Harris Leah S, Freeman Suzanne, Wang Ying-Chih
Jackson County Physical Therapy, Eagle Point, OR, USA.
California Rehabilitation and Sports Physical Therapy, Huntington Beach, CA, USA.
Ann Transl Med. 2019 Oct;7(Suppl 7):S251. doi: 10.21037/atm.2019.04.09.
Current healthcare providers function in an environment where there is increased emphasis on value-based models of reimbursement; therefore, the delivery of better patient outcomes is critical. Consequently, it is necessary to identify successful treatments that improve outcomes and can be applied across a broad range of clinic settings, treatment styles and therapist expertise.
Data from 2,450 patients who received Astym therapy as component of their outpatient rehabilitation (treatment group) was matched to data from 2,450 randomly chosen patients with similar orthopedic impairments who did not receive Astym therapy during their rehabilitation (control group). Data was collected across 116 clinics in 17 U.S. states. All patients completed a standardized functional status survey at admission and at discharge. The effectiveness (discharge functional status score), efficiency (number of treatment visits, treatment duration) and utilization (unit of functional improvement per visit) was compared across two groups. Ethics approval was not required for this study as this is an observational study, with both sets of participants receiving actual (not placebo) treatment.
Compared to the control sample, patients who received Astym therapy as part of their rehabilitation had higher discharge functional status (FS) scores (68.5 . 64.5, F =53.1, P<0.001) and had more functional improvement per visit noted with a higher utilization index (2.0 . 1.9, ANCOVA F =5.5, P=0.019), and after risk adjustment, had the same number of visits. There was no difference in duration of treatment episode across groups (Astym, 47.8±31.1 days; control, 47.5±30.0 days) (ANCOVA F =1.7, P=0.199).
Patients with musculoskeletal disorders who received Astym therapy as part of the treatment process experienced increased treatment effectiveness as compared to those who did not receive Astym therapy. The addition of Astym therapy improved physical therapy outcomes for patients across a broad range of treatment styles, clinical settings and therapist expertise.
当前医疗服务提供者所处的环境越来越强调基于价值的报销模式;因此,提供更好的患者治疗效果至关重要。因此,有必要确定能改善治疗效果且可应用于广泛临床环境、治疗方式和治疗师专业水平的成功治疗方法。
将2450名接受Astrom疗法作为门诊康复一部分的患者(治疗组)的数据与2450名随机选择的、在康复期间未接受Astrom疗法但有类似骨科损伤的患者(对照组)的数据进行匹配。数据收集自美国17个州的116家诊所。所有患者在入院时和出院时均完成了标准化功能状态调查。比较了两组的有效性(出院功能状态评分)、效率(治疗次数、治疗时长)和利用率(每次就诊功能改善单位)。由于本研究为观察性研究,两组参与者均接受实际(而非安慰剂)治疗,因此无需伦理批准。
与对照组相比,接受Astrom疗法作为康复一部分的患者出院时功能状态(FS)评分更高(68.5对64.5,F = 53.1,P < 0.001),每次就诊的功能改善更多,利用率指数更高(2.0对1.9,协方差分析F = 5.5,P = 0.019),且在风险调整后,就诊次数相同。两组治疗疗程的时长无差异(Astrom组,47.8±31.1天;对照组,47.5±30.0天)(协方差分析F = 1.7,P = 0.199)。
与未接受Astrom疗法的患者相比,在治疗过程中接受Astrom疗法的肌肉骨骼疾病患者治疗效果有所提高。Astrom疗法的加入改善了广泛治疗方式、临床环境和治疗师专业水平下患者的物理治疗效果。