nonsignificant, with discharge disposition to the preadmission residence.

This study adds to the medical outcomes movement by provision of: a descriptive overview of those patients with lower quadrant fractures who are referred to PT and the amount of PT utilization subsequent to those fractures; data to support the belief that functional outcomes may improve with increased PT utilization; and, documentation that PT utilization, while positively associated with hospital discharge to the preadmission residence, does not significantly impact on the discharge disposition. Although these results do not provide support for a definitive stance relative to PT utilization for improving functional outcomes, the positive associations provide an initial basis for inclusion of PT services in future health care reform initiatives.