Outpatient Physical Therapy Use Following Tibial Fractures: A Retrospective Commercial Claims Analysis (2022)

Abstract

Objective. The purpose of this study was to characterize outpatient physical therapy (OPT) use following tibial fractures and examine the variability of OPT attendance, time of initiation, number of visits, and length of care by patient, injury, and treatment factors. In the absence of clinical guidelines, results will guide future efforts to optimize OPT following tibial fractures. Methods. This study used 2016 to 2017 claims from the IBM MarketScan Commercial Claims Research Database. The cohort included 9079 patients with International Classification of Diseases: Tenth Revision (ICD-10) diagnosis codes for tibial fractures. Use in the year following initial fracturemanagement was determined using Current Procedural Terminology codes. Differences in use were examined using ?2 tests, t tests, and Kruskal-Wallace tests. Results. Sixty-seven percent of patients received OPT the year following fracture. OPT attendance was higher in female patients, in patients with 1 or no major comorbidity, and in the western United States. Attendance was higher in patients with upper tibial fractures, moderate-severity injuries, and treatment with external fixation and in patients discharged to an inpatient rehabilitation facility. Patients started OPT on average [SD] 50 [52.6] days after fracture and attended 18 [16.1] visits over the course of 101 [86.4] days. The timing of OPT, the number of visits attended, and the length of OPT care varied by patient, injury, and treatment-level factors. Conclusions. One-third of insured patients do not receive OPT following tibial fracture. The timing of OPT initiation, the length of OPT care, and the number of visits attended by patients with tibial fractures were highly variable. Further research is needed to standardize referral and prescription practices for OPT following tibial fractures. Impact. OPT use varies based on patient, injury, and treatment-level factors following tibial fractures. Results from this study can be used to inform future efforts to optimize rehabilitation care for patients with tibial fractures.

Original languageEnglish (US)
Article numberpzab034
JournalPhysical therapy
Volume101
Issue number5
DOIs
StatePublished - May 1 2021

Keywords

  • Claims Analysis
  • Fractures
  • Orthopedics
  • Trauma

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

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McLaughlin, K. H., Reider, L. M., Castillo, R. C., Ficke, J. R. (2021). Outpatient Physical Therapy Use Following Tibial Fractures: A Retrospective Commercial Claims Analysis. Physical therapy, 101(5), [pzab034]. https://doi.org/10.1093/ptj/pzab034

Outpatient Physical Therapy Use Following Tibial Fractures : A Retrospective Commercial Claims Analysis. / McLaughlin, Kevin H.; Reider, Lisa M.; Castillo, Renan C. et al.

In: Physical therapy, Vol. 101, No. 5, pzab034, 01.05.2021.

Research output: Contribution to journalArticlepeer-review

McLaughlin, KH, Reider, LM, Castillo, RC, Ficke, JR 2021, 'Outpatient Physical Therapy Use Following Tibial Fractures: A Retrospective Commercial Claims Analysis', Physical therapy, vol. 101, no. 5, pzab034. https://doi.org/10.1093/ptj/pzab034

(Video) Balancing AO Principles in Calcaneus Fractures

McLaughlin KH, Reider LM, Castillo RC, Ficke JR, Levy JF. Outpatient Physical Therapy Use Following Tibial Fractures: A Retrospective Commercial Claims Analysis. Physical therapy. 2021 May 1;101(5). pzab034. https://doi.org/10.1093/ptj/pzab034

McLaughlin, Kevin H. ; Reider, Lisa M. ; Castillo, Renan C. et al. / Outpatient Physical Therapy Use Following Tibial Fractures : A Retrospective Commercial Claims Analysis. In: Physical therapy. 2021 ; Vol. 101, No. 5.

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title = "Outpatient Physical Therapy Use Following Tibial Fractures: A Retrospective Commercial Claims Analysis",

abstract = "Objective. The purpose of this study was to characterize outpatient physical therapy (OPT) use following tibial fractures and examine the variability of OPT attendance, time of initiation, number of visits, and length of care by patient, injury, and treatment factors. In the absence of clinical guidelines, results will guide future efforts to optimize OPT following tibial fractures. Methods. This study used 2016 to 2017 claims from the IBM MarketScan Commercial Claims Research Database. The cohort included 9079 patients with International Classification of Diseases: Tenth Revision (ICD-10) diagnosis codes for tibial fractures. Use in the year following initial fracturemanagement was determined using Current Procedural Terminology codes. Differences in use were examined using ?2 tests, t tests, and Kruskal-Wallace tests. Results. Sixty-seven percent of patients received OPT the year following fracture. OPT attendance was higher in female patients, in patients with 1 or no major comorbidity, and in the western United States. Attendance was higher in patients with upper tibial fractures, moderate-severity injuries, and treatment with external fixation and in patients discharged to an inpatient rehabilitation facility. Patients started OPT on average [SD] 50 [52.6] days after fracture and attended 18 [16.1] visits over the course of 101 [86.4] days. The timing of OPT, the number of visits attended, and the length of OPT care varied by patient, injury, and treatment-level factors. Conclusions. One-third of insured patients do not receive OPT following tibial fracture. The timing of OPT initiation, the length of OPT care, and the number of visits attended by patients with tibial fractures were highly variable. Further research is needed to standardize referral and prescription practices for OPT following tibial fractures. Impact. OPT use varies based on patient, injury, and treatment-level factors following tibial fractures. Results from this study can be used to inform future efforts to optimize rehabilitation care for patients with tibial fractures.",

keywords = "Claims Analysis, Fractures, Orthopedics, Trauma",

author = "McLaughlin, {Kevin H.} and Reider, {Lisa M.} and Castillo, {Renan C.} and Ficke, {James R.} and Levy, {Joseph F.}",

note = "Funding Information: Funding was provided by the US Department of Health and Human Services, National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32 AR067708), and the Major Extremity Trauma Rehabilitation Consortium through the US Department of Defense (W81XWH-16-2-0060). Publisher Copyright: {\textcopyright} 2021 Oxford University Press. All rights reserved.",

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(Video) Locking plate Failures in Proximal Humerus Fractures

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T1 - Outpatient Physical Therapy Use Following Tibial Fractures

T2 - A Retrospective Commercial Claims Analysis

AU - McLaughlin, Kevin H.

AU - Reider, Lisa M.

AU - Castillo, Renan C.

AU - Ficke, James R.

AU - Levy, Joseph F.

N1 - Funding Information:Funding was provided by the US Department of Health and Human Services, National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32 AR067708), and the Major Extremity Trauma Rehabilitation Consortium through the US Department of Defense (W81XWH-16-2-0060). Publisher Copyright:© 2021 Oxford University Press. All rights reserved.

PY - 2021/5/1

Y1 - 2021/5/1

(Video) Pediatric Fracture Care | National Fellow Online Lecture Series

N2 - Objective. The purpose of this study was to characterize outpatient physical therapy (OPT) use following tibial fractures and examine the variability of OPT attendance, time of initiation, number of visits, and length of care by patient, injury, and treatment factors. In the absence of clinical guidelines, results will guide future efforts to optimize OPT following tibial fractures. Methods. This study used 2016 to 2017 claims from the IBM MarketScan Commercial Claims Research Database. The cohort included 9079 patients with International Classification of Diseases: Tenth Revision (ICD-10) diagnosis codes for tibial fractures. Use in the year following initial fracturemanagement was determined using Current Procedural Terminology codes. Differences in use were examined using ?2 tests, t tests, and Kruskal-Wallace tests. Results. Sixty-seven percent of patients received OPT the year following fracture. OPT attendance was higher in female patients, in patients with 1 or no major comorbidity, and in the western United States. Attendance was higher in patients with upper tibial fractures, moderate-severity injuries, and treatment with external fixation and in patients discharged to an inpatient rehabilitation facility. Patients started OPT on average [SD] 50 [52.6] days after fracture and attended 18 [16.1] visits over the course of 101 [86.4] days. The timing of OPT, the number of visits attended, and the length of OPT care varied by patient, injury, and treatment-level factors. Conclusions. One-third of insured patients do not receive OPT following tibial fracture. The timing of OPT initiation, the length of OPT care, and the number of visits attended by patients with tibial fractures were highly variable. Further research is needed to standardize referral and prescription practices for OPT following tibial fractures. Impact. OPT use varies based on patient, injury, and treatment-level factors following tibial fractures. Results from this study can be used to inform future efforts to optimize rehabilitation care for patients with tibial fractures.

AB - Objective. The purpose of this study was to characterize outpatient physical therapy (OPT) use following tibial fractures and examine the variability of OPT attendance, time of initiation, number of visits, and length of care by patient, injury, and treatment factors. In the absence of clinical guidelines, results will guide future efforts to optimize OPT following tibial fractures. Methods. This study used 2016 to 2017 claims from the IBM MarketScan Commercial Claims Research Database. The cohort included 9079 patients with International Classification of Diseases: Tenth Revision (ICD-10) diagnosis codes for tibial fractures. Use in the year following initial fracturemanagement was determined using Current Procedural Terminology codes. Differences in use were examined using ?2 tests, t tests, and Kruskal-Wallace tests. Results. Sixty-seven percent of patients received OPT the year following fracture. OPT attendance was higher in female patients, in patients with 1 or no major comorbidity, and in the western United States. Attendance was higher in patients with upper tibial fractures, moderate-severity injuries, and treatment with external fixation and in patients discharged to an inpatient rehabilitation facility. Patients started OPT on average [SD] 50 [52.6] days after fracture and attended 18 [16.1] visits over the course of 101 [86.4] days. The timing of OPT, the number of visits attended, and the length of OPT care varied by patient, injury, and treatment-level factors. Conclusions. One-third of insured patients do not receive OPT following tibial fracture. The timing of OPT initiation, the length of OPT care, and the number of visits attended by patients with tibial fractures were highly variable. Further research is needed to standardize referral and prescription practices for OPT following tibial fractures. Impact. OPT use varies based on patient, injury, and treatment-level factors following tibial fractures. Results from this study can be used to inform future efforts to optimize rehabilitation care for patients with tibial fractures.

KW - Claims Analysis

KW - Fractures

KW - Orthopedics

KW - Trauma

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(Video) Knee Injury Prevention

ER -

FAQs

When do you start physical therapy after tibial plateau fracture? ›

Physical Therapy for a Tibial Plateau Fracture

While physical therapy could begin immediately following the surgical procedure, most patients begin 2-3 weeks after their surgery. It is essential for the patient to remain NWB.

How long is physical therapy for a broken tibia? ›

When surgery is required these cases take around 4 months to heal. After this healing period, Physical Therapy most often continues until at 6 months, a patient is typically able to return to a normal life, albeit with certain limitations.

How long does it take to walk after a tibial plateau fracture? ›

If you had surgery for your tibial plateau fracture, you can put a little bit of weight on the leg after 6 weeks with the goal of walking normally by the 10th week. If you did not have surgery for your tibial plateau fracture, you can start walking safely with a knee brace in 4-6 weeks.

What is tibial plateau fracture? ›

A tibial plateau fracture is a bone fracture or break in the continuity of the bone occurring in the proximal (upper) part of the tibia (shinbone). The tibial plateau is one of the most critical loadbearing areas in the human body.

How do you strengthen your legs after a tibial plateau fracture? ›

Exercises to try include:
  1. Active knee ROM exercises.
  2. Weight-bearing exercises.
  3. Gait training.
  4. Lower-body exercises like squats, calve raises, and leg raises.
  5. Advanced stationary bike and treadmill workouts.
  6. Proprioception workouts.
17 Dec 2021

How long does a tibial plateau fracture hurt? ›

Depending on your injury, this will last 6 to 12 weeks. You may need to use crutches, a walker and/or a wheelchair. A knee immobilizer or hinged knee brace may be used to provide support for your leg.

Does weight bearing promote bone healing? ›

Weight-bearing is essential for bone healing in patients with autoimmune disease, fractures, and following orthopedic surgery. Low-intensity weight-bearing exercise has shown to be beneficial in bone healing over non-weight bearing exercises.

Why is a tibial plateau fracture so painful? ›

Knee pain after tibial plateau fractures is often due to arthrofibrosis, and the patient needs to be counseled that the time to achieve knee motion is now—not later when the patient thinks that it will feel better!

Can you still walk with a fractured tibia? ›

Can you still walk with a fractured tibia? In most cases, the answer is no. Walking after a tibia fracture can make your injury worse and may cause further damage to the surrounding muscles, ligaments and skin. Walking on a fractured tibia is also likely to be extremely painful.

Should I wear a knee brace after tibial plateau fracture? ›

Symptoms post tibial plateau fracture surgery

After your surgery you will be required to wear a cast or knee brace for as long as it is necessary until there has been sufficient healing of the fracture. Your leg will be maintained in extension to ensure healing of the surgical incision.

What does a tibial fracture feel like? ›

Symptoms are very similar to 'shin splints' with gradual onset pain on the inside of the shin. Individuals suffering from a tibial stress fracture typically feel an aching or burning (localized) pain somewhere along the bone. Swelling may be present at the fracture site.

How rare is a tibial plateau fracture? ›

Tibial plateau fractures comprise 1% of all fractures. The incidence of tibial plateau fractures is 10.3 per 100,000 people annually[2].

How long do you have to wear a brace after tibial plateau surgery? ›

The brace is usually discontinued about 6 weeks after surgery. The brace should be left in place at all times for the first two weeks after surgery, except during therapy and while taking a shower. It should be worn during sleep.

How long does a tibia fracture take to heal in adults? ›

Recovery. Most tibial shaft fractures take 4 to 6 months to heal completely. Some take even longer, especially if the fracture was open or broken into several pieces or if the patients uses tobacco products.

How long before you can put weight on a tibial plateau fracture? ›

Patients with tibial plateau fractures will be instructed to touch down (toe touch or foot flat) weight bear (approximately 10% of body weight) for at least 6 weeks. After the 6 week post op visit, patients may begin weight bearing as tolerated until full weight bearing is achieved.

Should I wear a knee brace after tibial plateau fracture? ›

Symptoms post tibial plateau fracture surgery

After your surgery you will be required to wear a cast or knee brace for as long as it is necessary until there has been sufficient healing of the fracture. Your leg will be maintained in extension to ensure healing of the surgical incision.

How long does it take for swelling to go down after tibial plateau fracture? ›

Most of the swellings subsided with time, but a small percentage of them persisted for a duration of 2 years or more after injury. The time for disappearance of the swelling in 50 per cent of the patients was 18.6 weeks.

Can a broken tibia heal in 4 weeks? ›

How Long Does a Fracture Take to Heal? Most fractures heal in 6-8 weeks, but this varies tremendously from bone to bone and in each person based on many of the factors discussed above. Hand and wrist fractures often heal in 4-6 weeks whereas a tibia fracture may take 20 weeks or more.

What is the treatment for a tibial plateau fracture? ›

Tibial Plateau Fracture Care

The most common non-surgical treatment is a short leg, non-weightbearing cast or a hinged knee brace, combined with physical therapy and rest. Fractures that have shifted require surgery.

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