Orthopedic surgeons and physical therapists differ regarding rehabilitative needs after lower extremity fracture repair.
Kevin H McLaughlin, Kristin R Archer, Babar Shafiq and 2 others
PMID 35594136WHAT IT FOUND
Surgeons refer most patients for peri-articular fractures and stiffness, but rarely consider pain severity.
Physical therapists, however, frequently adjust care based on pain and psychosocial factors, creating a gap between surgical referral priorities and actual therapy practice.
Key findings
01Surgeons most frequently refer patients for joint stiffness (98%), functional goals (80%), and strength limitations (76%), but only 29% consider pain severity.
02Physical therapists are significantly more likely than surgeons to report that pain severity, maladaptive pain behaviors, and patient self-efficacy affect their plan of care.
03Surgeons prescribe higher visit frequencies for peri-articular fractures (tibial plateau, distal femur, pilon) compared to foot fractures, but few physical therapists adjust visit frequency by fracture type.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Response rates could not be calculated due to anonymity and delivery issues, so it is unknown if respondents represent the broader population. Respondents were primarily academic surgeons and board-certified PT specialists, which may not reflect community practice. Surgeons make referral decisions before therapy begins, while PTs adapt care over time, making direct comparison of their 'decision factors' imperfect.
Declared interests
The authors declared no relevant conflicts of interest.
The easy way to misread this
Do not assume surgeons ignore pain. The survey shows pain is a less common *primary* driver for referral compared to stiffness, but it does not mean pain is excluded from the clinical picture or that surgeons disapprove of addressing it.