Frequency of Physical Therapist Intervention Is Associated With Mobility Status and Disposition at Hospital Discharge for Patients With COVID-19.
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2021-01
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Abstract
Objective
For patients diagnosed with the novel coronavirus, COVID-19, evidence is needed to understand the effect of treatment by physical therapists in the acute hospital on patient outcomes. The primary aims of this study were to examine the relationship of physical therapy visit frequency and duration in the hospital with patients' mobility status at discharge and probability of discharging home.Methods
This retrospective study included patients with COVID-19 admitted to any of 11 hospitals in 1 health system. The primary outcome was mobility status at discharge, measured using the Activity Measure for Post-Acute Care 6-Clicks basic mobility (6-Clicks mobility) and the Johns Hopkins Highest Level of Mobility scales. Discharge to home versus to a facility was a secondary outcome. Associations between these outcomes and physical therapy visit frequency or mean duration were tested using multiple linear or modified Poisson regression. Potential moderation of these relationships by particular patient characteristics was examined using interaction terms in subsequent regression models.Results
For the 312 patients included, increased physical therapy visit frequency was associated with higher 6-Clicks mobility (b = 3.63; 95% CI, 1.54-5.71) and Johns Hopkins Highest Level of Mobility scores (b = 1.15; 95% CI, 0.37-1.93) at hospital discharge and with increased probability of discharging home (adjusted relative risk = 1.82; 95% CI, 1.25-2.63). Longer mean visit duration was also associated with improved mobility at discharge and the probability of discharging home, though the effects were less pronounced. Few moderation effects were observed.Conclusion
Patients with COVID-19 demonstrated improved mobility at hospital discharge and higher probability of discharging home with increased frequency and longer mean duration of physical therapy visits. These associations were not generally moderated by patient characteristics.Impact
Physical therapy should be an integral component of care for patients hospitalized due to COVID-19. Providing sufficient physical therapist interventions to improve outcomes must be balanced against protection from viral spread.Lay summary
Patients with COVID-19 can benefit from more frequent and longer physical therapy visits in the hospital.Type
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Johnson, Joshua K, Brittany Lapin, Karen Green and Mary Stilphen (2021). Frequency of Physical Therapist Intervention Is Associated With Mobility Status and Disposition at Hospital Discharge for Patients With COVID-19. Physical therapy, 101(1). p. pzaa181. 10.1093/ptj/pzaa181 Retrieved from https://hdl.handle.net/10161/30530.
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Joshua Kurt Johnson
As a physical therapist researcher, I seek to better understand and improve rehabilitation care delivery using the learning health system framework. This prompts overlap in my work between data science and implementation science. I have the opportunity to use various sources of health data and engage in multiple quantitative and qualitative research methods. My work also lends naturally to partnership with healthcare leaders and clinicians. To facilitate this work, I have several roles at Duke University. In the School of Medicine, I am an Assistant Professor in the Division of Physical Therapy, Department of Orthopaedic Surgery, and Department of Population Health Sciences. I am also the Clinical Research Lead for the Duke University Health System Department of Rehabilitation and a member of the Duke Clinical Research Institute. Prior to joining the faculty at Duke, I was the Director of PM&R Outcomes Research at Cleveland Clinic. My PhD training was at the University of Utah. I hold a Doctor of Physical Therapy degree from Arcadia University and Bachelors degree in Athletic Training from Brigham Young University.
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