Article

Variation in referral rates for physical therapy exists at both the
individual physician and practice levels. The purpose of this study
was to explore the influence of physician and practice characteristics on
referral for physical therapy in patients with traumatic lower-extremity injury.
DESIGN: A cross-sectional survey was conducted. METHODS: In 2007, a Web-based
survey questionnaire was distributed to 474 surgeon members of the Orthopaedic
Trauma Association. The questionnaire measured physician and practice
characteristics, outcome expectations, and attitude toward physical therapy.
Referral for physical therapy was based on case vignettes. RESULTS: The response
rate was 58%. Surgeons reported that 57.6% of their patients would have a
positive outcome from physical therapy and 24.2% would have a negative outcome.
The highest physical therapy expectations were for the appropriate use of
assistive devices (80.7%) and improved strength (force-generating capacity)
(76.4%). The lowest outcome expectations were for improvements in pain (35.9%),
coping with the emotional aspects of disability (44.1%), and improvements in
workplace limitations (51.4%). Physicians reported that 32.6% of their patients
referred for physical therapy would have no improvement beyond what would occur
with a surgeon-directed home exercise program. Multivariate analyses showed
positive physician outcome expectations to have the largest effect on referral
for physical therapy (odds ratio=2.7, P<.001). CONCLUSIONS: The results suggest
that orthopedic trauma surgeons refer patients for physical therapy based mostly
on expectations for physical and motor outcomes, but may not be considering pain
relief, return to work, and psychosocial aspects of recovery. Furthermore, low
referral rates may be attributed to a preference for surgeon-directed home-based
rehabilitation. Future research should consider the efficacy of physical therapy
for pain, psychosocial and occupational outcomes, and exploring the differences
between supervised physical therapy and physician-directed home exercise programs.

Langue : ANGLAIS