The use of physical therapy for patients with pneumonia appears to be highly variable in US hospitals and is impacted by patient age, race, and comorbidities.

“There is a limited understanding of the provision of physical therapy (PT) services in hospitals, despite the fact that a large number of hospitalized patients receive PT and hospitals invest large amounts of money into PT staffing,” Joshua Johnson, PT, DPT, PhD, says. “We don’t know much about the types of patients who receive PT versus those that don’t, nor do we know much about the frequency of PT visits, the outcomes for patients who get PT versus those that don’t, or the costs of delivering those services.”

For a study published in The Journal of Hospital Medicine, Dr. Johnson and colleagues assessed whether the receipt of PT was associated with specific patient and hospital characteristics among a cohort with pneumonia. Emerging research indicates that PT improves physical function, discharge to home, and the risk for readmission, according to the study results. Among patients with pneumonia, in‐hospital PT is associated with reduced hospital length of stay, readmission, and mortality.

The researchers included administrative claims from 2010 to 2015 across 644 US hospitals. They reviewed associations between receiving at least one PT visit and patient characteristics, such as age, race, insurance, intensive care use, comorbidity status, and length of stay, as well as hospital characteristics, including academic status, rurality, size, and location. Exploratory measures included the timing and number of days with PT visits, as well as per‐visit and per‐admission costs, according to the study results.

PT Visits Vary By Age & Location

The analysis included 768,010 patients, most of whom were older than 60 (72.4%) and White (74.5%). A large percentage of patients were admitted through the ED (87.2%) and nearly three-quarters of the study population (71.1%) were insured by Medicare.

Nearly half of patients (49.1%) had PT. Patient characteristics independently associated with receipt of PT in both unadjusted and adjusted models included age, race, and comorbidity burden.

Following adjustment, older age most significantly increased the probability of PT—by an addition of 38% among patients older than 80 versus patients 50 or younger. Greater comorbidity burden, longer length of stay, and hospitalization in an urban location were also associated with a greater likelihood of receiving PT.

Conversely, being hospitalized in the South of the United States was associated with the most significant reduction in the likelihood of receiving PT—by a decrease of 9.1% compared with being hospitalized in the Midwest. Patients who were non-White and did not have Medicare also had a lower probability of receiving PT.

Overall, the median number of days until the first PT visit was 2, and the mean proportion of days with a visit was 35% (±20%). The median cost was $88.90 per visit and $224.00 per admission.

Future Research Needed to Determine Best Practices

The take-home message of the study results “is that the provision of PT services—and the costs for those services—for patients with pneumonia appears to be highly variable across US hospitals,” Dr. Johnson says.

He points to both the patient and hospital characteristics that were associated with a greater likelihood of receiving PT, such as being in an urban area, having a longer hospital stay, and higher comorbidity burden. “Not all of these are logical reasons for a patient to receive PT or not,” Dr. Johnson explains.

Anecdotal, real-world evidence shows that PT in patients with pneumonia may not always be clinically justified, he continues, and the study results provide some evidence to support such anecdotes. “While there is plenty of evidence that patients benefit from participation in PT interventions in the hospital, hospital leaders could take steps to better understand if the services provided within their own walls are consistent with existing evidence,” Dr. Johnson says. “When evidence doesn’t yet exist for specific patient populations, hospitals should identify best practices at a local level.”

A great deal of research is still needed, he continues. “We only examined patients with pneumonia, and we wonder if we would find something similar for other groups of patients. In general, these findings are merely the tip of the iceberg. Research is needed to illuminate current practices on utilization of PT interventions for hospitalized patients. We also need to better understand how, and for whom, PT interventions influence outcomes.”

Key Takeaways:

• Among patients with pneumonia, in‐hospital PT is associated with reduced hospital length of stay, readmission, and mortality
• However, the provision of PT services—and costs for those services—appears to be highly variable across US hospitals
• Further research is needed to better understand current practices for PT use for hospitalized patients