Post-Fracture Inpatient and Outpatient Physical/Occupational Therapy and Its Association with Survival Among Adults with Cerebral Palsy

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Oct 14

PMID 36233436

Authors

Daniel G Whitney

Tao Xu

Daniel Whibley

Dayna Ryan

Michelle S Caird

Edward A Hurvitz

Heidi Haapala

Affiliations

Soon will be listed here.

Abstract

Physical and/or occupational therapy (PT/OT) may improve post-fracture health and survival among adults with cerebral palsy (CP), but this has not been studied in the inpatient setting. The objective was to quantify the association between acute inpatient and outpatient PT/OT use with 1-year mortality among adults with CP. This was a retrospective cohort study of adults with CP with an incident fragility fracture admitted to an acute care or rehabilitation facility using a random 20% Medicare fee-for-service dataset. Acute care/rehabilitation PT/OT was measured as the average PT/OT cost/day for the length of stay (LOS). Weekly exposure to outpatient PT/OT was examined up to 6 months post-fracture. Cox regression examined the adjusted association between the interaction of acute care/rehabilitation average PT/OT cost/day and LOS with 1-year mortality. A separate Cox model added time-varying outpatient PT/OT. Of 649 adults with CP, average PT/OT cost/day was associated with lower mortality rate for LOS < 17 days (HR range = 0.78−0.93), and increased mortality rate for LOS > 27 days (HR ≥ 1.08) (all, p < 0.05). After acute care/rehabilitation, 44.5% initiated outpatient PT/OT, which was associated with lower mortality rate (HR = 0.52; 95% CI = 0.27−1.01). Post-fracture inpatient and outpatient PT/OT were associated with improved 1-year survival among adults with CP admitted to acute care/rehabilitation facilities.

Citing Articles

Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy.

Gottlieb R, Panzer K, Wang M, Leis A, Whitney D Phys Ther. 2023; 103(8).

PMID: 37440438 PMC: 10471154. DOI: 10.1093/ptj/pzad090.

References

Ross S, MacDonald M, Bigouette J . Effects of strength training on mobility in adults with cerebral palsy: A systematic review. Disabil Health J. 2016; 9(3):375-84. DOI: 10.1016/j.dhjo.2016.04.005. View

Whitney D, Bell S, Etter J, Prisby R . The cardiovascular disease burden of non-traumatic fractures for adults with and without cerebral palsy. Bone. 2020; 136:115376. DOI: 10.1016/j.bone.2020.115376. View

OConnell N, Smith K, Peterson M, Ryan N, Liverani S, Anokye N . Incidence of osteoarthritis, osteoporosis and inflammatory musculoskeletal diseases in adults with cerebral palsy: A population-based cohort study. Bone. 2019; 125:30-35. DOI: 10.1016/j.bone.2019.05.007. View

Whitney D, Hurvitz E, Ryan J, Devlin M, Caird M, French Z . Noncommunicable disease and multimorbidity in young adults with cerebral palsy. Clin Epidemiol. 2018; 10:511-519. PMC: 5935087. DOI: 10.2147/CLEP.S159405. View

Presedo A, Dabney K, Miller F . Fractures in patients with cerebral palsy. J Pediatr Orthop. 2007; 27(2):147-53. DOI: 10.1097/BPO.0b013e3180317403. View

Whitney D . Mediating effects of post-fracture cardiorespiratory disease on mortality for adults with cerebral palsy: A cohort study. Ann Phys Rehabil Med. 2022; 65(6):101661. PMC: 9613788. DOI: 10.1016/j.rehab.2022.101661. View

Whitney D, Xu T, Ryan D, Whibley D, Caird M, Hurvitz E . Post-fracture rehabilitation pathways and association with mortality among adults with cerebral palsy. Clin Rehabil. 2022; 37(1):119-131. PMC: 10150496. DOI: 10.1177/02692155221123544. View

van der Slot W, Nieuwenhuijsen C, van den Berg-Emons R, Bergen M, Hilberink S, Stam H . Chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy. Dev Med Child Neurol. 2012; 54(9):836-42. DOI: 10.1111/j.1469-8749.2012.04371.x. View

Ryan J, Peterson M, Ryan N, Smith K, OConnell N, Liverani S . Mortality due to cardiovascular disease, respiratory disease, and cancer in adults with cerebral palsy. Dev Med Child Neurol. 2019; 61(8):924-928. PMC: 6850409. DOI: 10.1111/dmcn.14176. View

10.

Whitney D, Caird M, Jepsen K, Hurvitz E, Hirth R . Excess healthcare spending associated with fractures among adults with cerebral palsy. Disabil Health J. 2022; 15(3):101315. PMC: 9308651. DOI: 10.1016/j.dhjo.2022.101315. View

11.

VanderWeele T . Principles of confounder selection. Eur J Epidemiol. 2019; 34(3):211-219. PMC: 6447501. DOI: 10.1007/s10654-019-00494-6. View

12.

Binder E, Brown M, Sinacore D, Steger-May K, Yarasheski K, Schechtman K . Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA. 2004; 292(7):837-46. DOI: 10.1001/jama.292.7.837. View

13.

Singh N, Quine S, Clemson L, Williams E, Williamson D, Stavrinos T . Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. J Am Med Dir Assoc. 2011; 13(1):24-30. DOI: 10.1016/j.jamda.2011.08.005. View

14.

Whitney D, Schmidt M, Hurvitz E . Shared Physiologic Pathways Among Comorbidities for Adults With Cerebral Palsy. Front Neurol. 2021; 12:742179. PMC: 8520916. DOI: 10.3389/fneur.2021.742179. View

15.

Neuman M, Silber J, Magaziner J, Passarella M, Mehta S, Werner R . Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med. 2014; 174(8):1273-80. PMC: 4122620. DOI: 10.1001/jamainternmed.2014.2362. View

16.

Whitney D, Schmidt M, Haapala H, Ryan D, Hurvitz E, Peterson M . Timecourse of Morbidity Onset Among Adults Living With Cerebral Palsy. Am J Prev Med. 2021; 61(1):37-43. DOI: 10.1016/j.amepre.2021.01.020. View

17.

Whitney D, Hurvitz E, Caird M . Critical periods of bone health across the lifespan for individuals with cerebral palsy: Informing clinical guidelines for fracture prevention and monitoring. Bone. 2021; 150:116009. DOI: 10.1016/j.bone.2021.116009. View

18.

Lindenauer P, Stefan M, Pekow P, Mazor K, Priya A, Spitzer K . Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries. JAMA. 2020; 323(18):1813-1823. PMC: 7218499. DOI: 10.1001/jama.2020.4437. View

19.

Mubark I, Abouelela A, Genena A, Al Ghunimat A, Sarhan I, Ashwood N . Mortality Following Distal Femur Fractures Versus Proximal Femur Fractures in Elderly Population: The Impact of Best Practice Tariff. Cureus. 2020; 12(9):e10744. PMC: 7603877. DOI: 10.7759/cureus.10744. View

20.

Mantopoulos T, Mitchell P, Welton N, McManus R, Andronis L . Choice of statistical model for cost-effectiveness analysis and covariate adjustment: empirical application of prominent models and assessment of their results. Eur J Health Econ. 2015; 17(8):927-938. DOI: 10.1007/s10198-015-0731-8. View