Exposure to therapy of older patients with trauma and factors that influence provision of therapy

Abstract

Background. Rehabilitation as soon as possible after trauma decreases sedentary behavior, deconditioning, length of stay, and risk of rehospitalization. Objective. The study objectives were to describe exposure of older patients with trauma to rehabilitation and to explore factors associated with the number and initiation of therapy sessions. Design. This was a retrospective study of data from electronic medical records. Methods. Randomly selected older patients with trauma were described with regard to demographics, trauma diagnoses, comorbidities, preadmission function, and exposure to therapy. Regression analyses explored factors associated with number of therapy sessions and days until therapy was ordered and completed. Results. Records for 137 patients were randomly selected from records for 1,387 eligible patients who had trauma and were admitted over a 2-year period to a level I trauma center. The 137 patients received 303 therapy sessions. The sample included 63 men (46%) and 74 women (54%) who were 78 (SD = 10) years of age; most patients were white (n=115 [84%]). All patients had orders for therapy, although 3 patients (2%) were never seen. An increase in comorbidities was associated with an increase in therapy sessions, a decrease in the number of days until an order was written, but an increase in the number of days from admission to evaluation. Injury severity was associated with a decrease in the number of days from admission to an order being written. A postponed or canceled therapy session was associated with increases in the number of days from admission to evaluation and in the number of days from an order being written to evaluation. Limitations. This study was a retrospective review of a small sample with subjective measures and several dichotomous variables. Conclusions. Increased injury severity, increased numbers of comorbidities, and postponed or canceled therapy sessions were associated with decreased time from admission to therapy orders, increased time from admission and orders to evaluation, and increased number of therapy sessions. © 2014 American Physical Therapy Association.