Castillo Renan C, MacKenzie Ellen J, Archer Kristin R, Bosse Michael J, Webb Lawrence X
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Arch Phys Med Rehabil. 2008 Oct;89(10):1873-9. doi: 10.1016/j.apmr.2008.01.032.
To examine the effect of physical therapy (PT) use on a range of measures of physical impairment in a cohort of patients with lower-extremity trauma.
Longitudinal, observational study of patients with severe lower-extremity trauma. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission and at 3, 6, 12, and 24 months postdischarge.
Eight level I trauma centers.
Patients (N=382) whose legs were salvaged after limb-threatening trauma to the lower limb.
Not applicable.
Unmet need for PT was assessed from 2 perspectives: an orthopedic surgeon and a physical therapist independently evaluated each patient and were asked whether the patient would benefit from PT. Patients classified by these health professionals as needing PT services over a given period and who reported receiving no PT at the end of that period were classified as having unmet need as evaluated by the orthopedic surgeon or physical therapist for that follow-up period. Multiple variable regression techniques were used to compare improvement in 5 measures of physical impairment and functional limitation between the met and unmet need groups over the periods of 3 to 6, 6 to 12, and 12 to 24 months: percentage of impairment in knee and ankle range of motion (ROM), reciprocal stair climbing pattern, gait deviations when walking, self-selected walking speed greater than 1.2 m/s (4 ft/s), and the mobility subscores of the FIM instrument.
Patients with unmet need for PT as assessed by a physical therapist were statistically significantly less likely to improve in all 5 of the selected domains of physical impairment and functional limitation than patients whose PT need was met. These results remained constant after adjustment for patient sociodemographic, personality, and social resources, as well as injury and treatment characteristics, reported pain intensity, and impairment level at the beginning of the study period. Patients with unmet need for PT as evaluated by an orthopedic surgeon were significantly worse off than patients with met need in only 1 of the 5 selected measures (ROM).
The results are consistent with a beneficial effect of PT after lower-extremity trauma. The results point to a need for improved standards for the prescription of PT services, and highlight the importance of involving a PT professional in the prescribing process.
探讨物理治疗（PT）对一组下肢创伤患者一系列身体损伤指标的影响。
对严重下肢创伤患者进行纵向观察性研究。在患者初次入院时以及出院后3、6、12和24个月，由研究协调员进行访谈，并由骨科医生和物理治疗师进行检查。
八个一级创伤中心。
下肢遭受威胁肢体的创伤后腿部得以保全的患者（N = 382）。
不适用。
从两个角度评估未满足的PT需求：骨科医生和物理治疗师分别对每位患者进行评估，并询问患者是否会从PT中受益。被这些医疗专业人员归类为在特定时期需要PT服务但在该时期结束时报告未接受PT的患者，在该随访期内被骨科医生或物理治疗师评估为有未满足的需求。使用多元回归技术比较在3至6个月、6至12个月和12至24个月期间，需求得到满足和未得到满足的两组患者在5项身体损伤和功能受限指标上的改善情况：膝关节和踝关节活动范围（ROM）的损伤百分比、交替上下楼梯模式、行走时的步态偏差、自选步行速度大于1.2米/秒（4英尺/秒）以及FIM工具的移动性子评分。
与PT需求得到满足的患者相比，经物理治疗师评估有未满足PT需求的患者在所选的所有5个身体损伤和功能受限领域的改善可能性在统计学上显著更低。在对患者的社会人口统计学、个性和社会资源以及损伤和治疗特征、报告的疼痛强度和研究期开始时的损伤水平进行调整后，这些结果仍然不变。经骨科医生评估有未满足PT需求的患者仅在所选的5项指标中的1项（ROM）上比需求得到满足的患者情况更差。
结果与下肢创伤后PT的有益效果一致。结果表明需要提高PT服务处方标准，并强调在处方过程中让PT专业人员参与的重要性。
