Orthopedic surgeons and physical therapists differ regarding rehabilitative needs after lower extremity fracture repair

ABSTRACT

Background

Little evidence is available to guide physical therapy (PT) following lower extremity fracture repair distal to the hip. As such, variability has been reported in the way PT is utilized post-operatively. Examination of current practice by orthopedic surgeons (OS) and physical therapists is needed to inform clinical practice guidelines in this area.

Objective

To describe current PT referral practices among OS, identify patient and clinical factors that affect PT referral, and examine differences between OS and physical therapists with regard to visit frequency, duration, and use of specific PT interventions.

Methods

Provider surveys.

Results

Surveys were completed by 100 OS and 347 physical therapists. Over half (54%) of OS reported referring “most patients” to PT and identified joint stiffness and strength limitations as top reasons for PT referral. Over 80% of OS and physical therapists indicated that joint stiffness, strength limitations, and patients’ functional goals affected their recommendations for PT visit frequency. More physical therapists than OS reported that pain severity (55% vs 25%, p < .001), maladaptive pain behaviors (64% vs. 33%, p < .001), and patient self-efficacy (70% vs. 49%, p = .003) affected their visit frequency recommendations. While OS recommended more frequent PT for patients with peri-articular fractures, fracture type had minimal impact on the visit frequencies recommended by physical therapists.

Conclusion

OS and physical therapists consider similar physical impairments when determining the need for PT and visit frequencies, however, physical therapists consider pain and psychosocial factors more often, with OS focusing more on injury type.

KEYWORDS:

• Trauma
• practice analysis
• health services
• survey
• pain

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09593985.2022.2078753

Additional information

Funding

This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases [grant number T32 AR067708] and the Department of Defense [award number W81XWH-10-2-0090];