Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA.
Phys Ther. 2011 Mar;91(3):330-45. doi: 10.2522/ptj.20090290. Epub 2011 Jan 13.
Medicare beneficiaries frequently receive physical therapy for musculoskeletal conditions. Little information is available about this care.
The purposes of this study were: (1) to describe characteristics, clinical outcomes, and utilization for Medicare beneficiaries receiving physical therapy in outpatient clinics within one integrated health care system; (2) to compare characteristics, outcomes, and utilization based on the body region affected; and (3) to examine factors predictive of outcomes and utilization.
This was a prospective, longitudinal study.
Medicare beneficiaries aged 65 years or older (n=1,840 episodes of care) participated in the study. Descriptive statistics were calculated for patient characteristics and outcomes. Comparisons were made based on body region. Regression models evaluated factors associated with change in pain, improved outcome, and utilization.
The patients' mean age was 74.2 years (SD=6.3), and 65.3% were female. The most common body regions were the lumbar spine, shoulder, and knee, collectively accounting for 71.3% of the episodes of care. Patients attended a mean of 6.8 visits (SD=4.7), and 63.9% experienced an improved outcome. Episodes of care for lumbar spine conditions had less reduction in pain, whereas shoulder conditions and foot/ankle conditions showed the greatest improvement. Care for hip conditions was least likely to result in an improved outcome. Knee conditions were most likely to have an improved outcome. Care for shoulder and knee conditions had the highest number of visits. Factors associated with greater reduction in pain and improved outcomes included greater initial pain or disability and attending more visits. Factors associated with greater utilization included a postsurgical condition and higher initial pain rating. Limitations The study was performed in one geographic region within a single health care delivery system.
The results provide information on outcomes of physical therapy for Medicare beneficiaries in one health care system. Further research is needed to examine optimal utilization and care for these patients.
医疗保险受益人为肌肉骨骼疾病经常接受物理治疗。关于这种治疗方法的信息很少。
本研究的目的是：（1）描述在一个综合医疗保健系统内的门诊接受物理治疗的医疗保险受益人的特征、临床结果和利用情况；（2）根据受影响的身体部位比较特征、结果和利用情况；（3）检查预测结果和利用的因素。
这是一项前瞻性、纵向研究。
参与研究的是年龄在 65 岁或以上的医疗保险受益人（1840 个疗程）。计算了患者特征和结果的描述性统计数据。根据身体部位进行了比较。回归模型评估了与疼痛变化、改善结果和利用相关的因素。
患者的平均年龄为 74.2 岁（SD=6.3），65.3%为女性。最常见的身体部位是腰椎、肩部和膝盖，这三个部位共同占疗程的 71.3%。患者平均就诊 6.8 次（SD=4.7），63.9%的患者结果得到改善。腰椎疾病的疗程疼痛减轻较少，而肩部和足部/脚踝疾病的改善最大。髋部疾病的治疗最不可能取得改善的结果。膝关节疾病最有可能取得改善的结果。肩部和膝关节疾病的就诊次数最多。与疼痛减轻和结果改善相关的因素包括初始疼痛或残疾程度更大，就诊次数更多。与利用率更高相关的因素包括术后情况和初始疼痛评分更高。局限性：该研究是在一个医疗保健提供系统内的一个地理区域进行的。
这些结果提供了一个医疗保健系统中医疗保险受益人的物理治疗结果的信息。需要进一步研究以检查这些患者的最佳利用和护理。
