Article

OBJECTIVE: To identify how treatment processes are related to functional outcomes
for patients seeking treatment for musculoskeletal impairments while controlling
for demographic and health characteristics at intake. DESIGN: Prospective,
observational cohort study. Treatment processes were not altered. Data were
collected continuously from June 2005 to January 2008. Descriptive statistics
were applied to compare patient characteristics, interventions, and outcomes
between impairment categories. Ordinary least-squares multiple regressions were
used to examine associations between patient characteristics at intake, treatment
processes, and functional outcomes. SETTING: Fifty-four community-based
outpatient physical therapy clinics of Maccabi Healthcare Services, a public
health plan in Israel. PARTICIPANTS: A consecutive sample of 22,019 adult
patients (mean age 51.2 y, standard deviation=15.7, range 18-96, 58% women)
seeking treatment due to lumbar spine, knee, cervical spine, or shoulder
impairments with functional measurements at intake and discharge. INTERVENTIONS:
Not applicable. MAIN OUTCOME MEASURE: Functional status at discharge. RESULTS:
Explanatory power ranged from 30% to 39%. Better outcomes were associated with
patient compliance with self-exercise and therapy attendance, application of
therapeutic exercise and manual therapy, and completion of 3 or more functional
surveys during the episode of care. Worse outcomes were associated with women,
electrotherapy for pain management, and therapeutic ultrasound for shoulder
impairments. Mixed results were found for group exercise programs. CONCLUSIONS:
The study of associations between treatment processes, patient characteristics,
and outcomes helps to describe practice and can be used to suggest ways to
improve outcomes in outpatient physical therapy practice.

Langue : ANGLAIS