Determinants of Care Seeking for Persons with Low Back and Neck Pain Treated By Physicians, Chiropractors or Physical Therapists

Low back and neck pain are frequent reasons for adults to seek healthcare. Three types of practitioners are commonly used in the United States: physicians, chiropractors and physical therapists. In this study, Andersen\u27s Behavioral Model of Health Services Utilization is used to examine care seeking and provider selection. Estimates of back and neck pain prevalence in the United States are presented as well as care seeking rates and care consumption estimates for patients who used the three providers of interest. Multivariate regression analyses are presented that model the variables that most influence care seeking and provider selection.Cases with the conditions of low back pain and neck pain were drawn from the Medical Expenditure Panel Survey Panel 6 participants. Episodes of care and non-care were defined and the provider used during an episode was identified.Determinants of care seeking for low back pain included MSA status, insurance coverage, perceived health status, number of comorbidities and number of episodes. Determinants of care seeking for neck pain included insurance coverage and number of episodes. When condition was included in the analysis, it was a determinant of care seeking. All of these variables are enabling factors or need factors in Andersen\u27s model.In the analysis of provider selection for low back pain, variables that determined the provider from whom care was sought included patient age, gender, race, ethnicity, marital status, MSA status, insurance coverage, perceived health status, if the condition was disabling and number of episodes. In the analysis of provider selection for neck pain, variables that determined the provider from whom care was sought included patient ethnicity, marital status, and if the condition was disabling.Andersen\u27s Behavioral Model adequately predicts care seeking in LBP and NP with enabling and need factors playing a predominant role. In terms of equity of access this finding indicates a problem of access to care for persons who were uninsured. In the case of provider selection, all the constructs from the model were found to have a role in prediction indicating that access may be inequitable in the case of some providers

Responding to stakeholder needs to engage rehabilitation professionals in the delivery of evidence-based health programming for adults with osteoarthritis

Although there are many evidence-based programs that promote healthy lifestyles and symptom modification for people with osteoarthritis, their delivery in rehabilitation clinical settings in the United States is limited. These programs can be a primary component of treatment or a discharge option to facilitate long-term mobility and pain management. The purpose of this perspective article is to describe a delivery model that brings one arthritis-appropriate, evidence-based intervention, the Arthritis Foundation's Walk With Ease program, to older adults seeking physical therapy related to their osteoarthritis. We embedded program delivery into a Doctor of Physical Therapy curriculum using a student health coaching approach and partnering with physical therapy clinics and other community agencies for participant referrals. This model of delivery is cost-effective, sustainable, and provides outcomes that meet goals of the national agenda for osteoarthritis. The model provides benefits for students in health professions education programs, community organizations and rehabilitation clinics, and adults living with osteoarthritis

Mind the Gap: An Analysis of Physical Therapist Earnings in the United States by Male/Female Sex

Abstract Objective Earnings discrepancies between male and female health and medical professionals are well documented. The purpose of this study was to examine the distribution of physical therapist earnings using a quartile regression approach to determine the nature of the gender-based differences in earnings between male and female physical therapists in the United States, with “gender” as defined by the dataset as being male or female. Methods This observational study used data from the 2014 to 2018 American Community Survey 5-year public use microdata file. The file contained 12,123 physical therapist cases weighted to an estimate of the physical therapist active workforce of 238,221 (95% CI = 232,587 to 243,855). To analyze the influence of gender on earnings, a multivariable quantile regression approach was used in which physical therapist earnings were the dependent variable and the variables representing the geographic distribution, social characteristics, and employment characteristics were the independent variables. Results In 2018 dollars, the average annual earnings of a physical therapist were $73,444.98 (95$72,498.19 to $74,391.11), with a median value of$71,735.09. Differences in male and female earnings were evident in both the unadjusted bivariable and in the adjusted values produced by the quartile regression. The ratios of female-to-male earnings at each quartile were 0.89, 0.90, and 0.89. When age of the earner is accounted for, male physical therapists earned more than female therapists in both the 30-to-54-year age group and the ≥55-year age group. In the youngest age group of earners under 30 years of age, the differences were substantially smaller. Conclusions Gender differences in income persist across the distribution of earnings, resulting in female physical therapists earning approximately 10% less than their male counterparts. The differences are most distinct as physical therapists advance in their careers. Impact The etiology of the earnings gap is unknown, but gender equity has not been achieved yet for physical therapy. </jats:sec

The persistence of gender and racial disparities in vascular lower extremity amputation: An examination of HCUP-NIS data (2002–2011)

The purpose of this study was to examine trends in racial and gender disparities in the severity of lower extremity amputation among individuals with peripheral artery disease (PAD) over the period of a decade (2002–2011). This is a longitudinal secondary analysis of data from the Healthcare Utilization Project Nationwide Inpatient Survey (HCUP-NIS) for the years 2002–2011. Level of amputation was determined from ICD-9-CM procedure and coded as either transfemoral (TF) or transtibial (TT). The main predictors were gender and race; covariates including age, race, income, insurance status and presence of vascular disease were incorporated as control variables in regression analysis. A total 121,587 cases of non-traumatic dysvascular amputations were identified. Female gender (odds ratio (OR) 1.35; 95% confidence interval (CI) 1.32, 1.39) and black race (OR 1.17; 95% CI 1.12, 1.23) are both significantly associated with increased odds for receiving TF amputation with no change in these odds over the decade of study. Other covariates with significant associations with TF amputation level include increased age (OR 1.03; 95% CI 0.99, 1.09), low income (OR 1.21; 95% CI 1.15, 1.27), Medicaid insurance (OR 1.36; 95% CI 1.29, 1.44), Medicare insurance (OR 1.27; 95% CI 1.21, 1.32), and cerebrovascular disease (OR 2.12; 95% CI 2.03, 2.23). In conclusion, although overall rates of amputation have decreased, disparities in level of amputation related to female gender and black race have not significantly changed over time. Higher-level amputation has significant consequences from a quality-of-life, medical and economic perspective. </jats:p