Outpatient Physical Therapy Utilization Following Tibia Fractures: A Retrospective Commercial Claims Analysis.

OBJECTIVE The purpose of this study was to characterize outpatient physical therapy (OPT) utilization following tibia fractures and examine the variability of OPT attendance, time of initiation, number of visits, and length of care by patient, injury, and treatment factors. In the absence of clinical guidelines, results will guide future efforts to optimize OPT following tibia fractures. METHODS This study utilized 2016-2017 claims from the IBM MarketScan Commercial Claims Research Database. The cohort included 9079 patients with ICD-10 diagnosis codes for tibia fractures. Utilization the year following initial fracture management was determined using Current Procedural Terminology codes. Differences in utilization were examined using chi-square, t tests, and Kruskal-Wallace tests. RESULTS Sixty-seven percent of patients received OPT the year following fracture. OPT attendance was higher among female patients, patients with one or no major comorbidity, and in the Western United States. Attendance was higher among patients with upper tibia fractures, moderate-severity injuries, and treatment with external fixation and among patients discharged to an inpatient rehabilitation facility. On average, patients started OPT 50 days (SD = 52.6) after fracture; attended 18 visits (SD = 16.1) over the course of 101 days (SD = 86.4). The timing of OPT, the number of visits attended, and the length of OPT care varied by patient, injury, and treatment-level factors. CONCLUSIONS One third of insured patients do not receive OPT following tibia fracture. The timing of OPT initiation, the length of OPT care, and the number of visits attended by patients with tibia fractures were highly variable. Further research is needed to standardize referral and prescription practices for OPT following tibia fractures. IMPACT OPT utilization varies based on patient, injury, and treatment-level factors following tibia fractures. Results from this study can be used to inform future efforts to optimize rehabilitation care for patients with tibia fractures.