Factors Associated with Surgeon Referral for Physical Therapy in Patients with Traumatic Lower-Extremity Injury: Results of a National Survey of Orthopedic Trauma Surgeons

Details

• Personal Author:
  Arche KR ; Bosse MJ ; MacKenzie EJ ; Pollak AN ; Riley LH 3rd
• Description:
  BACKGROUND: Variation in referral rates for physical therapy exists at both the individual physician and practice levels. OBJECTIVE: The purpose of this study was to explore the influence of physician and practice characteristics on referral for physical therapy in patients with traumatic lower-extremity injury. DESIGN: A cross-sectional survey was conducted. METHODS: In 2007, a Web-based survey questionnaire was distributed to 474 surgeon members of the Orthopaedic Trauma Association. The questionnaire measured physician and practice characteristics, outcome expectations, and attitude toward physical therapy. Referral for physical therapy was based on case vignettes. RESULTS: The response rate was 58%. Surgeons reported that 57.6% of their patients would have a positive outcome from physical therapy and 24.2% would have a negative outcome. The highest physical therapy expectations were for the appropriate use of assistive devices (80.7%) and improved strength (force-generating capacity) (76.4%). The lowest outcome expectations were for improvements in pain (35.9%), coping with the emotional aspects of disability (44.1%), and improvements in workplace limitations (51.4%). Physicians reported that 32.6% of their patients referred for physical therapy would have no improvement beyond what would occur with a surgeon-directed home exercise program. Multivariate analyses showed positive physician outcome expectations to have the largest effect on referral for physical therapy (odds ratio=2.7, P<.001). CONCLUSIONS: The results suggest that orthopedic trauma surgeons refer patients for physical therapy based mostly on expectations for physical and motor outcomes, but may not be considering pain relief, return to work, and psychosocial aspects of recovery. Furthermore, low referral rates may be attributed to a preference for surgeon-directed home-based rehabilitation. Future research should consider the efficacy of physical therapy for pain, psychosocial and occupational outcomes, and exploring the differences between supervised physical therapy and physician-directed home exercise programs. [Description provided by NIOSH]
• Subjects:
  Epidemiology Mental Health Occupational Health Safety Surveys And Questionnaires Workplace
• Keywords:
  Physical-therapy Psychological-reactions Psychological-responses Questionnaires Statistical-analysis Work-environment Work-operations Work-practices Workplace-studies
• ISSN:
  0031-9023
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Maryland ; North Carolina ; OSHA Region 3 ; OSHA Region 4 ; Tennessee
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  89
• Issue:
  9
• NIOSHTIC Number:
  nn:20035899
• Citation:
  Phys Ther 2009 Sep; 89(9):893-905
• Contact Point Address:
  Kristin R. Archer, PhD, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Medical Center East-South Tower, Ste 4200, Nashville, TN 37232
• Email:
  kristin.archer@vanderbilt.edu
• Federal Fiscal Year:
  2009
• Performing Organization:
  Johns Hopkins University
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Physical Therapy
• End Date:
  20280630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:0c1c139f8ece5ab95d13c01807226b05f1aa7dd4b2066ec40851fd140a86aa516be4759c5acdfc8b6f99be4aa98d048d79b9395a903ecadce99ff9be0f177acc
• Download URL:
  https://stacks.cdc.gov/view/cdc/187577/cdc_187577_DS1.pdf
• File Type:
  [PDF - 178.54 KB ]