Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy

Abstract Objective Fragility fractures are common among adults with cerebral palsy (CP), but clinical rehabilitation use after fracture and its effect on long-term health outcomes have not been sufficiently studied. The objectives of this study were to identify patterns of the use of physical therap...

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Veröffentlicht in:PTJ: Physical Therapy & Rehabilitation Journal 2023-08, Vol.103 (8), p.1
Hauptverfasser: Gottlieb, Rachel E W, Panzer, Kate V, Wang, Mia, Leis, Aleda M, Whitney, Daniel G
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creator Gottlieb, Rachel E W
Panzer, Kate V
Wang, Mia
Leis, Aleda M
Whitney, Daniel G
description Abstract Objective Fragility fractures are common among adults with cerebral palsy (CP), but clinical rehabilitation use after fracture and its effect on long-term health outcomes have not been sufficiently studied. The objectives of this study were to identify patterns of the use of physical therapy, occupational therapy, or both in the 6-month postfracture period and the association with 3-year mortality in adults with CP. Methods This retrospective cohort study included adults who were ≥18 years old, had CP, and had sustained an incident fragility fracture between January 1, 2014, and December 31, 2016, as identified from a random 20% Medicare fee-for-service dataset. Six-month outpatient physical therapy or occupational therapy use patterns after fracture were identified using group-based trajectory modeling. Cox regression determined the association between physical therapy or occupational therapy use trajectory patterns and mortality from 6 months to 3 years after fracture, adjusting for confounders. Effect modification by key characteristics was tested, including age, sex, and the modified Whitney Comorbidity Index (mWCI), which is a CP-specific comorbidity index that better captures overall medical complexity. Results Of the 2429 participants included, the majority (73.2%) were characterized as having little to no probability of physical therapy or occupational therapy use, whereas 16.0 and 10.7% were characterized as having early initiation and later initiation, respectively. Compared to the mortality rate for the little to no physical therapy or occupational therapy group, the mortality rates were 26% lower for the early physical therapy or occupational therapy initiation group (hazard ratio [HR] = 0.74; 95% CI = 0.55–1.00) and were 20% lower for the later initiation group (HR = 0.80; 95% CI = 0.57–1.12). There was effect modification by the mWCI. The mortality rate was lower when the early initiation and later initiation groups were compared to the little to no initiation group across all mWCI values examined (median and interquartile range), but the effect was stronger (ie, lower mortality rate) for lower mWCI values for both early initiation and later initiation groups. Conclusion Most adults with CP underutilize outpatient physical therapy or occupational therapy services within 6 months postfracture. Early or later initiation versus little to no physical therapy or occupational therapy use was associated with a lower HR of mortality, althoug
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The objectives of this study were to identify patterns of the use of physical therapy, occupational therapy, or both in the 6-month postfracture period and the association with 3-year mortality in adults with CP. Methods This retrospective cohort study included adults who were ≥18 years old, had CP, and had sustained an incident fragility fracture between January 1, 2014, and December 31, 2016, as identified from a random 20% Medicare fee-for-service dataset. Six-month outpatient physical therapy or occupational therapy use patterns after fracture were identified using group-based trajectory modeling. Cox regression determined the association between physical therapy or occupational therapy use trajectory patterns and mortality from 6 months to 3 years after fracture, adjusting for confounders. Effect modification by key characteristics was tested, including age, sex, and the modified Whitney Comorbidity Index (mWCI), which is a CP-specific comorbidity index that better captures overall medical complexity. Results Of the 2429 participants included, the majority (73.2%) were characterized as having little to no probability of physical therapy or occupational therapy use, whereas 16.0 and 10.7% were characterized as having early initiation and later initiation, respectively. Compared to the mortality rate for the little to no physical therapy or occupational therapy group, the mortality rates were 26% lower for the early physical therapy or occupational therapy initiation group (hazard ratio [HR] = 0.74; 95% CI = 0.55–1.00) and were 20% lower for the later initiation group (HR = 0.80; 95% CI = 0.57–1.12). There was effect modification by the mWCI. The mortality rate was lower when the early initiation and later initiation groups were compared to the little to no initiation group across all mWCI values examined (median and interquartile range), but the effect was stronger (ie, lower mortality rate) for lower mWCI values for both early initiation and later initiation groups. Conclusion Most adults with CP underutilize outpatient physical therapy or occupational therapy services within 6 months postfracture. Early or later initiation versus little to no physical therapy or occupational therapy use was associated with a lower HR of mortality, although the effect was stronger and statistically significant among those with less medical complexity. Impact Throughout their lives, the use of rehabilitation services in individuals with CP, including physical therapy and occupational therapy, dramatically declines despite the need for continued rehabilitation across their lifespans. This study characterized longitudinal physical therapy or occupational therapy use patterns in the 6 months following a fragility fracture among adults with CP and found that nearly 3 in 4 adults with CP had little to no physical therapy or occupational therapy use during this critical window to optimize postfracture health and function. Further, those who more regularly used physical therapy or occupational therapy services, regardless of the timing of initiation (early vs later), had significantly improved survival up to 3 years after fracture, suggesting the need for greater access to and delivery of clinical rehabilitation services.</description><identifier>ISSN: 0031-9023</identifier><identifier>ISSN: 1538-6724</identifier><identifier>EISSN: 1538-6724</identifier><identifier>DOI: 10.1093/ptj/pzad090</identifier><identifier>PMID: 37440438</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adult ; Aged ; Care and treatment ; Cerebral palsy ; Cerebral Palsy - rehabilitation ; Comorbidity ; Diagnosis ; Female ; Fractures, Bone ; Humans ; Male ; Medicare ; Mortality ; Occupational Therapy ; Outpatients ; Patient outcomes ; Physical therapy ; Rehabilitation ; Retrospective Studies ; Therapeutics, Physiological ; United States - epidemiology</subject><ispartof>PTJ: Physical Therapy &amp; Rehabilitation Journal, 2023-08, Vol.103 (8), p.1</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>COPYRIGHT 2023 Oxford University Press</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c588t-1ac64f193b8f5a1c00352c72a581d866d5899f21d123325664d667f03f51fafa3</cites><orcidid>0000-0003-2132-1527</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37440438$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gottlieb, Rachel E W</creatorcontrib><creatorcontrib>Panzer, Kate V</creatorcontrib><creatorcontrib>Wang, Mia</creatorcontrib><creatorcontrib>Leis, Aleda M</creatorcontrib><creatorcontrib>Whitney, Daniel G</creatorcontrib><title>Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy</title><title>PTJ: Physical Therapy &amp; Rehabilitation Journal</title><addtitle>Phys Ther</addtitle><description>Abstract Objective Fragility fractures are common among adults with cerebral palsy (CP), but clinical rehabilitation use after fracture and its effect on long-term health outcomes have not been sufficiently studied. The objectives of this study were to identify patterns of the use of physical therapy, occupational therapy, or both in the 6-month postfracture period and the association with 3-year mortality in adults with CP. Methods This retrospective cohort study included adults who were ≥18 years old, had CP, and had sustained an incident fragility fracture between January 1, 2014, and December 31, 2016, as identified from a random 20% Medicare fee-for-service dataset. Six-month outpatient physical therapy or occupational therapy use patterns after fracture were identified using group-based trajectory modeling. Cox regression determined the association between physical therapy or occupational therapy use trajectory patterns and mortality from 6 months to 3 years after fracture, adjusting for confounders. Effect modification by key characteristics was tested, including age, sex, and the modified Whitney Comorbidity Index (mWCI), which is a CP-specific comorbidity index that better captures overall medical complexity. Results Of the 2429 participants included, the majority (73.2%) were characterized as having little to no probability of physical therapy or occupational therapy use, whereas 16.0 and 10.7% were characterized as having early initiation and later initiation, respectively. Compared to the mortality rate for the little to no physical therapy or occupational therapy group, the mortality rates were 26% lower for the early physical therapy or occupational therapy initiation group (hazard ratio [HR] = 0.74; 95% CI = 0.55–1.00) and were 20% lower for the later initiation group (HR = 0.80; 95% CI = 0.57–1.12). There was effect modification by the mWCI. The mortality rate was lower when the early initiation and later initiation groups were compared to the little to no initiation group across all mWCI values examined (median and interquartile range), but the effect was stronger (ie, lower mortality rate) for lower mWCI values for both early initiation and later initiation groups. Conclusion Most adults with CP underutilize outpatient physical therapy or occupational therapy services within 6 months postfracture. Early or later initiation versus little to no physical therapy or occupational therapy use was associated with a lower HR of mortality, although the effect was stronger and statistically significant among those with less medical complexity. Impact Throughout their lives, the use of rehabilitation services in individuals with CP, including physical therapy and occupational therapy, dramatically declines despite the need for continued rehabilitation across their lifespans. This study characterized longitudinal physical therapy or occupational therapy use patterns in the 6 months following a fragility fracture among adults with CP and found that nearly 3 in 4 adults with CP had little to no physical therapy or occupational therapy use during this critical window to optimize postfracture health and function. Further, those who more regularly used physical therapy or occupational therapy services, regardless of the timing of initiation (early vs later), had significantly improved survival up to 3 years after fracture, suggesting the need for greater access to and delivery of clinical rehabilitation services.</description><subject>Adult</subject><subject>Aged</subject><subject>Care and treatment</subject><subject>Cerebral palsy</subject><subject>Cerebral Palsy - rehabilitation</subject><subject>Comorbidity</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Fractures, Bone</subject><subject>Humans</subject><subject>Male</subject><subject>Medicare</subject><subject>Mortality</subject><subject>Occupational Therapy</subject><subject>Outpatients</subject><subject>Patient outcomes</subject><subject>Physical therapy</subject><subject>Rehabilitation</subject><subject>Retrospective Studies</subject><subject>Therapeutics, Physiological</subject><subject>United States - epidemiology</subject><issn>0031-9023</issn><issn>1538-6724</issn><issn>1538-6724</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUuLFDEUhYMoTs_oyr0EhEGQmsmjUpVaFo2OAy3dixnEVZHOYzpNVaXMY1H-I_-l6YciLiSLC7nfvfdwDgBvMLrBqKG3U9zfTj-EQg16BhaYUV5UNSmfgwVCFBcNIvQCXIawRwjhumxeggtalyUqKV-Anys3PtmYlB1FDzciRu3HAJ2BGxei8ULG5DVcpziJaPUY4WY3Bysz_LDTXkwzFKOCaynTAXDjX43HoI_N-xhgG4KT9kjArzbuIC2-aeHhF-ej6G2cYTtkJbBVqc_4EVlqr7f-KKsP8yvwwuSqX5_rFXj89PFh-blYre_ul-2qkIzzWGAhq9Lghm65YQLL7AEjsiaCcax4VSnGm8YQrDChlLCqKlVV1QZRw7ARRtAr8P60d_Lue9IhdoMNUve9GLVLoSOccsLKpiYZffcPunfJZwtCRxHLd0nDykzdnKgn0evOjsbFbGt-Sg9WulEbm__buq6y1LI-DHw4DUjvQvDadJO3g_Bzh1F3iLzLkXfnyDP99iwibQet_rC_M87A9Qlwafrvpl8vFbav</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Gottlieb, Rachel E W</creator><creator>Panzer, Kate V</creator><creator>Wang, Mia</creator><creator>Leis, Aleda M</creator><creator>Whitney, Daniel G</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IAO</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2132-1527</orcidid></search><sort><creationdate>20230801</creationdate><title>Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy</title><author>Gottlieb, Rachel E W ; Panzer, Kate V ; Wang, Mia ; Leis, Aleda M ; Whitney, Daniel G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c588t-1ac64f193b8f5a1c00352c72a581d866d5899f21d123325664d667f03f51fafa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Care and treatment</topic><topic>Cerebral palsy</topic><topic>Cerebral Palsy - rehabilitation</topic><topic>Comorbidity</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Fractures, Bone</topic><topic>Humans</topic><topic>Male</topic><topic>Medicare</topic><topic>Mortality</topic><topic>Occupational Therapy</topic><topic>Outpatients</topic><topic>Patient outcomes</topic><topic>Physical therapy</topic><topic>Rehabilitation</topic><topic>Retrospective Studies</topic><topic>Therapeutics, Physiological</topic><topic>United States - epidemiology</topic><toplevel>online_resources</toplevel><creatorcontrib>Gottlieb, Rachel E W</creatorcontrib><creatorcontrib>Panzer, Kate V</creatorcontrib><creatorcontrib>Wang, Mia</creatorcontrib><creatorcontrib>Leis, Aleda M</creatorcontrib><creatorcontrib>Whitney, Daniel G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Academic OneFile</collection><collection>Physical Education Index</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>PTJ: Physical Therapy &amp; Rehabilitation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gottlieb, Rachel E W</au><au>Panzer, Kate V</au><au>Wang, Mia</au><au>Leis, Aleda M</au><au>Whitney, Daniel G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy</atitle><jtitle>PTJ: Physical Therapy &amp; Rehabilitation Journal</jtitle><addtitle>Phys Ther</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>103</volume><issue>8</issue><spage>1</spage><pages>1-</pages><issn>0031-9023</issn><issn>1538-6724</issn><eissn>1538-6724</eissn><abstract>Abstract Objective Fragility fractures are common among adults with cerebral palsy (CP), but clinical rehabilitation use after fracture and its effect on long-term health outcomes have not been sufficiently studied. The objectives of this study were to identify patterns of the use of physical therapy, occupational therapy, or both in the 6-month postfracture period and the association with 3-year mortality in adults with CP. Methods This retrospective cohort study included adults who were ≥18 years old, had CP, and had sustained an incident fragility fracture between January 1, 2014, and December 31, 2016, as identified from a random 20% Medicare fee-for-service dataset. Six-month outpatient physical therapy or occupational therapy use patterns after fracture were identified using group-based trajectory modeling. Cox regression determined the association between physical therapy or occupational therapy use trajectory patterns and mortality from 6 months to 3 years after fracture, adjusting for confounders. Effect modification by key characteristics was tested, including age, sex, and the modified Whitney Comorbidity Index (mWCI), which is a CP-specific comorbidity index that better captures overall medical complexity. Results Of the 2429 participants included, the majority (73.2%) were characterized as having little to no probability of physical therapy or occupational therapy use, whereas 16.0 and 10.7% were characterized as having early initiation and later initiation, respectively. Compared to the mortality rate for the little to no physical therapy or occupational therapy group, the mortality rates were 26% lower for the early physical therapy or occupational therapy initiation group (hazard ratio [HR] = 0.74; 95% CI = 0.55–1.00) and were 20% lower for the later initiation group (HR = 0.80; 95% CI = 0.57–1.12). There was effect modification by the mWCI. The mortality rate was lower when the early initiation and later initiation groups were compared to the little to no initiation group across all mWCI values examined (median and interquartile range), but the effect was stronger (ie, lower mortality rate) for lower mWCI values for both early initiation and later initiation groups. Conclusion Most adults with CP underutilize outpatient physical therapy or occupational therapy services within 6 months postfracture. Early or later initiation versus little to no physical therapy or occupational therapy use was associated with a lower HR of mortality, although the effect was stronger and statistically significant among those with less medical complexity. Impact Throughout their lives, the use of rehabilitation services in individuals with CP, including physical therapy and occupational therapy, dramatically declines despite the need for continued rehabilitation across their lifespans. This study characterized longitudinal physical therapy or occupational therapy use patterns in the 6 months following a fragility fracture among adults with CP and found that nearly 3 in 4 adults with CP had little to no physical therapy or occupational therapy use during this critical window to optimize postfracture health and function. Further, those who more regularly used physical therapy or occupational therapy services, regardless of the timing of initiation (early vs later), had significantly improved survival up to 3 years after fracture, suggesting the need for greater access to and delivery of clinical rehabilitation services.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>37440438</pmid><doi>10.1093/ptj/pzad090</doi><orcidid>https://orcid.org/0000-0003-2132-1527</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Care and treatment
Cerebral palsy
Cerebral Palsy - rehabilitation
Comorbidity
Diagnosis
Female
Fractures, Bone
Humans
Male
Medicare
Mortality
Occupational Therapy
Outpatients
Patient outcomes
Physical therapy
Rehabilitation
Retrospective Studies
Therapeutics, Physiological
United States - epidemiology
title Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy
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