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Inpatient Physical Therapy After Orthopedic Lower Extremity Surgery in Children With Cerebral Palsy
Amy F Bailes1, Colleen Mangeot, Natalie J Murphy
1PT III Division of Occupational Therapy and Physical Therapy (Dr Bailes) and Division of Pediatric Orthopaedics (Dr McCarthy), Cincinnati Children's Hospital, Cincinnati, Ohio; Department of Rehabilitation, Nutrition and Exercise Sciences (Dr Bailes), University of Cincinnati, Cincinnati, Ohio, Statistical Consulting Core (Ms Mangeot), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Physical Medicine and Rehabilitation (Ms Murphy), School of Medicine, and Department of Health Systems, Management and Policy (Drs McManus and Richardson), Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Sondermind Inc (Dr Richardson), Denver, Colorado; Department of Orthopaedic Surgery (Dr McCarthy), University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
Inpatient physical therapy access after lower extremity surgery varies for children with cerebral palsy (CP). Factors like region, technology dependence, hospital size, age, and surgical burden influence therapy receipt.
Area of Science:
- Orthopedics
- Pediatric Physical Therapy
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) often necessitates orthopedic interventions, particularly for lower extremity (LE) impairments.
- Understanding disparities in post-surgical inpatient (IP) physical therapy (PT) is crucial for optimizing care in pediatric CP populations.
Discussion:
- Variability in IP PT receipt post-LE surgery for CP patients was observed across different hospital types and patient demographics.
- Geographic region (South, West) and technology dependence were associated with lower PT likelihood.
- Larger hospital size, specific age groups (11-14 years), and higher surgical burden correlated with increased PT utilization.
Key Insights:
- Seventy-five percent of pediatric CP patients received IP PT after LE orthopedic surgery.
- Significant disparities exist in access to acute physical therapy services.
- Patient and hospital characteristics are key determinants of therapy receipt.
Outlook:
- This study highlights the need for further investigation into the causes of these access discrepancies.
- Future research should aim to develop strategies for equitable distribution of physical therapy services for children with CP.
- Standardizing care pathways can improve outcomes for this vulnerable population.
Purpose:
To characterize and examine the variability in receipt of inpatient (IP) physical therapy after lower extremity (LE) orthopedic surgery for individuals with cerebral palsy (CP) across hospital-level (region, bed size) and individual characteristics (gender, age, race/ethnicity, insurance type, technology dependency, and surgical burden).
Methods:
We retrospectively analyzed physical therapy billing data of children with CP who had LE orthopedic surgery from October 1, 2015, through September 30, 2017, from the Pediatric Health Information Services (PHIS) database.
Results:
Seventy-five percent of individuals received IP physical therapy during the hospital stay. Individuals from the South and West and those who were technology dependent were less likely to receive IP therapy. Those at large hospitals, aged 11 to 14 years, and with a high surgical burden were more likely to receive therapy.
Conclusions:
Results provide a starting point for future research on the discrepancies of acute physical therapy services in children diagnosed with CP. (Supplemental digital content video abstract available at: http://links.lww.com/PPT/A420).
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