Physical Therapy Services for Older Adults with at Least Moderately Severe Hip or Knee Arthritis in 2 Ontario Counties

J. DENISE POWER, CHERYL A. COTT, ELIZABETH M. BADLEY, and GILLIAN A. HAWKER

ABSTRACT.

Objective. Physical therapy (PT) is a recommended treatment for the management of arthritis. We investigated factors related to referral to PT services in people with hip or knee arthritis and describe characteristics of treatment received.

Methods. As part of a longitudinal study of the population aged ≥ 55 years with at least moderately severe hip or knee arthritis in 2 Ontario counties (n = 1350), participants were surveyed in the third year of followup about use of PT. Participants were categorized as to whether they had total joint replacement surgery in the past year (TJR group, n = 52) or did not (non-TJR group, n = 1298). Multivariate logistic regression was used to identify determinants of referral to PT considering sociodemographic characteristics, comorbidity, use of prescribed arthritis medication, and arthritis severity (WOMAC summary score).

Results. Overall, 18.7% of the cohort was referred to PT in the past year: 65.4% of the TJR group and 16.8% of the non-TJR group. The only significant predictor of PT in the TJR group was current use of prescribed arthritis medication. Greater arthritis severity, current use of prescribed arthritis medication, and greater comorbidity were significant independent predictors of referral to PT for the non-TJR group in multivariate logistic regression. The Ontario Health Insurance Plan paid for the majority of PT received.

Conclusion. Low rates of referral to PT in the previous year suggest possible underutilization. Further research is needed to examine patterns of use of PT throughout the course of the arthritis disease process and to examine barriers to PT access. (J Rheumatol 2005;32:123-9)

Key Indexing Terms:

PHYSICAL THERAPY
ARTHRITIS
REFERRAL

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From the Arthritis Community Research and Evaluation Unit (ACREU), Toronto Western Research Institute, University Health Network; Department of Public Health Sciences, University of Toronto; Department of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto; Department of Health Policy, Management and Evaluation, University of Toronto; and Department of Medicine, Division of Rheumatology, Faculty of Medicine, University of Toronto, and Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.

Supported by grants MT-12919 and MT-15468 from the Canadian Institutes for Health Research (formerly the Medical Research Council of Canada), The Arthritis Society (97-083), Physicians' Services Incorporated Foundation (95-47), the Canadian Orthopaedic Foundation, the University of Toronto Dean's Fund (00026896), the Ontario Ministry of Health and Long-Term Care (grant to ACREU), and the Canadian Arthritis Network. Dr. Hawker receives support as a Canadian Institute of Health Research Scientist.

J.D. Power, MHSc, Research Associate, ACREU, Toronto Western Research Institute; C.A. Cott, PhD, Associate Professor, Department of Physical Therapy, University of Toronto, Deputy Director, ACREU, Toronto Western Research Institute; E.M. Badley, DPhil, Professor, Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Head, Division of Outcomes and Population Health, Director, ACREU, Toronto Western Research Institute; G.A. Hawker, MD, MSc, Director, Clinical Epidemiology and Health Care Research Program, University of Toronto, Associate Professor of Medicine, Faculty of Medicine, University of Toronto, F.M. Hill Professor in Academic Women's Medicine, Sunnybrook and Women's College Health Sciences Centre.

Address reprint requests to Prof. E.M. Badley, Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, 399 Bathurst Street, MP10-316, Toronto, Ontario M5T 2S8. E-mail: badley@uhnres.utoronto.ca

Submitted October 23, 2003; revision accepted August 8, 2004.

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