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Physical Therapy Utilization Among Hospitalized Patients With Pediatric Acute Lymphoblastic Leukemia
Rozalyn L Rodwin1, Xiaomei Ma2,3, Kirsten K Ness4
1Section of Pediatric Hematology/Oncology, Department of Pediatrics, Yale School of Medicine, New Haven, CT.
Insights
Physical therapy (PT) is crucial for children with acute lymphoblastic leukemia (ALL) to improve physical function. However, less than 30% of pediatric ALL patients receive PT, indicating a need for increased access and intervention.
Area of Science:
- Pediatric Oncology
- Rehabilitation Medicine
- Health Services Research
Background:
- Pediatric acute lymphoblastic leukemia (ALL) survivors face risks of impaired physical function due to treatment.
- Early physical therapy (PT) is recognized for its potential to enhance physical function and overall health in children undergoing ALL treatment.
- However, current data on the utilization of PT services among pediatric ALL patients remains limited.
Purpose of the Study:
- To investigate the utilization rates of physical therapy (PT) among pediatric patients diagnosed with acute lymphoblastic leukemia (ALL).
- To identify sociodemographic and clinical factors associated with receiving PT within one year of initial hospitalization for ALL.
- To understand disparities in PT access for this vulnerable patient population.
Main Methods:
- A retrospective cohort study was conducted using the Premier Healthcare Database.
- Included were patients aged 0-21 years hospitalized with ALL between January 1, 2010, and March 31, 2017.
- A generalized mixed linear model was employed to analyze factors associated with PT utilization.
Main Results:
- Only 27.2% of pediatric ALL patients received PT within one year of their first ALL admission; this rate increased to 58.9% for those with neuromuscular conditions.
- Older age groups (10-14 and 15-21 years) and Hispanic ethnicity were associated with higher odds of receiving PT compared to younger children (0-4 years) and White patients, respectively.
- Patients treated by non-hematology/oncology specialists or at non-teaching hospitals had lower odds of receiving PT.
Conclusions:
- The study highlights significantly low rates of physical therapy utilization among pediatric ALL patients, even those with neuromuscular conditions.
- Disparities in PT access were observed based on age, ethnicity, and healthcare setting.
- Interventions aimed at increasing PT services and addressing utilization disparities are recommended to improve physical function and long-term health outcomes for pediatric ALL survivors.
Purpose:
Patients with pediatric acute lymphoblastic leukemia (ALL) are at risk for impaired physical function from treatment. Early physical therapy (PT) may improve physical function and health in children with ALL, yet little is known about PT utilization in this population.
Methods:
Leveraging the Premier Healthcare Database, we conducted a cohort study including participants hospitalized with ALL at age 0-21 years from January 1, 2010, through March 31, 2017. A generalized mixed linear model assessed sociodemographic and clinical variables associated with receiving PT within 1 year of first hospitalization.
Results:
Among 5,488 pediatric ALL patients from 330 hospitals (median age 7 years, interquartile range = 4-14 years), only 27.2% overall and 58.9% with neuromuscular conditions received PT within a year of first ALL admission. In multivariable analysis, patients more likely to receive PT were age 10-14 years (odds ratio [OR] = 1.46; 95% CI, 1.20 to 1.76) or 15-21 years (OR = 1.66; 95% CI, 1.36 to 2.02) versus 0-4 years and Hispanic (OR = 1.27; 95% CI, 1.04 to 1.56) versus White. Patients less likely to receive PT were treated by a nonhematology/oncology pediatric (OR = 0.56; 95% CI, 0.46 to 0.70) or adult (OR = 0.50; 95% CI, 0.38 to 0.65) specialist versus a pediatric hematologist/oncologist and treated at a nonteaching hospital (OR = 0.53; 95% CI, 0.36 to 0.79) versus a teaching hospital.
Conclusion:
Only 27.2% of pediatric ALL patients overall and 58.9% with neuromuscular conditions receive inpatient PT within a year of first ALL admission. Interventions to increase inpatient PT services to pediatric ALL patients and address disparities in PT utilization may improve the physical function and long-term health of survivors.
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