Predictors of Postoperative Physical Therapy Utilization After Common Orthopaedic Procedures

Area of Science:

• Orthopaedic Surgery
• Rehabilitation Medicine
• Health Services Research

Background:

• Physical therapy (PT) is crucial for recovery following orthopaedic surgery.
• Predictors of postoperative PT utilization across diverse orthopaedic procedures are not well understood.
• This study investigates demographic and clinical factors influencing PT use after common orthopaedic surgeries.

Purpose of the Study:

• To identify demographic and clinical predictors of physical therapy (PT) utilization after eight common orthopaedic procedures.
• To analyze factors associated with PT use in a diverse national cohort from the NIH All of Us Research Program.
• To understand the relationship between PT utilization and postoperative outcomes, such as emergency department visits.

Main Methods:

• Analysis of 12,666 patients undergoing 8 orthopaedic procedures from the NIH All of Us Research Program.
• Primary outcome: PT utilization within 180 days of surgery.
• Multivariable logistic regression used to identify predictors, adjusting for demographics, comorbidities, insurance, employment, preoperative PT, and early postoperative opioid prescriptions.

Main Results:

• Overall postoperative PT utilization was 44%.
• Preoperative PT (aOR, 8.91) and early postoperative opioid prescriptions (aOR, 1.66) were strong predictors of higher PT utilization.
• Female sex was associated with lower PT utilization (aOR, 0.85), particularly after total knee arthroplasty (aOR, 0.78).

Conclusions:

• Preoperative PT and early opioid prescriptions are key predictors of postoperative PT utilization.
• Female sex shows a consistent association with reduced PT use, suggesting potential sex-based disparities.
• Findings underscore the need to investigate strategies addressing rehabilitation access barriers, including preoperative PT, equitable opioid prescribing, and insurance-related issues.