title: Use and perceived need of physical therapy following severe lower-extremity trauma.
abstract: OBJECTIVE
  To examine the utilization of physical therapy (PT), the level of perceived need for PT, and the proportion of patients with perceived need receiving no PT in a cohort of severe lower-extremity trauma patients treated at level I trauma centers.
  
  
  METHODS
  Longitudinal, observational study of severe lower-extremity trauma patients. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission, and at 3, 6, 12, and 24 months postdischarge.
  
  
  METHODS
  Eight level I trauma centers.
  
  
  METHODS
  Of 601 patients age 18 to 65 enrolled in the parent study over a 40-month period, 550 with unilateral study injuries and followed up at least once over the 2-year study period were included in this analysis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Patient reported number of PT visits at each follow-up time point, inpatient rehabilitation admissions, and their perceived need for PT. Perceived need for PT was also assessed by an orthopedic surgeon and a physical therapist. Overall, concordance between physician, physical therapist, and patient's assessment of need for PT was low, with kappa statistics ranging between .12 and .41.
  
  
  RESULTS
  Amputation and reconstruction patients used comparable amounts of PT services. Regardless of the criteria used to evaluate need, the proportion of patients with perceived need for PT receiving no PT services increased over the course of the follow-up, from 23% to 46% at first follow-up to over 68% by 2 years. Factors associated with increased risk for having a perceived need but receiving no therapy included lack of private insurance, pain, lower levels of education, lower fitness levels at time of injury, being a smoker, and having severe muscle injury.
  
  
  CONCLUSIONS
  The results suggest a significant proportion of patients in the severe lower-extremity trauma population have perceived need for PT, yet receive no PT services.
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
authors.forename: Lawrence X
authors.initials: LX
authors.lastname: Webb
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bosse
authors.forename: Jennifer
authors.initials: J
authors.lastname: Avery
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D019637:Orthopedic Procedures / Q000379:methods; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011336:Probability; D020127:Recovery of Function; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome