ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1262

Sociodemographic and Clinical Correlates of Physical Therapy Utilization in Adults with Symptomatic Knee Osteoarthritis

Maura D. Iversen1,2, Todd A. Schwartz3, Leigh F. Callahan4, Yvonne M. Golightly5, Adam P. Goode6, Carla Hill7, Kim Huffman8, Ami Pathak9 and Kelli Allen10, 1Northeastern University, Department of Physical Therapy, and Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 2Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, 3Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, 4Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, 5Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 6O, Duke University, Durham, NC, 7University of North Carolina at Chapel Hill, Chapel Hill, NC, 8School of Medicine, Division of Rheumatology, Immunology and Molecular Physiology and Durham VA Medical Center, Duke University, Durham, NC, 9Comprehensive Physical Therapy, Chapel Hill, NC, 10University of North Carolina at Chapel Hill and Durham VA Medical Center, Chapel Hill, NC

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Monday, November 14, 2016

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

Explanatory variable

Odds Ratio

95%CI

p-value

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
Employed 0.58 0.36– 1.00 0.0502
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*

Disclosure: M. D. Iversen, None; T. A. Schwartz, None; L. F. Callahan, None; Y. M. Golightly, None; A. P. Goode, None; C. Hill, None; K. Huffman, None; A. Pathak, None; K. Allen, None.

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 .

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