Julia Chevan

Determinants of Utilization and Expenditures for Episodes of Ambulatory Physical Therapy Among Adults

Background Comprehensive information on determinants and patterns of use and spending for ambulatory physical therapy services is needed to inform health planning and policy decisions. Most research in the literature on this topic is limited to specific payers, age groups, and conditions. Objective The purpose of this study was to examine factors associated with the resource intensity of physical therapy episodes for adults in the United States as measured by number of visits and expenses per visit. Design This study was a secondary analysis of longitudinal survey data from the Medical Expenditure Panel Survey (MEPS) panels 9, 10, and 11. Methods An analytic file was created based on data from the longitudinal data files for 3 MEPS panels and the annual office-based and hospital outpatient event files. A total of 1,377 episodes of physical therapy care were identified. Variation in both the total number of visits per episode and expenses per visit was examined by fitting regression models to evaluate the effects of selected independent variables classified into 4 categories: episode-level variables, demographic characteristics, geographic variables, and health status indicators. Results Average total expenses per episode (in 2007 dollars) were

Factors Associated With Care Seeking From Physicians, Physical Therapists, or Chiropractors by Persons With Spinal Pain: A Population-Based Study

1,184 (median=

Demographic determinants of participation in strength training activities among U.S. adults.

651), with an average number of visits per episode of 9.6 (median=6.0) and average expenses per visit of

The Gender Gap in Peer-Reviewed Publications by Physical Therapy Faculty Members: A Productivity Puzzle

130 (median=

Do As I Do: Exercise Habits of Physical Therapists, Physical Therapist Assistants, and Student Physical Therapists

95). Significant variation by geographic characteristics, sex, and one comorbid condition (high blood pressure) was found in the number of visits model. In the expenditures model, expenses per visit were associated with age/insurance coverage, setting (hospital outpatient versus office based), primary condition category, and mental health status. Limitations Limitations include limited sample sizes of physical therapy users and lack of detailed clinical information. Conclusions Variability in the resource intensity of physical therapy episodes is influenced to some degree by nonclinical variables.

Nontarget- and Target-oriented Functional Reach Among Older Adults at Risk for Falls

STUDY DESIGN Secondary analysis of longitudinal population-based survey data. OBJECTIVES To investigate factors associated with care seeking for physician-referred physical therapy (MD/PT), as compared to physician-only (MD) or chiropractic-only (DC) care for spinal pain. BACKGROUND Although a large proportion of ambulatory physical therapy visits are related to spinal pain, physical therapists are not the most commonly seen provider. The majority of visits are to physicians, followed by chiropractors. We attempted to understand more about this disparity by examining social and demographic factors that differentiate between persons who see these providers. METHODS Episodes of care were constructed from participants in 2 panels from the Medical Expenditure Panel Survey who had spinal pain. The provider of care was identified for each episode, and logistic regression was used to determine factors associated with MD/PT use compared to MD use, and MD/PT use compared to DC use. RESULTS The majority of patients (61%) received MD care for spinal pain, followed by those who received DC (28%) and MD/PT (11%) care. Female sex, higher levels of education, and higher income were significantly associated with MD/PT care over MD care. Increased age, female sex, lower self-health rating, and presence of at least 1 disability day were all significantly associated with MD/PT care over DC care. CONCLUSION Sociodemographic and clinical factors are associated with those who get MD/PT care as compared to MD or DC care. We found evidence of an access disparity for physical therapy and identified population characteristics that both increase and reduce the likelihood of physical therapy service use.

Culture, Language, and Resources: Overcoming Barriers to Research Collaboration With Physical Therapist Education Program Faculty in a Developing Country

This study used a health services approach to examine the demographic correlates of participation in strength training activities among U.S. adults. The purpose of this study was to develop a profile of adults who participate in strength training activities and analyze the demographic factors that predict strength training participation. The study was a secondary data analysis employing a nonexperimental correlational design. Subjects for the study were derived from the data source, the 2003 National Health Interview Survey, a multistage probability survey that produced a U.S. representative sample of 29,783 adults capable of participating in strength training. The prevalence of strength training participation among adults was calculated, and a logistic regression equation was used to develop a multivariate model of factors that influence participation. Twenty-one percent of adults participated in strength training activities on at least 2 days of the week. In the regression, participation was associated with age, sex, ethnicity, marital status, level of education, and census region. The likelihood of participating in regular strength training activities was lower among older adults and women but higher with increasing levels of education and with participation in other aerobic type exercise. Strength training professionals should employ public health methodologies to promote continuation of this type of activity among those who were shown to participate regularly and to improve participation among those subgroups with lower levels of activity.

The persistence of gender and racial disparities in vascular lower extremity amputation: An examination of HCUP-NIS data (2002–2011)

Background Studies of peer-reviewed article publication by faculty in higher education show men publish more than women. Part of the difference in publishing appears to be attributable directly to gender. Gender differences in publishing productivity have not been explored in physical therapy. Objective The purpose of this study was to explore effects of gender on peer-reviewed publication productivity in physical therapy. Design This was a cross-sectional study using survey methods. Methods A survey was administered to a random sample of 881 physical therapy faculty members; 459 responses were used for analysis. Results Men were more likely than women to be married, have children, hold a PhD degree, be tenured or on a tenure track, and hold the position of department chair. There was a significant difference in peer-reviewed publication rates between male and female respondents. Negative binomial regression models revealed that female gender was a negative predictor of peer-reviewed publication, accounting for between 0.51 and 0.58 fewer articles per year for women than for men over the course of a career. Reasons for the gender differences are not clear. Limitations Factors such as grant funding, laboratory resources, nature of collaborative relationships, values for different elements of the teaching/research/service triad, and ability to negotiate the academic culture were not captured by our model. Conclusions The gender gap in peer-reviewed publishing productivity may have implications for individuals and the profession of physical therapy and should be subject to further exploration.

No short-term savings in health care expenditures for physically active adults.

Background Physical therapy practitioners are among the many health care professionals who can counsel their patients to address the public health care concern of physical inactivity. Health care providers who are physically active themselves are more likely to counsel patients on the benefits of activity. Objective The purposes of this study were: (1) to examine the leisure-time physical activity habits of physical therapists, physical therapist assistants, and student physical therapists in the United States using Centers for Disease Control and Prevention and American College of Sports Medicine (CDC-ACSM) recommendations and (2) to compare these habits with those of the general population and other health care professionals. Design A cross-sectional survey design was used. Methods There were 2 data sources. A random sample of American Physical Therapy Association members completed an online survey that included questions about physical activity habits worded in same manner as the leisure-time activities section of the 2005 National Health Interview Survey (NHIS). The final study sample comprised 1,238 participants: 923 physical therapists, 210 student physical therapists, and 105 physical therapist assistants. The 2005 NHIS public use data files were the source for the same information about the general US population and for a subset of health care professionals. Rates of participation in vigorous and moderate physical activity were analyzed. Results Physical therapists, physical therapist assistants, and student physical therapists exercised at higher rates than adults and health-diagnosing professionals in the 2005 NHIS. Limitations The study may be limited by sampling and response bias. Conclusions This study identified that physical therapists, physical therapist assistants, and student physical therapists are meeting CDC-ACSM physical activity guidelines at higher rates than the US adult population and health-diagnosing professionals. These rates exceed the physical activity targets set for adults in Healthy People 2010.

Sex Disparities in Level of Amputation

Background: Functional reach is a tool commonly used to assess an individuals risk for falls. On occasion, clinicians substitute the use of a target during functional reach for the original nontarget task. The purpose of this study was to compare target‐oriented and nontarget‐oriented functional reach scores among a sample of older adults at risk for falling. Methods: Sixty‐five volunteers (≥65 years) with an average nontarget‐oriented functional reach of less than 7 inches participated in this study. Three trials of nontarget‐oriented functional reach (FR) were performed using the standard method. An average of these trials was calculated. Subjects then performed the target‐oriented functional reach (TOFR) task. The TOFR task was repeated at increasing distances until the subject violated test conditions. A paired samples t‐test and Pearson correlation were used to compare average FR and final TOFR scores. Results: The FR scores (4.5 ± 2.0 inches) and TOFR scores (7.8 ± 2.2 inches) were significantly different (t64=‐15.2, p<.001) and moderately correlated (r=.65, p<.001). Conclusions: The findings of this study indicate that target‐and nontarget‐oriented functional reach scores of elders at risk for falls are different in magnitude but correlated. Consequently, the results of these two methods of testing are not interchangeable. They do, however, appear to be measuring balance as an underlying common construct.