Date Presented 04/04/19
Musculoskeletal disorders, including the elbow, wrist, and hand, are very common disabilities worldwide. Patients who experience elbow, wrist, and hand musculoskeletal pain are frequently seen in outpatient therapy. Using a sample of 89,422 patients from 3,400 outpatient clinics, this session will identify immutable and mutable factors that are the best predictors of a high functional recovery.
Primary Author and Speaker: Jason Hughes
Additional Authors and Speakers: Teal Benevides, Pamalyn Kearney, Michael Iwama, Leigh Lehman
Contributing Authors: Ying-Chih Wang
PURPOSE: Musculoskeletal disorders, including elbow, wrist, and hand impairments, are the second most common disability worldwide and place a large burden on the health care system (Southerst et al., 2015; Walker-Bone & Linaker, 2016). Patients who experience elbow, wrist, and hand musculoskeletal pain are frequently seen in therapy. The aim of this study was to determine immutable and mutable characteristics of patients who responded well to therapy with low visit utilization and patients who responded poorly despite high visit utilization.
DESIGN: This is a cross-sectional study. Demographic information pertaining to a sample of 89,422 patients in 3,400 outpatient therapy clinics for elbow, wrist, and hand impairments was analyzed.
METHODS: From the demographic information, multinomial regression analysis was used to identify significant patient characteristics predictive of treatment response.
RESULTS: Based on odds ratios, the immutable patient characteristic that was statistically significant of low risk of a poor outcome categorization was no history of surgery. Statistically significant mutable patient characteristics included acuity of less than 22 days, no medication use, and payer source. When compared to private insurance, individuals at low risk of a poor outcome were more likely to use private companies than worker’s compensation, litigation, or automotive. Conversely, they were more likely to have Medicare or Medicaid than to use private insurance. Based on odds ratios, immutable patient characteristics of those in the high-risk category were being female, having greater than three comorbidities, and having a surgical history. Mutable patient characteristics of those in the high-risk category were acuity of 22 days or greater, exercising less than 3 times a week, medication use, and payer source. Individuals who were at high risk of a poor outcome were more likely to use worker’s compensation, litigation, or automotive compared to having private insurance.
CONCLUSION: Significant patient characteristics were found, which allow for the identification of patients who are likely to benefit more from rehabilitation services versus those whose care might should include a more multidisciplinary approach. We are not suggesting withholding treatment from these individuals. However, knowledge of predictive factors early in treatment could be beneficial in prioritizing rehabilitation needs and acknowledging when consults for other services are needed. Further research is needed on the prognosis of patients seeking rehabilitation for elbow, wrist, and hand diagnoses related to cost, timing of care, and cost/benefit ratios.
References
Southerst, D., Yu, H., Randhawa, K., Cote, P., D'Angelo, K., Shearer, H. M., . . . Taylor-Vaisey, A. (2015). The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Chiropr Man Therap, 23, 30. doi:10.1186/s12998-015-0075-6
Walker-Bone, K., & Linaker, C. H. (2016). Prediction of prognosis for people off sick with upper extremity musculoskeletal disorders. Occup Environ Med, 73(12), 805-806. doi:10.1136/oemed-2016-103884
