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Objective. The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain (LBP). Methods. This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic LBP (N = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a [greater than or equal to]50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index. Results. Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients. Conclusion. Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic LBP more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not. Impact. This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic LBP. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach. Keywords: Patient-Centered Care, Precision Medicine, Risk Factors, Telemedicine, Introduction During the early phases of the coronavirus disease-2019 (COVID-19) pandemic, state and federal policies were modified, allowing many physical therapists in the United States to begin providing care through [...]

Objective. Physical function is associated with important outcomes, yet there is often a lack of continuity in routine assessment. The purpose of this study was to determine data elements and instruments for longitudinal measurement of physical function in routine care among patients transitioning from acute care hospital setting to home with home health care. Methods. A 4-round modified Delphi process was conducted with 13 participants with expertise in physical therapy, health care administration, health services research, physiatry/medicine, and health informatics. Three anonymous rounds identified important and feasible data elements. A fourth in-person round finalized the recommended list of individual data elements. Next, 2 focus groups independently provided additional perspectives from other stakeholders. Results. Response rates were 100% for online rounds 1, 3, and 4 and 92% for round 2. In round 1, 9 domains were identified: physical function, participation, adverse events, behavioral/emotional health, social support, cognition, complexity of illness/disease burden, health care utilization, and demographics. Following the fourth round, 27 individual data elements were recommended. Of these, 20 (74%) are 'administrative' and available from most hospital electronic medical records. Additional focus groups confirmed these selections and provided input on standardizing collection methods. A website has been developed to share these results and invite other health care systems to participate in future data sharing of these identified data elements. Conclusion. A modified Delphi consensus process was used to identify critical data elements to track changes in patient physical function in routine care as they transition from acute hospital to home with home health. Impact. Expert consensus on comprehensive and feasible measurement of physical function in routine care provides health care professionals and institutions with guidance in establishing discrete medical records data that can improve patient care, discharge decisions, and future research. Keywords: Acute Care, Home Care Services, Measurement: Applied, Medical Informatics, Introduction Within the framework of the International Classification of Functioning, Disability and Health, physical function is the result of interaction between a person's body parts, their whole person, and their [...]

Objective. The aim of this study was to examine the association between the length of time between an emergency department (ED) visit and the subsequent initiation of physical therapist intervention for low back pain (LBP) on 1-year LBP-related health care utilization (ie, surgery, advanced imaging, injections, long-term opioid use, ED visits) and costs. Methods. This retrospective cohort study focused on individuals who consulted the ED for an initial visit for LBP. Claims from a single statewide, all-payers database were used. LBP-related health care use and costs for the 12 months after the ED visit were extracted. Poisson and general linear models weighted with inverse probability treatment weights were used to compare the outcomes of patients who attended physical therapy early or delayed after the ED visit. Results. Compared with the delayed physical therapy group (n = 94), the early physical therapy group (n = 171) had a lower risk of receiving lumbar surgery (relative risk [RR] = 0.47, 95% CI = 0.26-0.86) and advanced imaging (RR = 0.72, 95% CI = 0.55-0.95), and they were less likely to have long-term opioid use (RR = 0.45, 95% CI = 0.28-0.76). The early physical therapy group incurred lower costs (mean = $3,806, 95% CI = $1,998-$4,184) than those in the delayed physical therapy group (mean = $8,689, 95% CI = $4,653-$12,727). Conclusion. Early physical therapy following an ED visit was associated with a reduced risk of using some types of health care and reduced health care costs in the 12 months following the ED visit. Impact Statement. The ED is an entry point into the health care system for patients with LBP. Until now, the impact of the length of time between an ED visit and physical therapy for LBP has not been well understood. This study shows that swift initiation of physical therapy following an ED visit for LBP is associated with lower LBP-related health utilization for some important outcomes and lower LBP-related health care costs., Worldwide, low back pain (LBP) disables a greater number of people than any other health care condition. (1) Annual direct and indirect LBP-related health care costs are estimated to be [...]

Objective. Poor knowledge of the relationships between physical function (PF) in the hospital and patient outcomes in an inpatient rehabilitation facility (IRF) limits the identification of patients most appropriate for discharge to an IRF. This study aimed to test for independent associations between PF measured via the AM-PAC '6-clicks' basic mobility short form in the hospital and outcomes in an IRF. Methods. This was a retrospective cohort study. Primary data were collected from an acute hospital and IRF at 1 academic medical center. Associations were tested between PF at hospital admission or discharge and PF improvement in the IRF, discharge from the IRF to the community, and 30-day hospital events by estimating adjusted relative risk (aRR) using modified Poisson regression and the relative difference in IRF length of stay (LOS) using Gamma regression. Results. A total of 1323 patients were included. Patients with moderately low, (aRR = 1.50; 95% CI = 1.15-1.93), moderately high (aRR = 1.52; 95% CI = 1.16-2.01), or high (aRR = 1.37; 95% CI = 1.02-1.85) PF at hospital discharge were more likely than those with very low PF to improve their PF while in the IRF. These same patients were more likely to discharge from IRF to the community and had significantly shorter IRF LOS. Hospital-measured PF did not differentiate risk for 30-day hospital events. Conclusion. Patients with moderate--but not very low or very high--PF measured near the time of acute hospital discharge were likely to achieve meaningful PF improvement in an IRF. They also had a shorter IRF LOS so may be ideal candidates for discharge to IRF. Prospective studies with larger samples are necessary to test this assertion. Impact. Providers in the hospital should identify patients with moderate PF near the time of hospital discharge as those who may benefit most from post-acute rehabilitation in an IRF., Medicare costs on post-acute care (PAC) utilization exceeded $59 billion in 2013, nearly tripling since 2001. (1) Therefore, new policies aim to improve the value of PAC utilization in the [...]

Background. In the United States, low back pain (LBP) is among the most common symptoms prompting a health care visit. Patients can receive escalated care, such as advanced imaging or invasive procedures, before guideline-recommended options offered by physical therapists. A guideline-concordant alternative care pathway (RapidAccess) that emphasized early physical therapy for patients with LBP before they consulted a physiatrist was implemented. Evaluating the implementation of care pathways, such as RapidAccess using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, provides a broader understanding of the barriers to implementation. Objective. The purpose of this study was to evaluate the implementation of a guideline-concordant care pathway for patients with LBP using a RE-AIM framework. Design. This study used a prospective observational cohort design. Methods. Patients with a chief complaint of LBP who were scheduling a new appointment with physiatry were eligible. Eligible patients chose whether or not to participate in RapidAccess before a consultation with a physiatrist. Implementation outcomes were evaluated using the RE-AIM framework. Results. During the study period, 1556 patients with LBP called to schedule a new visit with a physiatrist. Of these, 400 (25.7%) were eligible for RapidAccess, and 124 (31% of those eligible) participated in the program (reach). Of the 400 eligible patients, 225 (56.3%) were offered RapidAccess (adoption). Compared with patients who were managed in physical therapy following a consultation with a physiatrist, RapidAccess participants demonstrated improvement in physical function with physical therapist management (effectiveness); 58.9% cancelled their physiatrist visit (implementation), and rates of imaging and injections were lower (effectiveness). Reach and adoption (maintenance) trended downward beyond the first 6 months of the project. Limitations. The results are from a single health system and might not be broadly generalizable. Conclusions. The RE-AIM framework was useful in evaluating the implementation of RapidAccess. Factors influencing reach and adoption must be further examined., Low back pain (LBP) is one of the most common symptoms prompting a health care visit in the United States, accounting for about 5% of all physician visits. (1,2) LBP [...]

Background. Patients who consult a physical therapist for low back pain (LBP) may receive initial and subsequent management from different therapists. The impact that physical therapy provider continuity has on health care use in patients with LBP is insufficiently studied. Objective. The objective of this study was to examine the impact of continuity of the physical therapy provider on health care use and costs in patients with LBP referred from primary care. Design. The study design included a retrospective analysis of claims data. Methods. Data from an all-payer claims database were examined. Logistic regression was used to evaluate the association between physical therapy provider continuity and health care use during the 1-year period following a visit with a primary care provider for LBP. Results. Patients who experienced greater physical therapy provider continuity had a decreased likelihood of receiving lumbar surgery. They also paid less (mean = $1737 [95% confidence interval, $1602-$1871]) than those who experienced less physical therapy provider continuity (mean = $2577 [95% confidence interval, $2008-$3l45]). Limitations. The degree of causality between any predictor and outcome variables cannot be determined due to the observational nature of the study. Conclusions. Greater continuity of the physical therapy provider appears to be associated with a decreased likelihood of surgical treatment for LBP and lower health care costs related to LBP., Low back pain (LBP) is the third most costly health care condition in the USA after diabetes and heart disease. (1) A frequent pattern of care for patients with LBP [...]