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Orthopedic Surgeons and Physical Therapists Differ in Assessment of Need for Physical Therapy After Traumatic Lower-Extremity Injury

K.R. Archer, PT, PhD, DPT, is Assistant Professor, Department of Orthopaedics and Rehabilitation, School of Medicine, Vanderbilt University Medical Center, Medical Center East–South Tower, Suite 4200, Nashville, TN 37232 (USA).
E.J. MacKenzie, PhD, is Fred and Julie Soper Professor and Chair, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
R.C. Castillo, PhD, is Assistant Professor, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University.
M.J. Bosse, MD, is Director of Clinical Research and Orthopaedic Traumatologist, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
The LEAP Study Group is: Ellen J. MacKenzie, PhD; Michael J. Bosse, MD; James F. Kellam, MD; Andrew R. Burgess, MD; Lawrence X. Webb, MD; Marc F. Swiontkowski, MD; Roy Sanders, MD; Alan L. Jones, MD; Mark P. McAndrew, MD; Brendan Patterson, MD; Melissa L. McCarthy, ScD; Thomas G. Travison, PhD; and Renan C. Castillo, PhD.

kristin.archer{at}vanderbilt.edu

Background: Lower-extremity injuries constitute the leading cause of trauma hospitalizations among people under the age of 65 years. Rehabilitation has the potential to favorably influence the outcomes associated with traumatic lower-extremity injuries.

Objectives: The objectives of this study were to explore variability in surgeon and physical therapist assessments of the need for physical therapy in patients with traumatic lower-extremity injuries and to determine the factors associated with assessments of need.

Design: This study was a retrospective cohort investigation.

Methods: Participants were 395 patients treated by reconstruction in the Lower-Extremity Assessment Project. They were evaluated at 8 level I trauma centers at 3, 6, and 12 months after hospitalization by an orthopedic surgeon and a physical therapist to determine the need for physical therapy. Analyses included multilevel logistic regression.

Results: Chi-square analyses showed that surgeon and therapist assessments of need differed statistically across trauma centers. Surgeons were more likely to assess a need for therapy at 3 months when participants had low work self-efficacy, impaired knee flexion range of motion (ROM), and weight-bearing limitations and at 6 and 12 months when participants had impaired knee flexion ROM and weight-bearing and balance limitations. Therapists were more likely to assess a need for therapy at 3 months when participants had moderate to severe pain and at 6 and 12 months when participants had low work self-efficacy, pain, impaired knee flexion ROM, and balance limitations.

Conclusions: The results revealed variability in assessments of the need for physical therapy at the provider and trauma center levels. Differences in provider assessments highlight the need for communication and further investigation into the outcomes and timing of physical therapy for the treatment of traumatic lower-extremity injuries.

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