Physical therapists' management of patients in the acute care setting: An observational study

Abstract

Background. Previous literature has not fully described physical therapists' management of patients across diagnoses in the acute care setting or how that management might vary by facility. Objective. The purposes of this study were to describe patient management by physical therapists in the acute care setting and to examine variations in patient management across facilities. Design. This was an observational study. Methods. Fifty clinicians practicing at 3 academic medical centers in the northeastern United States agreed to participate. Over a 2-week period, clinicians completed checklists indicating the details of patient visits. Logistic analyses, controlling for patient age and diagnosis and accounting for clustering of data, were conducted to examine the odds of patients having several categories of examinations, goals, and interventions. Results. Participants provided 2,364 visits to 896 patients. More than 75% of patients in each facility received examinations, goals, and interventions related to functional ability. Median number of visits per patient, duration of visits, and number of visits in which the patient was not treated varied across facilities. Patients with orthopedic conditions were more likely than those with medical/surgical conditions to receive several types of examinations, goals, and interventions. The odds of patients having examinations, goals, and interventions related to functional abilities were greater in facility 2 than in facility 1. Limitations. Limitations include the convenience sample, use of an untested data collection tool, and use of only age and diagnosis to control for case mix. Conclusion. This study of physical therapist practice in 3 acute care facilities suggests that patient management focuses on functional activity. There was no clear pattern of examinations, goals, and interventions related to specific diagnoses. A small degree of variation was found in practice across the facilities. © 2009 American Physical Therapy Association.