Cross-sectional examination of patient and therapist factors affecting participation in physical therapy in acute care hospital settings

Abstract

Background. Research has demonstrated benefits of early and continued physical therapy for patients in acute care hospitals. Despite known benefits, scheduled sessions do not always result in treatment. Reported percentages for nontreatment are 15% to 25%. Understanding when and why nontreatment occurs is fundamental to future interventions to reduce it and provide patients with needed services. Objective. The study objective was to describe nontreatment and the extent to which attributes of the patient, physical therapist, and environment affect its occurrence at a suburban community hospital. Design. This was a cross-sectional study. Methods. Medical records for 1,252 patients who were scheduled for 6,246 physical therapy sessions were reviewed. Therapist demographics were collected via a questionnaire. Results. Therapist sexes were equally represented, and most therapists were nonwhite and worked full time at the hospital. The nontreatment percentage for individual therapists ranged from 5.4% to 23.2%. This percentage was 1.3% for the first scheduled session but nearly 20% for the remaining sessions. In more than 30% of nontreatment events, the specific therapist attempting treatment was not identified. Patients were much less likely to experience nontreatment if they were scheduled for therapy on a Tuesday or if they were in the hospital for a musculoskeletal condition. Sunday had a particularly high percentage of nontreatment. Limitations. The participants were recruited from a single hospital. The specific therapist associated with nontreatment events was not always known. Conclusions. Hospital and rehabilitation department policies and culture for weekend therapy staffing should be evaluated in light of the high percentage of nontreatment on Sunday. The impact of patient diagnosis on nontreatment must be evaluated further and may reflect hospital culture. Future research efforts should be designed to obtain data on the assigned therapist for all instances of nontreatment.