Rp. Difabio et W. Boissonnault, PHYSICAL THERAPY AND HEALTH-RELATED OUTCOMES FOR PATIENTS WITH COMMONORTHOPEDIC DIAGNOSES, The Journal of orthopaedic and sports physical therapy, 27(3), 1998, pp. 219-230
Assessing both physical and mental health is necessary in clinical set
tings to quantify the scope of disability and to evaluate the effectiv
eness of treatment programs. Changes in health-related quality of life
following physical therapy treatment for many patients with orthopaed
ic-related diagnoses is not known. The purposes of this study were to
describe changes in health-related quality of life between the initial
assessment and the time of discharge from physical therapy for the mo
st common orthopaedic diagnoses and to compare the patterns of deficit
among diagnostic categories. Patient outcomes in this study were eval
uated from a large database generated by the Focus on Therapeutic Outc
omes (FOTO) network. Health-related and employment outcomes were descr
ibed for adult patients who were classified using ICD-9-CM codes. The
most common orthopaedic diagnostic categories were sacroiliac sprain,
back sprain, low back pain (radiating and nonradiating), neck sprain,
neck pain (radiating and nonradiating), adhesive capsulitis of the sho
ulder, rotator cuff injury, shoulder sprain, knee dislocation, knee sp
rain, and knee derangement. The primary outcome measure was a 17-item
questionnaire (the MOS-17) derived from the RAND 36-item Health Survey
(SF-36) and the 12-item Short Form Health Survey (SF-12). The compari
son of each cohort to population norms was made by calculating a stand
ard score on patient data adjusted for age and gender. An effect size
was calculated to measure the change in health or employment status be
tween the initial assessment and discharge from physical therapy. For
all diagnostic categories, health-related quality of life with respect
to norms and employment status showed a consistent pattern of improve
ment at the time of discharge compared with the initial assessment The
re were only small changes in physical function for neck and shoulder
diagnostic categories. Nearly all of the diagnostic categories had lar
ge reductions in bodily pain. The amount of clinical change in the phy
sical components of health-related quality of life-especially the phys
ical function and role physical domains-differed substantially across
specific diagnostic categories. The largest improvements in the physic
al function occurred for patients with knee dislocation and knee sprai
n. Patients with knee dislocation also had the largest improvement in
role limitations due to physical problems. The design of this study do
es not permit conclusions about the efficacy of physical therapy Furth
er study is needed to determine in the finding of different levels of
health status improvement across diagnostic categories was due to the
nature of the outcome measure, the type of treatments given to each pa
tient or other confounding variables, like depression or preinjury fun
ctional level.