O3242: Delay in Time to Physical Therapy After Orthopaedic Surgery

Background: Pediatric patients are often prescribed physical therapy following an orthopaedic diagnosis or surgical procedure; however, many children experience delays, which can consequently prolong recovery. The purpose of this study was to identify the factors that delay the patient’s ability to receive timely care after referral to physical therapy (PT).

Methods: Pediatric patients who were ordered physical therapy after orthopaedic treatment were prospectively recruited to participate in this study. Patients were administered a Pediatric Outcomes Data Collection Instrument (PODCI) (self or parent-reported) at 6 weeks post initial referral. A delay was defined as a wait of 2 weeks or more between the referral and first physical therapy appointment.

Results: 100 patients with an orthopaedic etiology were enrolled. 60% (60/100) of patients had government insurance and 40% (40/100) had private insurance. Significant differences were revealed between insurance type (p=0.005), ethnicity (p=0.01), and site of injury in time to first appointment (p=0.03). Patients with government insurance were 3.4 times more likely than patients with private insurance to experience a delay to physical therapy (95% CI: 1.5, 8.2). Only 27% (11/40) of patients with private insurance experienced a delay as compared to 57% (34/60) of patients with government insurance. Of the patients with public insurance who experienced a delay, 10% (6/60) were never able to see a physical therapist. All privately insured patients were ultimately seen in PT. More than half (59/100) of participants completed a PODCI; however, there was no correlation was found between PODCI score and delay in therapy (p>0.28).

Conclusion: Patients with government insurance were over three times more likely to experience a delay to attend a physical therapy appointment than patients with private insurance. Ten percent of patients with public insurance were never able to see a physical therapist. These findings demonstrate a marked inequality in access to care based on insurance type.