Does Physical Therapy Produce Value for Post-Operative and/or Non-Operative Foot and Ankle Patients?

Category: Outcomes Introduction/Purpose: Healthcare is at a unique time in history where patient reported outcomes have become important in assessing value and subsequent reimbursement with pay-4-performance initiatives. It is unclear whether physical function, pain and depressive symptoms can assist providers determine if additional physical therapy may improve care for foot and ankle patients considering post-op and/or non-operative care. The purpose of this research was to examine symptom severity (PROMIS PF, PI, and Dep) after surgery or with non-operative care at the start of formal physical therapy to determine if this symptom severity presentation and/or change in symptoms over time are predictors of improvement in physical function as assessed by PROMIS PF. Methods: PROMIS scales were available at the start and end of physical therapy treatment for 377 patients with foot and ankle ICD10 codes. The mean age (40.2±18.1 years), body mass index (BMI) (28.9±7.9 kg/m2), and proportion of females (62.1%) were recorded. The median number of physical therapy visits was 5 (interquartile range=5). Clinical categories of greater than 20 were identified for 7 groups including: Achilles rupture (n=24), Fracture (n=34), Ankle Pain (n=105), Foot Pain (n= 50), Ankle Sprain (n=51), Achilles Non-Rupture (n=45) and Other (n=68). Two multivariate linear regression models; 1) solely using data available at the start of therapy (age, gender, BMI, diagnosis category, PROMIS scores at the start of physical therapy); And, 2) a second model adding change in PROMIS PI, DP and completed visits to model 1 were examined for their ability to predict change in PF (Start to end of physical therapy). Results: The average change in PROMIS PF was 6.5±8.8 with a range of -20 to 49.1. Correlations of PROMIS scales at the start of therapy with change in PROMIS PF were r-values