de Heer Hendrik D, Warren Meghan
Northern Arizona University, Department of Physical Therapy and Athletic Training, Flagstaff, AZ.
Spine (Phila Pa 1976). 2016 Oct 1;41(19):1515-1522. doi: 10.1097/BRS.0000000000001571.
A retrospective cohort study.
The aim of this study was to evaluate associations between receipt and quantity of outpatient physical therapy (PT) during an episode of care and 30-day and 180-day hospital admissions for any condition and lumbar spine conditions.
Low back pain (LBP) is a common cause of hospitalization and the most common reason Medicare beneficiaries utilize outpatient PT. The association between PT and hospitalization among patients with LBP is unknown.
A national sample of Medicare Fee-for-Service claims included 413,608 beneficiaries with an International Classification of Disease 9th revision (ICD-9) code of LBP and 1,415,037 episodes of care between June 1, 2010, and June 30, 2011. Episodes were classified as PT episodes or non-PT episodes. Relative risk of hospitalization from the episode start date was caldulated, adjusting for health status (Charlson comorbidity index), prior care utilization (number of prior hospitalizations and total number of episodes), an indicator of LBP severity (number of LBP ICD-9 codes), and demographics (sex, race/ethnicity, age).
The proportion of 30-day hospitalization for any condition was 3.42% for PT episodes of care and 6.54% for non-PT episodes. For 180-day hospitalization, proportions were 15.45% (PT) and 21.65% (non-PT). The adjusted relative risk reduction of PT (vs. non-PT) was 41% for 30 days [99% confidence interval (CI) 38-44] and 22% for 180 days (20-24). For admitting diagnoses of lumbar spine, reductions were 65% at 30 days and 32% at 180 days. More PT treatment days showed greater 30-day risk reductions. For any condition, compared with non-PT, reductions were 24% for 1 to 2 treatment days (lowest tertile), 45% for 3 to 7 days, and 65% for more than 8 days (highest tertile). Stronger effects were found for lumbar spine admissions. Associations between PT quantity and 180-day hospitalization were less consistent. Limitations of Medicare claims include the potential for inaccuracies, limited knowledge about disease severity, and which PT interventions were conducted.
Receipt of PT during an episode had a 22% to 65% reduced relative risk of hospitalization, with greater short-term reductions for more PT treatment days.
一项回顾性队列研究。
本研究旨在评估在一个护理期间接受门诊物理治疗（PT）的情况、PT的量与因任何疾病和腰椎疾病导致的30天及180天住院之间的关联。
腰痛（LBP）是住院的常见原因，也是医疗保险受益人使用门诊PT的最常见原因。LBP患者中PT与住院之间的关联尚不清楚。
一个医疗保险按服务付费索赔的全国样本包括413,608名患有国际疾病分类第九版（ICD - 9）LBP编码的受益人以及2010年6月1日至2011年6月30日期间的1,415,037个护理事件。这些事件被分类为PT事件或非PT事件。计算从事件开始日期起的住院相对风险，并对健康状况（Charlson合并症指数）、先前护理利用情况（先前住院次数和事件总数）、LBP严重程度指标（LBP ICD - 9编码数量）和人口统计学特征（性别、种族/民族、年龄）进行调整。
对于任何疾病，PT护理事件的30天住院比例为3.42%，非PT事件为6.54%。对于180天住院，比例分别为15.45%（PT）和21.65%（非PT）。PT（与非PT相比）调整后的相对风险降低在30天时为41%[99%置信区间（CI）38 - 44]，在180天时为22%（20 - 24）。对于腰椎的入院诊断，30天时降低65%，180天时降低32%。更多的PT治疗天数显示出更大的30天风险降低。对于任何疾病，与非PT相比，1至2个治疗天数（最低三分位数）降低24%，3至7天降低45%，超过8天（最高三分位数）降低65%。在腰椎入院方面发现了更强的效果。PT量与180天住院之间的关联不太一致。医疗保险索赔的局限性包括可能存在不准确之处、对疾病严重程度的了解有限以及进行了哪些PT干预措施。
在一个护理期间接受PT使住院的相对风险降低了22%至65%，更多的PT治疗天数在短期内降低风险的幅度更大。
3级。
