Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia.
Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia.
Disabil Rehabil. 2022 Aug;44(17):4729-4737. doi: 10.1080/09638288.2021.1918772. Epub 2021 Apr 30.
An essential measure of hip fracture (HF) rehabilitation, the amount of physical therapy (PT) used per patient, has been severely understudied. This study (1) evaluates post-acute PT use after HF in Estonia, (2) presents causal variation modelling for examining inter- and intra-regional disparities, and (3) analyses its temporal trends.
This retrospective cohort study used validated population-wide health data, including patients aged ≥50 years, with an index HF diagnosed between January 2009 and September 2017. Patients' 6-month PT use was analysed and reported separately for acute and post-acute phases.
While most of the included 11,461 patients received acute rehabilitation, only 40% of them received post-acute PT by a median of 6 h. Analyses based on measures of central tendency revealed 2.5 to 2.6-fold inter-regional differences in HF post-acute rehabilitation. Variation modelling additionally detected intra-regional disparities, showing imbalances in the fairness of allocating local rehabilitation resources between a county's patients.
This study demonstrates the advantages of causal variation modelling for identifying inter- and intra-regional disparities in rehabilitation. The analyses revealed persisting large multi-level disparities and accompanying overall inaccessibility of PT in HF rehabilitation in Estonia, showing an urgent need for system-wide improvements.Implications for rehabilitationThis study demonstrates the advantages of causal variation modelling for identifying inter- and intra-regional disparities in rehabilitation, using an essential outcome measure - used physical therapy hours.The study revealed large multi-level disparities and overall inaccessibility of physical therapy in hip fracture rehabilitation in Estonia, showing an urgent need for system-wide improvements.This study expands our knowledge on unstudied topics - hip fracture post-acute care and long-term physical therapy use.This regional analysis provides the first evidence-based regional-level basis for improving the rehabilitation system in Estonia.
髋部骨折 (HF) 康复的一个重要衡量标准是每位患者接受的物理治疗 (PT) 量，而这一指标的研究严重不足。本研究（1）评估了爱沙尼亚 HF 患者的急性期后 PT 使用情况，（2）提出了因果变异模型以检验区域间和区域内的差异，（3）分析了其时间趋势。
本回顾性队列研究使用了经过验证的人群范围的健康数据，包括年龄≥50 岁的患者，索引 HF 诊断于 2009 年 1 月至 2017 年 9 月之间。分析并单独报告了患者的 6 个月 PT 使用情况，分为急性期和恢复期。
虽然大多数纳入的 11461 名患者接受了急性康复治疗，但仅有 40%的患者在急性期后接受了 6 小时的 PT。基于集中趋势的分析表明，HF 康复的区域间差异高达 2.5 至 2.6 倍。变异模型分析还发现了区域内的差异，显示了在为县内患者分配当地康复资源方面的公平性失衡。
本研究展示了因果变异模型在识别康复方面的区域间和区域内差异的优势。分析结果显示，爱沙尼亚 HF 康复中仍然存在大量多层次的差异和整体上无法获得 PT 的情况，迫切需要进行系统范围的改进。
本研究使用一个基本的预后指标——实际使用的物理治疗时长，展示了因果变异模型在识别康复中的区域间和区域内差异的优势。研究结果显示，爱沙尼亚的髋部骨折康复中存在大量多层次的差异和整体上无法获得物理治疗的情况，迫切需要进行系统范围的改进。本研究扩展了我们对未研究课题的了解，包括髋部骨折的急性期后护理和长期物理治疗的使用。本区域分析为改善爱沙尼亚康复系统提供了首个基于循证的区域水平的基础。
