A retrospective design was employed to determine what factors are predictive of achieving a successful outcome for individuals with knee osteoarthritis following an episode of physical therapy. Success was defined as achieving the minimum clinically important difference with the change in the lower extremity functional scale (LEFS). Receiving guideline adherent care was hypothesized to increase odds of success. Data for treatment interventions, health care utilization, patient characteristics, and LEFS scores were collected from electronic health records from 2014–2018 across 34 outpatient clinics. The sample (N = 706) was primarily female, White, and older adults. Receiving guideline adherent care did not predict odds of achieving success. Patient age, initial LEFS score, opioid prescription, number of visits, and Medicare/Medicaid insurance were predictive of the outcome. Increasing age after 65 years predicted decreased odds of success. Older adults showed improved odds with an opioid prescription and with increased number of visits from two through 18 therapy sessions. Opportunities exist for further health services research on optimal management of knee OA, including underutilization of physical therapy (only 6% in this study), measuring adherence to CPGs, determining recommended intensity for interventions, and the effects of non-physical therapy interventions such as opioid use on outcomes.
AhnA.FerrerC.ParkC.SnyderD. J.MaronS. Z.MikhailC.KeswaniA.MolloyI. B.BronsonM. J.MoschettiW. E.JevsevarD. S.PoeranJ.GalatzL. M.MouchaC. S. (2019). Defining and optimizing value in total joint arthroplasty from the patient, payer, and provider perspectives. The Journal of Arthroplasty, 34(10), 2290–2296.
2.
AlcockG. K.WerstineM. S.RobbinsS. M.StratfordP. W. (2012). Longitudinal changes in the Lower Extremity Functional Scale after anterior cruciate ligament reconstructive surgery. Clinical Journal of Sport Medicine, 22(3), 234–239.
3.
ALMohizaM. A.SpartoP. J.MarchettiG. F.DelittoA.FurmanJ. M.MillerD. L.WhitneyS. L. (2016). A quality improvement project in balance and vestibular rehabilitation and its effect on clinical outcomes. Journal of Neurologic Physical Therapy, 40(2), 90–99. https://doi.org/10.1097/NPT.0000000000000125
4.
American Academy of Orthopaedic Surgeons. (2013). Treatment of osteoarthritis of the knee: Evidence-based guideline (2nd ed.). Journal of the American Academy of Orthopaedic Surgeons. https://journals.lww.com/jaaos/pages/default.aspx
BekkeringG. E.Van TulderM. W.HendriksE. J.KoopmanschapM. A.KnolD. L.BouterL. M.OostendorpR. A. (2005). Implementation of clinical guidelines on physical therapy for patients with low back pain: Randomized trial comparing patient outcomes after a standard and active implementation strategy. Physical Therapy, 85(6), 544–555. https://doi.org/10.1093/ptj/85.6.544
8.
BennellK. L.HinmanR. S.MetcalfB. R.CrossleyK. M.BuchbinderR.SmithM.McCollG. (2003). Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis. Journal of Orthopaedic Research, 21(5), 792–797.
9.
BinkleyJ. M.StratfordP. W.LottS. A.RiddleD. L. (1999). The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application. Physical Therapy, 79(4), 371–383.
10.
BoydC. M.DarerJ.BoultC.FriedL. P.BoultL.WuA. W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. The Journal of the American Medical Association, 294(6), 716–724.
11.
BoydC.SmithC. D.MasoudiF. A.BlaumC. S.DodsonJ. A.GreenA. R.KelleyA.MatlockD.OuelletJ.RichM. W.SchoenbornN. L.TinettiM. E. (2019). Decision making for older adults with multiple chronic conditions: Executive summary for the American Geriatrics Society guiding principles on the care of older adults with multimorbidity. Journal of the American Geriatrics Society, 67(4), 665–673.
CherkinD.DeyoR. A.BergA. O. (1991). Evaluation of a physician education intervention to improve primary care for low-back pain II: Impact on patients. Spine, 16(10), 1173–1178.
15.
de OliveiraD. C. S.BarbozaS. D.da CostaF. D.CabralM. P.SilvaV. M. P.DionisioV. C. (2014). Can pain influence the proprioception and the motor behavior in subjects with mild and moderate knee osteoarthritis?BMC Musculoskeletal Disorders, 15(321), 1–8.
16.
DeHaanM. N.GuzmanJ.BayleyM. T.BellM. J. (2007). Knee osteoarthritis clinical practice guidelines—How are we doing?The Journal of Rheumatology, 34(10), 2099–2105.
17.
DhawanA.MatherR. C.KarasV.EllmanM. B.YoungB. B.BachB. R.ColeB. J. (2014). Original article: An epidemiologic analysis of clinical practice guidelines for non-arthroplasty treatment of osteoarthritis of the knee. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 30, 65–71. https://doi.org/10.1016/j.arthro.2013.09.002
18.
DowellD.HaegerichT. M.ChouR. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. Morbidity and Mortality Weekly Report, 65(No. RR-1), 1–49. https://doi.org/10.15585/mmwr.rr6501e1
19.
FairbankJ. C.PynsentP. B. (2000). The Oswestry disability index. Spine, 25(22), 2940–2953.
20.
FritzJ. M.ClelandJ. A.BrennanG. P. (2007). Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists?Medical Care, 45(10), 973–980.
21.
GozaloP. L.ResnikL. J.SilverB. (2016). Benchmarking outpatient rehabilitation clinics using functional status outcomes. Health Services Research, 2. https://doi.org/10.1111/1475-6773.12344
22.
HornM. E.BrennanG. P.GeorgeS. Z.HarmanJ. S.BishopM. D. (2016). Clinical outcomes, utilization, and charges in persons with neck pain receiving guideline adherent physical therapy. Evaluation & the Health Professions, 39(4), 421–434. https://doi.org/10.1177/0163278715583510
23.
IversenM. D.SchwartzT. A.von HeidekenJ.CallahanL. F.GolightlyY. M.GoodeA.HillC.HuffmanK.PathakA.CookeJ.AllenK. D. (2018). Sociodemographic and clinical correlates of physical therapy utilization in adults with symptomatic knee osteoarthritis. Physical Therapy, 98(8), 670–678. https://doi.org/10.1093/ptj/pzy052
24.
JevsevarD. S. (2013). Treatment of osteoarthritis of the knee: Evidence-based guideline (2nd ed.), JAAOS—Journal of the American Academy of Orthopaedic Surgeons, 21(9), 571–576. https://doi.org/10.5435/jaaos-21-09-571
25.
KarlenE.McCathieB. (2015). Implementation of a quality improvement process aimed to deliver higher-value physical therapy for patients with low back pain: Case report. Physical Therapy, 95(12), 1712–1721. https://doi.org/10.2522/ptj.20150035
26.
KennedyD. M.StratfordP. W.RiddleD. L.HannaS. E.GollishJ. D. (2008). Assessing recovery and establishing prognosis following total knee arthroplasty. Physical Therapy, 88(1), 22–32. https://doi.org/10.2522/ptj.20070051
27.
LeechR. D.EylesJ.BattM. E.HunterD. J. (2018). Lower extremity osteoarthritis: Optimising musculoskeletal health is a growing global concern: a narrative review. British Journal of Sports Medicine, 53(13), 806–811. https://doi.org/10.1136/bjsports-2017-098051
28.
LixL. M.SmithM.PitzM.AhmedR.QuonH.GriffithJ.TurnerD.HongS.PriorH.BanerjeeA.KosevaI.KulbabaC. (2016). Cancer data linkage in Manitoba: Expanding the infrastructure for research. Manitoba Centre for Health Policy, College of Medicine, Faculty of Health Sciences, University of Manitoba.
29.
MacLeanC. (2017). Value-based purchasing for osteoarthritis and total knee arthroplasty: What role for patient-reported outcomes?Journal of the American Academy of Orthopaedic Surgeons, 25, S55–S59. https://doi.org/10.5435/JAAOS-D-16-00638
30.
MehtaS. P.FultonA.QuachC.ThistleM.ToledoC.EvansN. A. (2016). Measurement properties of the lower extremity functional scale: A systematic review. The Journal of Orthopaedic and Sports Physical Therapy, 46(3), 200–216. https://doi.org/10.2519/jospt.2016.6165
31.
MeiyappanK. P.CoteM. P.BozicK. J.HalawiM. J. (2019). Adherence to the American Academy of Orthopaedic Surgeons clinical practice guidelines for nonoperative management of knee osteoarthritis. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2019.08.051
32.
National Guideline Clearinghouse. (2014). Guideline summary: Osteoarthritis care and management in adults. Agency for Health Care Research and Quality (AHRQ). https://www.guideline.gov
33.
QuanH.LiB.CourisC. M.FushimiK.GrahamP.HiderP.JanuelJ. M.SundararajanV. (2011). Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American Journal of Epidemiology, 173(6), 676–682.
34.
RundellS. D.GoodeA. P.FriedlyJ. L.JarvikJ. G.SullivanS. D.BresnahanB. W. (2015). Role of health services research in producing high-value rehabilitation care. Physical Therapy, 95(12), 1703–1711. https://doi.org/10.2522/ptj.20150033
35.
RundellS. D.ResnikL.HeagertyP. J.KumarA.JarvikJ. G. (2020). Comparing the performance of comorbidity indices in predicting functional status, health-related quality of life, and total health care use in older adults with back pain. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 143–148.
36.
SharabianiM. T.AylinP.BottleA. (2012). Systematic review of comorbidity indices for administrative data. Medical Care, 50(12), 1109–1118.
37.
StevansJ. M.BiseC. G.McGeeJ. C.MillerD. L.RockarP.JrDelittoA.. (2015). Evidence-based practice implementation: case report of the evolution of a quality improvement program in a multicenter physical therapy organization. Physical Therapy, 95(4), 588–599. https://doi.org/10.2522/ptj.20130541
38.
StratfordP. W.BinkleyJ. M.WatsonJ.Heath-JonesT. (2000). Feature articles—Validation of the LEFS on patients with total joint arthroplasty. Physiotherapy Canada, 52(2), 97–105.
39.
StratfordP. W.KennedyD. M. (2006). Performance measures were necessary to obtain a complete picture of osteoarthritic patients. Journal of Clinical Epidemiology, 59(2), 160–167.
40.
TabachnickB. G.FidellL. S. (2006). Using multivariate statistics. (5th ed.). Allyn & Bacon.
41.
Tasci BozbasG.SendurO. F.AydemirA. H. (2017). Primary knee osteoarthritis increases the risk of falling. Journal of Back and Musculoskeletal Rehabilitation, 30(4), 785–789. https://doi.org/10.3233/BMR-150413
VernonH.MiorS. (1991). The Neck Disability Index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics. 14(7), 409–415.
44.
WestbyM.KlemmA.LiL.JonesA. (2016). Emerging role of quality indicators in physical therapist practice and health service delivery. Physical Therapy, 96(1), 90–100. https://doi.org/10.2522/ptj.20150106
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