Factors Affecting Physical Therapy Use Among Older Adults With RA

Sociocultural and economic disparities affect physical therapy utilization among adults aged at least 65 years with rheumatoid arthritis (RA), according to study results published in The Journal of Rheumatology.

To examine how sociocultural and economic factors impact the use of physical therapy among individuals aged 65 years or older with RA, researchers performed annual cross-sectional analyses using Medicare fee-for-service claims filed between 2012 and 2016.

Trends in physical therapy use and the number of visits were examined using annual billing claims for physical therapy services from 2013 to 2016. Race, ethnicity, and Medicaid status data were obtained from the Master Beneficiary Summary File. Logistic regression analyses determined associations between race, ethnicity, dual coverage, and physical therapy use.

A total of 106,470 patients were included in the final cohort. Of these, 83.9% identified as non-Hispanic White, 8.8% identified as non-Hispanic Black, and 7.2% identified as Hispanic. The average patient age was 75.8 years, 75% were women, and 22.6% had dual Medicare/Medicaid coverage.

Patients who identified as non-Hispanic Black (adjusted odds ratio [aOR], 0.77) and Hispanic (aOR, 0.92) were less likely to use physical therapy services than patients who identified as non-Hispanic White. Approximately 10% to 13% of non-Hispanic White patients, 9% to 11% of patients who identified as Hispanic, and 6% to 10% of patients who identified as non-Hispanic Black used physical therapy services.

Patients with dual Medicare/Medicaid coverage were also less likely to use physical therapy services than those with Medicare-only coverage, with 5% to 8% of those with dual coverage and 10% to 14% without dual coverage using physical therapy services.

Patients with dual coverage were 0.58 times more likely to utilize a medium number of physical therapy visits rather than a low number of visits compared against those without dual coverage.

Study limitations included patients not being allowed to identify as multiple races or select race and ethnicity separately, exclusion of several racial groups with low sample sizes, and reduced generalizability. Additionally, associations between physical therapy use and clinical outcomes could not be examined.

The study authors concluded, “We found sociocultural and economic disparities in physical therapy utilization in older adults with RA. To address these disparities, we must identify and address the underlying factors that influence the disparities.”