- Title
- The influence of physical therapy use on outcomes for musculoskeletal disorders of the lower extremity
- Creator
- Young, Jodi
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Physical therapy, including exercise therapy, is a core recommendation for many individuals with musculoskeletal disorders. Despite this, there is limited evidence for optimal dosing for individuals, specifically in lower extremity disorders. Receiving the optimal dose of physical therapy, and exercise therapy, may maximize patient outcomes and reduce downstream healthcare utilization (HCU), costs, and recurrence rates. In order to provide efficient and effective care to individuals with lower extremity disorders, determining the most appropriate dosing is necessary. Purpose: The aims of this thesis were to investigate 1) how specific dosing parameters of exercise therapy were associated with pain and functional outcomes in the lower extremity (knee and foot/ankle); 2) the type and timing of interventions, including physical therapy and exercise therapy, for individuals with PFP and how exercise therapy is associated with the recurrence of knee pain; 3) how the use of radiographic imaging for the knee is related to the timing of physical therapy in individuals with PFP and recurrences of knee pain, and; 4) the association between timing of physical therapy for individuals with PFP and downstream HCU and costs and recurrence rates. Methods: Two systematic reviews including studies from 2005-2016 determined the relationship between particular exercise therapy dosing variables and pain and functional outcomes (using overall effect sizes) in individuals with lower extremity (knee and foot/ankle) musculoskeletal disorders. Dosing variables included (1) single session duration which was defined as the length of time for one exercise session; (2) frequency which was defined as how often the patient performed exercise; (3) the total number of exercise sessions which was how many sessions an individual took part in over the course of the study; and (4) duration of care which was defined as the total number of weeks an individual performed exercise. Data from the electronic medical records and claims data collected from 2009-2013 from a larger cohort (n=74,408) and a smaller subset (n=23,332) of the larger cohort of individuals in the United States Military Health System diagnosed with PFP were studied. Descriptive statistics, including means, standard deviations and frequencies, were used to describe the cohort and interventions received by individuals in the studies, risk statistics including odds ratios, were used to describe relationships between grouping variables being studied, and generalized linear model analyses, including negative binomial and binary logit regression, were used to identify associations between specific grouping variables. Results: The main findings of the systematic reviews of individuals being treated for knee and foot/ankle diagnoses were that (1) 24 total exercise therapy sessions and 8 and 12 week durations of care were associated with large effect sizes for improving pain and/or function in knee osteoarthritis; (2) when sets and repetitions were performed to tolerance in patients with Achilles tendinopathy, there was a large effect on pain and function; and (3) in individuals with plantar heel pain, a daily home exercise program was associated with large effect sizes for pain and function. In the cohort of 74,408 individuals in the United States Military Health System diagnosed with PFP, most individuals (n=46,338; 62.3%) did not receive additional care after the initial PFP diagnosis. Physical therapists were the most common specialty provider when care was received. Exercise therapy was the most common non-pharmacological intervention used, and there was a lower odds of recurrence (additional episode(s) of care) if six or more total visits of exercise therapy occurred in the initial episode of care. Another management strategy, knee radiographs, were provided to a large number of individuals in the first seven days after diagnosis and in the two year time frame after diagnosis. When investigating the timing of the radiographs in those who were already referred to physical therapy (n=23,332), the odds of initiating physical therapy within 30 days were lower, the odds of a recurrence of knee pain were higher, and the mean days from diagnosis to initiation of physical therapy were lower if individuals received a radiograph. In the original cohort of 74,408 individuals, the odds of receiving downstream healthcare utilization, recurrence rates were all lowest in those who saw a physical therapist as the initial contact provider (physical therapy first) when compared to early physical therapy (1-30 days after diagnosis) and delayed physical therapy (30-90 days after diagnosis). Knee-related costs were also lowest in the physical therapy first group. Conclusions: While optimal dosing parameters for individuals with lower extremity diagnoses remain generally unknown, this thesis provides evidence that larger doses of exercise therapy are associated with fewer recurrences of knee pain, early knee radiograph use may be related to a delay in the timing of physical therapy and are associated with more recurrences of knee pain, and seeing a physical therapist as the initial contact provider is associated with lower odds of downstream healthcare utilization and recurrences of knee pain, and decreases overall knee-related costs. Clinicians and researchers can integrate these findings when developing intervention plans and future research studies.
- Subject
- physical therapy; musculoskeletal disorders; dosing parameters; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1504945
- Identifier
- uon:55600
- Rights
- Copyright 2022 Jodi Young
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 9 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 2 MB | Adobe Acrobat PDF | View Details Download |