Maura D Iversen1, Todd A Schwartz2, Johan von Heideken3, Leigh F Callahan4, Yvonne M Golightly5, Adam Goode6, Carla Hill7, Kim Huffman8, Ami Pathak9, Jennifer Cooke10, Kelli D Allen11. 1. Department of Medicine, Section of Clinical Sciences, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Thurston Arthritis Research Center, Univer-sity of North Carolina, Chapel Hill, North Carolina; and Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, 301C Robinson Hall, Boston, MA 02115 (USA). 2. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina. 3. Department of Women's and Children's Health, Karolinska Institutet. 4. Thurston Arthritis Research Center and Department of Medicine, University of North Carolina. 5. Thurston Arthritis Research Center, Department of Medicine, and Department of Epidemiology, University of North Carolina. 6. Department of Orthopedic Surgery, Division of Physical Therapy, Duke University Medical Center, Durham, North Carolina. 7. Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina. Dr Hill is a board-certified orthopaedic clinical specialist and is certified in the McKenzie method of mechanical diagnosis and therapy. 8. Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center; and Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, North Carolina. 9. Comprehensive Physical Therapy Center, Chapel Hill, North Carolina. 10. Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina. 11. Thurston Arthritis Research Center, University of North Carolina; Department of Medicine, University of North Carolina; and Center for Health Services Research in Primary Care, Durham VA Medical Center.
Abstract
Background: Physical therapy is essential for conservative management of symptomatic knee osteoarthritis (OA). However, physical therapy utilization data are limited for knee OA. Objective: The purpose of this study is to identify correlates of physical therapy utilization among adults with symptomatic knee OA. Design: The design consisted of secondary analysis using baseline data from a randomized controlled trial of 350 adults with physician-diagnosed symptomatic knee OA. Methods: Patients completed baseline surveys regarding demographics, pain, function, medical history, and prior physical therapy utilization for symptomatic knee OA. Multivariable logistic regression identified correlates of physical therapy utilization, with models adjusted for body mass index and age. Interactions of race and sex with all other characteristics were evaluated. Results: One hundred and eighty-one patients (52%) reported prior physical therapy utilization. Factors independently associated with increased odds of physical therapy utilization were female sex (odds ratio [OR] = 3.06, 95% CI = 1.58-5.93), bachelor degree or higher degree (OR = 2.44, 95% CI = 1.15-5.16), prior knee injury (OR = 1.86, 95% CI = 1.08-3.19), and duration of knee OA symptoms (OR = 2.16, 95% CI = 1.09-4.29 for >5-10 years; OR = 2.11, 95% CI = 1.10-4.04 for >10 years). Whites who had received a joint injection were >3 times as likely to have utilized physical therapy (OR = 3.69, 95% CI = 1.94-7.01); this relationship did not exist for non-whites who had received joint injections. Limitations: A sample enrolled in an exercise study may limit generalizability. Self-report of physical therapy may misclassify utilization. It cannot be determined whether lack of utilization resulted from lack of referral or from patients choosing not to attend physical therapy. Conclusion: Physical therapy is underutilized to manage symptomatic knee OA. Women and those with a bachelor degree or higher degree, prior knee injury, and longer duration of knee OA symptoms were more likely to have used therapy previously. Differences by race in the link between joint injection and physical therapy utilization may reflect a reduced likelihood of referral and decreased use of health interventions for symptomatic knee OA among non-whites, or both.
Background: Physical therapy is essential for conservative management of symptomatic knee osteoarthritis (OA). However, physical therapy utilization data are limited for knee OA. Objective: The purpose of this study is to identify correlates of physical therapy utilization among adults with symptomatic knee OA. Design: The design consisted of secondary analysis using baseline data from a randomized controlled trial of 350 adults with physician-diagnosed symptomatic knee OA. Methods: Patients completed baseline surveys regarding demographics, pain, function, medical history, and prior physical therapy utilization for symptomatic knee OA. Multivariable logistic regression identified correlates of physical therapy utilization, with models adjusted for body mass index and age. Interactions of race and sex with all other characteristics were evaluated. Results: One hundred and eighty-one patients (52%) reported prior physical therapy utilization. Factors independently associated with increased odds of physical therapy utilization were female sex (odds ratio [OR] = 3.06, 95% CI = 1.58-5.93), bachelor degree or higher degree (OR = 2.44, 95% CI = 1.15-5.16), prior knee injury (OR = 1.86, 95% CI = 1.08-3.19), and duration of knee OA symptoms (OR = 2.16, 95% CI = 1.09-4.29 for >5-10 years; OR = 2.11, 95% CI = 1.10-4.04 for >10 years). Whites who had received a joint injection were >3 times as likely to have utilized physical therapy (OR = 3.69, 95% CI = 1.94-7.01); this relationship did not exist for non-whites who had received joint injections. Limitations: A sample enrolled in an exercise study may limit generalizability. Self-report of physical therapy may misclassify utilization. It cannot be determined whether lack of utilization resulted from lack of referral or from patients choosing not to attend physical therapy. Conclusion: Physical therapy is underutilized to manage symptomatic knee OA. Women and those with a bachelor degree or higher degree, prior knee injury, and longer duration of knee OA symptoms were more likely to have used therapy previously. Differences by race in the link between joint injection and physical therapy utilization may reflect a reduced likelihood of referral and decreased use of health interventions for symptomatic knee OA among non-whites, or both.
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