Fresh Articles: Week of 3/17/25

First, a few "YouTube shorts” cut from Episode Six, which we filmed today!

Articles being reviewed this week on my Linked In, shared here first for our subscribers!

Monday 3/17

Factors Associated With Physical Therapy Attendance Rate and Self-Discharge in People With Chronic Pain (Balinski et al., 2024)

Background & Importance

• Chronic pain affects an estimated 40% of U.S. adults and is linked with increased healthcare costs, impaired mobility, and lower productivity.

• Physical therapy (PT) is a frontline, cost-effective treatment for chronic pain—reducing reliance on opioids and expensive medical services.

Study Design & Methods

• Retrospective chart review combined with a survey of evaluating physical therapists.

• Conducted in an urban academic hospital–based outpatient orthopedic PT clinic.

• Sample included 200 patients with chronic low back and/or knee pain and 23 physical therapists.

• Used Poisson regression to analyze PT attendance rates and logistic regression to examine self-discharge factors.

Key Findings

• Attendance & Self-Discharge Rates: Average PT attendance rate was 73%, with a self-discharge rate of 55%.

• Factors Associated with Attendance Rate:

  • Therapist Comfort Level: Higher comfort with treating chronic pain was linked to a 5% decrease in attendance rate for every 1-point increase.

  • Duration of Episode of Care: Longer care episodes slightly increased attendance (0.2% increase per additional day).

• Factors Associated with Self-Discharge:

  • Number of Completed Visits: Reduced the odds of self-discharge by 9% per visit.

  • Patient No-Show Rate: Increased the odds of self-discharge.

  • Therapist Comfort Level: Higher comfort level was associated with a 60% increase in the odds of self-discharge.

Discussion & Implications

• Paradoxical Role of Therapist Comfort: Comfort in treating chronic pain may not cover all aspects of patient management (e.g., psychosocial factors, patient education).

• Clinical Implications: Identifying patient-specific barriers early may improve adherence and reduce healthcare costs.

• Limitations: Findings are specific to a single urban academic setting.

Tuesday 3/18

Associations Between Physical Therapy Continuity of Care and Health Care Utilization and Costs in Patients With Low Back Pain: A Retrospective Cohort Study (Magel et al., 2018)

Background & Importance

• Low back pain (LBP) is one of the most costly conditions in the U.S.

• Continuity of care with the same physical therapist may impact patient outcomes and costs.

Objective

• Examine how continuity with a PT provider influences health care utilization and costs over a 1-year period.

Study Design & Methods

• Retrospective cohort study using Utah’s All Payer Claims Database.

• Patients aged 18–64 with a new LBP consultation, referred to PT within 30 days.

• Independent Variable: PT provider continuity (measured by a continuity index).

• Outcomes Assessed: Advanced imaging, emergency visits, epidural injections, lumbar surgery, and total LBP-related healthcare costs.

Key Findings

• High Provider Continuity: Associated with a lower likelihood of lumbar surgery (OR: 0.49) and lower healthcare costs ($1737 vs. $2577, p < .001).

• No significant associations with advanced imaging, epidural injections, or emergency visits.

Discussion & Implications

• Continuity Benefits: Reduced surgical interventions and overall costs.

• Cost Implications: Improving continuity could lower healthcare costs.

• Limitations: Retrospective nature limits causality; no data on pain levels, function, or practice-level factors.

Wednesday 3/19

Increasing Demand vs. Limited Supply

Key Points

• Growing shortage of physical therapists due to an aging population, higher chronic condition rates, and increased rehabilitation demand.

• Rural areas and some Southern and Midwestern states are particularly underserved.

• Contributing issues include fewer new graduates, uneven distribution, and rising retirement rates.

• Suggestion: Policymakers and organizations need targeted recruitment and retention strategies.
  (Source: Vivian – "What States Need Physical Therapists the Most?" https://www.vivian.com/community/allied-health/what-states-need-physical-therapists-the-most/)

Thursday 3/20

Patient Attitudes and Beliefs Associated with Self-Referral to Physical Therapy for Musculoskeletal Complaints: A Qualitative Study (Alshareef et al., 2023)

Background & Importance

• Non-pharmacologic treatments like PT are recommended for managing musculoskeletal pain to reduce opioid use and improve outcomes.

• Self-referral to PT allows direct access without prior physician consultation.

• Utilization of self-referral is estimated at around 6% in privately insured populations.

Objective

• Identify factors influencing patients' decisions to access PT through self-referral versus provider referral.

Methods

• Qualitative study using semi-structured interviews of 32 healthcare workers with musculoskeletal complaints.

• Setting: Large, self-funded employer with financial incentives for self-referral.

• Analysis: Grounded theory approach with open coding.

Key Findings

• Self-Referral Pathway: Awareness of reduced copay, positive past experiences, openness to alternative therapies.

• Provider Referral Pathway: Lack of awareness, preference for physician diagnosis, and belief that PT may not address underlying issues.

Discussion & Implications

• There is a knowledge gap regarding the process of self-referral.

• Promoting awareness and understanding could increase utilization and enhance patient outcomes.

Friday 3/21

“Return on Investment in Physical Therapy: Professional Tension” by Ambler, Jette, and Nordstrom:
Student debt in physical therapy has become a significant concern, prompting action from professional organizations like the American Physical Therapy Association (APTA). Recent studies have shown that high student debt can negatively impact the economic ROI of a physical therapy degree. The article argues for a holistic approach to understanding ROI that goes beyond simple economic factors. Key points include:

• Economic Factors: Lower earning potential compared to other doctoral health professionals when debt load exceeds $150,000.

• Non-Economic Factors: Intrinsic rewards such as work enjoyment, helping others, and continuous learning play a significant role in career satisfaction.

• Balancing Factors: Personal philosophy about debt and the appeal of the profession may outweigh economic considerations for some individuals.

• Implications: Understanding ROI from both individual and systemic perspectives is crucial for the profession’s future. Collaboration in research and advocacy is necessary to improve healthcare in the U.S.

In conclusion, the authors emphasize the importance of researching how economic and non-economic factors interact to influence career choices and workforce retention.