Intervention goals determine physical therapists' workload in the acute care setting

Abstract

Background. Investigating determinants of physical therapy workload in the acute care setting is essential for planning interventions, for justifying resource allocation, and for reimbursement. Objective. The objective of this study was to examine whether International Classification of Functioning, Disability and Health (ICF) intervention goals (ICF categories representing goals of physical therapy interventions typical for an acute care hospital) could predict physical therapy workload in the acute care hospital setting. Design. This investigation was a multicenter, observational cohort study. Methods. Patients were recruited from a representative sample of 32 acute care hospitals across Switzerland if they received physical therapy during their inpatient stay for the treatment of any injury or disease in 1 of 3 main diagnostic categories: musculoskeletal, neurological, and cardiopulmonary conditions. Physical therapists completed questionnaires at the time of the patients' discharge to report on ICF intervention goals. Information on workload was collected retrospectively from hospital documentation systems. Multivariable regression models were used to identify the intervention goals independently associated with workload. Results. The mean workload for 642 patients (mean age=61 years [SD=18 years], 45% women) was 370 minutes. The daily workload for interventions ranged from 33 minutes (cardiopulmonary conditions) to 49 minutes (neurological conditions). There were significant variations in workload across hospital sites and medical disciplines. The goal "maintaining a body position" emerged as a significant indicator of a higher workload for all condition groups; the goals "attention functions" and "transferring oneself" were indicators for neurological and musculoskeletal conditions, respectively. Limitations. Not all potential predictors of workload could be examined. Other, person- or setting-specific variables might have been relevant to workload. Case mix and clinical practice were representative only for Swiss hospitals. Conclusions. A small set of intervention goals were the major factors influencing physical therapy workload, independent of diagnosis or clinical specialty. Describing variability in physical therapists' practices in the acute care setting and relating these data to relevant patient-centered outcomes are the initial steps for improving resource allocation and reimbursement for interventions that maintain or improve functioning. © 2010 American Physical Therapy Association.