A Combination of Active and Passive or Manual Physical Therapy Interventions Reduces the Likelihood of Patient Early Self-discharge from Care

Research Objectives: Early access to guideline adherent physical therapy in the treatment of musculoskeletal pain has been shown to improve patient outcomes. Using a large outpatient database, we investigated the association between active and passive care during the initial evaluation with completion of a full plan of care (POC).

Design: This study was a retrospective analysis of a de-identified administrative database. Treatment received during the initial evaluation (IE) was defined as “active,” “passive,” or “manual” based on previous research that defined active and passive treatment using administrative codes. Patients were stratified by intervention type and divided into those who completed their POC (discharge by therapist) and patients who ended their POC early (self-discharge).

Setting: Data for analysis was collected at the clinic level. The clinics are part of the Ivy Outpatient Rehabilitation Network, an outpatient rehabilitation provider consisting of 600+ clinics across 17 states.

Participants: Participants received an IE between 07/01/2023 and 12/30/2023. Episodes of care were included if they contained a CPT billing code for an active, manual, or passive-based intervention during the IE.

Interventions: N/A

Main Outcome Measures: Bivariate analyses (Pearson’s chi-squared test) were conducted to determine differences between participants who completed their POC and participants who self-discharged. Adjusted logistic regression was used to determine the likelihood of self-discharge while controlling for chief complaint (pain), total units and inclusion grouping. Between group differences were calculated and reported as adjusted odds ratios (aOR).

Results: A significantly greater proportion of patients who completed their POC received active and manual interventions during their IE (46%) compared to patients who self-discharged (44%, p< 0.001). Patients who received active and manual (aOR: 0.90; 95% CI={0.86, 0.94]), active and passive (aOR: 0.88; 95% CI=[0.80,0.96]), or active, manual and passive (aOR: 0.91; 95% CI = [0.85, 0.98]) therapies had significantly decreased odds of self-discharging when compared to those who received only active interventions. Patients who reported pain as their chief complaint had significantly greater odds of self-discharging compared to patients who reported a different chief complaint (aOR: 1.34; 95% CI=[1.29,1.40]). Patients that received three or more total units of treatment had significantly lower odds of self-discharging compared to patients that received 1-2 units (aOR: 0.92; 95% CI=[0.88,0.97]).

Conclusions: Patients who receive a combination of active, passive, and manual interventions have 9% lower odds of self-discharge in six or fewer visits compared to patients who only receive active interventions.

Author(s) Disclosures: The authors declare no conflicts of interest.