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The following is a summary of “Appropriateness of Prior Authorization Requirements for Total Shoulder Arthroplasty: A Systematic Review,” published in the September 2024 issue of Surgery by Banks et al.
Total shoulder arthroplasty (TSA) has emerged as a widely accepted intervention for glenohumeral osteoarthritis (GHOA), with an anticipated increase in procedural rates. This trend has significantly increased prior authorization (PA) requests for TSA, thereby imposing considerable administrative burdens on healthcare providers. Among the notable PA requirements is the stipulation for preoperative physical therapy (PT), a treatment modality for GHOA that lacks comprehensive empirical support and is not endorsed by the American Academy of Orthopedic Surgery (AAOS) as a requisite for treatment.
To investigate the efficacy of preoperative PT in this context, researchers conducted a systematic literature review adhering to PRISMA guidelines, focusing on studies with level IV evidence or higher that specifically addressed the effectiveness of preoperative PT for patients with GHOA. The search across databases, including PubMed, Embase, and Medline, yielded 210 studies, of which only three met the inclusion criteria. The review results were mixed; two of the three studies provided evidence in favor of preoperative PT, while only one study utilized a randomized controlled trial (RCT) design, highlighting a critical gap in high-quality research within this area.
The findings from their review indicate a scarcity of robust evidence supporting the routine application of preoperative PT in the management of GHOA, which starkly contrasts the current PA requirements necessitating such therapy for patients to qualify for coverage. This discrepancy underscores the urgent need for physician advocacy to challenge and reform these existing PA mandates, as they may not align with the best practices for patient care and could hinder timely access to necessary surgical interventions. Overall, this review serves as a call to action for healthcare providers to engage actively in advocacy efforts to revise PA protocols, thus ensuring that patient treatment pathways are based on sound clinical evidence rather than administrative requirements.
Source: sciencedirect.com/science/article/abs/pii/S1058274624006736
