Session Title: Healthcare Disparities in Rheumatology - ARHP Poster
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Although physical therapy (PT) is recommended for managing symptomatic knee osteoarthritis (sxKOA), little is known about correlates of PT utilization among adults with sxKOA. This study aimed to: (1) describe the prevalence of PT utilization among adults with sxKOA enrolled in an exercise trial and (2) identify sociodemographic and clinical correlates of PT utilization for sxKOA.
Methods : This cross-sectional study is a secondary analysis of data from a randomized controlled trial (RCT) of 350 adults (aged >=18 years) with physician-diagnosed sxKOA (median WOMAC pain=5, range=0-20, and median WOMAC function=22.5, range =0-68) recruited from a large tertiary medical center and an ongoing prospective cohort study. Patients completed baseline demographic and medical history questions and whether they had utilized PT to manage sxKOA (yes/no). Logistic regression was used to develop a parsimonious set of correlates of PT utilization, with all models adjusted for body mass index and age. We evaluated all race by predictor and gender by predictor pairwise interactions.
Results : Of 350 patients, 249 (74%) were Caucasian, 72% female, 50% obese or very obese, mean age was 62.5 years (SD=11.3). The median duration of KOA symptoms was 10 years (<1 to 65). 147(42%) had received a knee joint injection, 175 (50%) had a prior knee injury, and 182 (52%) reported PT utilization for their KOA. Factors independently associated with increased odds of PT utilization were: female gender, having a college education, history of a knee injury, duration of KOA symptoms, and having family members with KOA. Individuals who were Caucasian and had received a joint injection were 3.69 times more likely to have utilized PT; this relationship did not exist for non-Caucasians (Table 1). Employment tended to be associated with a reduced likelihood of PT utilization.
Conclusion : Of persons with sxKOA that enrolled in an exercise intervention, roughly half reported prior PT utilization. Demographic and clinical features were associated with PT utilization for adults with sxKOA; strongest correlates were female gender, higher education, and longer duration of KOA symptoms. Differences by race in the link between joint injection and PT may reflect a reduced likelihood of health interventions for sxKOA among non-Caucasians. More research is needed to facilitate PT utilization among adults with sxKOA, especially men and those with lower educational attainment. Limitations of this study include the use of a convenience sample enrolled in an RCT, the potential for misclassification of PT utilization due to self-report and inability to determine whether lack of utilization was due to clinicians not offering PT or patients not attending PT. Diverse characteristics of the sample allowed for evaluation of PT utilization by race.
|Table 1. Correlates of Physical Therapy Service Use for Managing Knee Osteoarthritis from Multivariable Logistic Regression (n=348)|
Model c statistic = 0.74
|Have received a joint injection Caucasian||3.69||1.94 – 7.01||<0.0001|
|Non-Caucasian||1.18||0.44 – 3.18||0.748|
|Female||3.06||1.58 – 5.93||0.001|
|College educated||2.44||1.15 – 5.16||0.020|
|Having at least 1 Family Member with KOA||1.64||0.95 – 2.87||0.07|
|History of Knee Injury||1.86||1.08 – 3.19||0.025|
|Duration KOA symptoms, years > 5 to 10 > 10 Referent < 1 to 5||2.16 2.11||1.09 – 4.29 1.1 – 4.04||0.02 0.025|
* P-value for interaction 0.058*
To cite this abstract in AMA style:Iversen MD, Schwartz TA, Callahan LF, Golightly YM, Goode AP, Hill C, Huffman K, Pathak A, Allen K. Sociodemographic and Clinical Correlates of Physical Therapy Utilization in Adults with Symptomatic Knee Osteoarthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/sociodemographic-and-clinical-correlates-of-physical-therapy-utilization-in-adults-with-symptomatic-knee-osteoarthritis/. Accessed March 25, 2019.
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