Article

Although physical therapy is a proven and recommended intervention
for managing rheumatoid arthritis (RA), few studies have explored correlates of
physical therapy service use among people with RA.
The purposes of
this study were: (1) to describe physical therapy use among people with RA and
(2) to identify biopsychosocial factors associated with physical therapy use. It
was expected that use of physical therapy services would be lower than previously
reported, considering recent medical advancements, and that including contextual
factors may lead to identification of new factors associated with physical
therapy use. DESIGN: This was a cohort study.
METHODS: Of 1,032 patients
prospectively recruited from a large hospital registry, 772 completed baseline
and laboratory assessments, received a physical examination, and completed a
1-year follow-up survey regarding physical therapy service use. Measures
included: demographics (ie, age, sex, marital status, race, employment,
disability status, insurance, income, comorbidities, and education), disease
duration, RA medications, self-efficacy (assessed with the Arthritis
Self-Efficacy Scale), social support (assessed with the Berkman-Syme Social
Network Index), function (assessed with the Multi-Dimensional Health Assessment
Questionnaire), and disease activity (assessed with the Rheumatoid Arthritis
Disease Activity Index). Self-reported use of physical therapy (yes/no) was
assessed at the 1-year follow-up. A staged regression approach, based on a
theoretical model, was used to select and enter variables into the regression to
develop a parsimonious set of predictors. RESULTS: The patients were well
educated and had modestly high incomes, and most had health insurance.
Approximately 15.3% of the patients used physical therapy services during the
designated follow-up period. Using multivariable modeling, the most significant
predictors of physical therapy service use were moderate to high disease activity
(odds ratio [OR]=1.4, 95% confidence interval [CI]=1.1-1.8), less than a college
education (OR=0.5, 95% CI=0.2-0.8), greater social networks (OR=2.1, 95%
CI=1.3-3.5), and being on disability (OR=2.4, 95% CI=1.3-4.6). LIMITATIONS: The
limitations of this study were use of a convenience sample and the potential for
misclassification of physical therapy service use. CONCLUSIONS: Patients with
less than college education were less likely to receive physical therapy
services, and those with more active disease, those who were on disability, and
those who had greater social networks were more likely to receive physical
therapy services.

Langue : ANGLAIS