2012 Annual Conference

Lai Si U, Jarod Hall, Jeffrey Guild, Rauna Dallman, Hao (Howe) Liu

Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX

Physical therapists have been one of the primary healthcare providers in nursing homes, especially for patients who need to improve their functional mobility and ability to accomplish activities of daily living. However, for many entry level therapists, working in a skilled nursing facility may not be their first choice for job pursuit due to lack of knowledge about patients who are often referred to physical therapy for evaluation and treatment (“PT eval and Tx”).  The purpose of this research is to understand the most common medical diagnoses, physical therapy treatment diagnoses, and other demographic information used for physical therapists to initiate their assessment, plan their intervention, and predict rehabilitation outcomes.

One hundred and eighteen referrals were recruited from two different nursing homes in a state in the south.

Referrals to physical therapy were collected in a 12-month period from two different nursing homes. All data from these referrals were reviewed and analyzed with descriptive method.

SPSS 17.0 was used for the data review and analysis.

Among all referrals, the five most commonly referred medical diagnoses (from most to least) were hip fracture, congestive heart failure, pneumonia, stroke, and osteoarthritis. The most common physical therapy treatment diagnosis was generalized muscle weakness (gait difficulty) (85.6%). On average, each patient had six past medical diagnoses; the top six are hypertension (43.2%), dementia (32%), depression (24.6%), degenerative joint disease/osteoarthritis (23.7%), urinary tract infection (21.2), and stroke (16%). The average number of days of patient hospitalization was 11.2. Prior to referral to physical therapy, over 38% of total referred patients lived in his/her own home or apartment before they were hospitalized or admitted directly to the nursing home. After an average of 24.8 days of PT intervention, over 75% of all patients were discharged to nursing home care or nursing home restorative programs. Less than 8% of patients were discharged back to his/her home or apartment. The top three causes of discharge from PT include reaching maximal rehabilitation potential, meeting rehabilitation goals, and hospitalization.

The majority of medical diagnoses that ended in patient hospitalization involved musculoskeletal and cardiopulmonary systems. Generalized weakness and/or gait difficulty are most common PT treatment diagnoses. Most of the patients who previously were not nursing home residents continued to stay in nursing homes even after they were discharged from physical therapy service.

Before and during PT evaluations and interventions, physical therapists (particularly for entry level therapists) have to understand how a patient’s primary medical diagnosis and physical therapy treatment diagnosis (or diagnoses) may affect the patient’s functional mobility including general strength and gait pattern. Therefore, a reasonable treatment plan can be set up and a better outcome prediction may be available for the patient.