Article

Investigating determinants of physical therapy workload in the acute
care setting is essential for planning interventions, for justifying resource
allocation, and for reimbursement. The objective of this study was to
examine whether International Classification of Functioning, Disability and
Health (ICF) intervention goals (ICF categories representing goals of physical
therapy interventions typical for an acute care hospital) could predict physical
therapy workload in the acute care hospital setting. DESIGN: This investigation
was a multicenter, observational cohort study. METHODS: Patients were recruited
from a representative sample of 32 acute care hospitals across Switzerland if
they received physical therapy during their inpatient stay for the treatment of
any injury or disease in 1 of 3 main diagnostic categories: musculoskeletal,
neurological, and cardiopulmonary conditions. Physical therapists completed
questionnaires at the time of the patients' discharge to report on ICF
intervention goals. Information on workload was collected retrospectively from
hospital documentation systems. Multivariable regression models were used to
identify the intervention goals independently associated with workload. RESULTS:
The mean workload for 642 patients (mean age=61 years [SD=18 years], 45% women)
was 370 minutes. The daily workload for interventions ranged from 33 minutes
(cardiopulmonary conditions) to 49 minutes (neurological conditions). There were
significant variations in workload across hospital sites and medical disciplines.
The goal "maintaining a body position" emerged as a significant indicator of a
higher workload for all condition groups; the goals "attention functions" and
"transferring oneself" were indicators for neurological and musculoskeletal
conditions, respectively. LIMITATIONS: Not all potential predictors of workload
could be examined. Other, person- or setting-specific variables might have been
relevant to workload. Case mix and clinical practice were representative only for
Swiss hospitals. CONCLUSIONS: A small set of intervention goals were the major
factors influencing physical therapy workload, independent of diagnosis or
clinical specialty. Describing variability in physical therapists' practices in
the acute care setting and relating these data to relevant patient-centered
outcomes are the initial steps for improving resource allocation and
reimbursement for interventions that maintain or improve functioning.

Langue : ANGLAIS