Article

OBJECTIVE: To examine the association between physical therapy (PT) amount and
type (eg, active exercise and passive modalities) received postmeniscectomy with
subsequent days of work disability. DESIGN: Historical prospective study.
SETTING: Workers' compensation administrative claims data source. PARTICIPANTS:
Patients (N=3888) with a new knee injury filed between January 1, 2001, and
December 31, 2003, who underwent meniscectomy within 6 months postinjury.
INTERVENTIONS: PT services received within 42 days postmeniscectomy. Patients
were divided into 9 groups based on PT service amount and type received during
the exposure period (no PT, only low active, only high active, only low passive,
only high passive, low active/low passive, high active/low passive, low
active/high passive, high active/high passive). MAIN OUTCOME MEASURE: Number of
disability days post-exposure period and truncated at the end of the 1.5-year
outcome period based on lost-time payments. RESULTS: During the exposure period,
32.5% received no PT services, 15.3% had only active, 1.5% had only passive, and
50.8% had a combination of both. After controlling for covariates (including
severity indicators and physical job demands), receipt of any passive services
was associated significantly with a greater number of disability days, and no
significant differences were found for those who received only active PT compared
with those receiving no PT. Severity indicators, including opioid use pre- and
postsurgery, more disability before surgery, and greater surgery severity, were
associated with more disability days, whereas physical job demands were not.
CONCLUSIONS: Our results suggest that passive PT services provided
postmeniscectomy may be counterproductive to work resumption. In addition,
disability duration was shorter or no different for those who received no PT
services than for those who received any type of PT services. With better control
of confounders in future studies, a beneficial effect of active PT might be
found. For the development of rehabilitation guidelines, randomized controlled
trials are needed to better understand the effectiveness of active and passive PT
services postmeniscectomy.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS