Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Factors Associated with the Use of Physical Therapy by People with Hip and Knee Osteoarthritis.
Jorge1, Renata T. B., Sayre4, Eric C., Kopec2, Jacek, Cibere2, Jolanda, Esdaile2, John M., Bar3, Sherry, Li2, Linda C.
Current guidelines recommend exercise as a first-line management for hip and knee osteoarthritis (OA). Physical therapists (PTs) are trained to prescribe exercise for managing arthritis; however, little is known about the factors associated with the use of physical therapy services by people with OA. This study aimed to assess factors associated with the use of physical therapy by people with hip and/or knee OA.
Eligible participants were those identified from a provincial administrative database between 1992 and 2006 as meeting the case definitions for OA, and had two or more medical visits or one hospitalization for OA within a 365-day period. We collected information on the WOMAC, use of healthcare service such as physical therapy in the past 12 months, and sociodemographics. Logistic regression was used to assess the factors associated with PT visits. Guided by the Andersen Model of Health Services Use, the dependent variables were grouped into predisposing characteristics (age, sex, body mass index), enabling factors (education, employment status, health authority region), and need factors (duration of diagnosis, number of comorbid conditions, estimated baseline WOMAC score). Because WOMAC was collected after the PT visits, we penalized the WOMAC scores of those who visited a PT by 15% (i.e., assuming that those who saw a PT improved by 15% after treatment). Sensitivity analyses were done by varying this assumption from 10 to 20%. Contribution of the enabling factors to PT visits was estimated by the difference of 100 minus the ratio of R2 of the reduced model (with predisposing and need factors only) versus the R2 of the full model.
1,349 participants completed the survey and reported having knee/hip OA (knee OA only=700; hip OA only=261; knee and hip OA=388). The mean age was 67.1 (SD=11.1), 816 (60.5%) were females, and 921 (68.3%) were diagnosed with OA 6 years ago or longer. They had an average of 1.8 (SD=1.5) comorbid conditions. 325 participants (24.1%) visited a PT in the past 12 months. Mean estimated baseline WOMAC score was 34.3 (SD=20.4). Higher education (OR=3.17, 95% CI=2.02, 4.97), living in the Fraser Health Authority (OR=0.62, 95% CI=0.40, 0.96) or Northern Health Authority (OR=0.46, 95% CI=0.29, 0.74), and having an estimated baseline WOMAC score >=50 vs. <=10 (OR=3.57, 95% CI=2.07, 6.16) were significant predictors for seeing a PT. Assuming physical therapy improved the WOMAC score by 15%, enabling factors accounted for 68.3% of the variance for seeing a PT that the full model accounted for. Sensitivity analyses indicated that this percentage ranged from 61.4% to 77.1%.
Enabling factors, rather than patients' needs, appeared to be the largest driver of the use of physical therapy by people with hip/knee OA. The findings indicated potential inequity in the use of physical therapy for the management of hip/knee OA.
To cite this abstract, please use the following information:
Jorge, Renata T. B., Sayre, Eric C., Kopec, Jacek, Cibere, Jolanda, Esdaile, John M., Bar, Sherry, et al; Factors Associated with the Use of Physical Therapy by People with Hip and Knee Osteoarthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2055