APTA CSM: Poster Presentation

CVA Therapy Referrals Driven by Patient Reports

CVA Therapy Referrals

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Anaheim, Calif. — Patients who experienced cerebrovascular accidents (CVA) and had difficulties afterward with mobility and/or activities of daily living (ADLs) were most likely to be referred for outpatient therapy if they reported those mobility/ADL deficits to their healthcare providers, according to a poster presentation shown at the 2016 American Physical Therapy Association’s Combined Sections Meeting in February.

Trisha Sando, DPT, CWS, MSc, a doctoral student in the division of epidemiology, Department of Family Medicine & Population Health, Virginia Commonwealth University School of Medicine in Richmond, Va., presented her study entitled, “Patient Reports of Post-CVA Deficits Are the Driving Factor for Post-Acute Therapy Referral.”

In discussing her work, Sando told Mobility Management that many stroke patients continue to have difficulty with everyday functions after leaving their acute care setting.

Why Do CVA Patients Get Referred?

“The goal of this research study was (1) determine how many people with each type of ADL and mobility deficit following a CVA in 2011-2012 are present in the non-institutionalized population; (2) how many of those with deficits have been referred to physical therapy (PT) and/or occupational therapy (OT); and (3) to determine which functional mobility and ADL deficits increase the likelihood that a patient who has had a stroke will be referred to physical or occupational therapy in the outpatient setting,” Sando explained.

“My hypothesis for aim number three was that functional deficits — such as difficulty walking in the home and standing up from a chair — would increase the odds a patient would be referred. For ADLs I hypothesized that toileting and dressing would increase the odds of referral.”

The sheer volume of patients in the United States who sustain CVAs makes understanding the outpatient therapy equation critical.

“Stroke is the leading cause of disability in the U.S.,” Sando said, “and PTs and OTs have unique roles that can help patients decrease deficits and train caregivers. Participation in physical therapy and occupational therapy can prevent injury to patients and caregivers, as well as decrease the risk of further decline, decrease risk of complications of impaired mobility, and improve overall quality of life for patients. However, there is little research on how many people with CVA deficits are receiving potentially life-changing services. Understanding how many patients are receiving needed services and who is more likely to receive the services will help the PT and OT professions to design intervention to increase referral rates and decrease disability in the population who have had CVAs.”

Sando added that while most patients studied do have mobility/ADL difficulties, many of them do not receive the outpatient physical or occupational therapy that could be helpful: “Our study utilized data from the Health and Retirement survey and found that 60 percent of people who suffered a CVA in 2011-2012 have one or more functional or ADL deficits. However, only 29 percent of people reporting a deficit have been referred to postacute PT or OT services.”

Not All Deficits Are Treated Equally

Sando’s work also found differences between the most commonly reported deficits and the types of deficits most likely to result in patients being referred to therapy:

  • Balance, flexing the shoulder over 90°, and walking one block were the most commonly reported deficits.
  • Feeding problems were the deficits most likely to result in a PT/OT referral, followed by toileting and bed mobility deficits.
  • People who reported a deficit to their healthcare providers were more than seven times more likely to be referred to PT or OT services than those who did not report a deficit to their providers.
  • People with balance deficits or bathing deficits were four times more likely to be referred to PT or OT services than those who had neither deficit.

As those results suggest, not all mobility/ADL deficits were treated equally when it came to whether or not the patient was referred for OT or PT.

“People who have difficulty sitting more than two hours, standing from a chair, and are unable to flex their shoulder over 90° have no increase in likelihood of being referred compared to those without these deficits,” Sando noted.

What does she hope will come from her study?

“This research shows that many people who have residual CVA deficits are not receiving referrals to providers — PT and/or OT — who can decrease these deficits and potentially improve quality of life,” Sando said. “My hope is both professions can use this information to educate referring healthcare providers of what services we can offer to their patients who have had a stroke. It can also be used to educate patients, patient caregivers and other patient advocates that discussing functional and ADL deficits with their provider can increase the odds of being referred to PT and OT services. The ultimate goal would be to increase referral to PT and OT services and reduce the burden of functional and ADL deficits on patients and the U.S. healthcare system.”

This article originally appeared in the April 2016 issue of Mobility Management.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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