Physical and occupational therapy utilization and associated factors among adults with cerebral palsy: Longitudinal modelling to capture distinct utilization groups.

The study used billing records only, so it could not measure cerebral palsy type, severity, function, pain, mobility, or whether therapy was clinically needed. Physical therapy, occupational therapy, and other physical therapy services were combined into one therapy measure, so the paper cannot separate which service was used or who delivered it. Only 42.4% of the cohort had a distinguishable cerebral palsy phenotype in the claims, and that variable was not used in the main models. The analysis required 3 years of continuous Medicare enrollment, which excluded 3,085 eligible adults; most of those exclusions were deaths, so the sample may miss people who died or changed insurance. Using 1 year to identify cerebral palsy may miss some cases, although a 2-year identification check gave similar results. About 87% had dual Medicare and Medicaid enrollment, so the cohort may represent people with high healthcare service use and may not apply to all adults with cerebral palsy. There was no non-cerebral palsy comparison group, so low therapy use cannot be judged as a disparity from these data alone. The associations with race, region, age, and comorbidities may be caused by unmeasured factors such as provider supply, transport, finances, stigma, insurance coverage, or cultural differences. The study did not show that more therapy improves health, function, or aging; it only described patterns of recorded therapy use. Multinomial model fit statistics were not available, so the adjusted associations should be interpreted cautiously.

Neil Kamdar reports consulting services for the University of New Mexico and Lucent Surgical related to algorithm development within electronic medical records. All other authors declare no conflict of interest. The article is indexed as NIH extramural research support, but no specific funder is named in the text.

Do not conclude that physical or occupational therapy prevented decline or that age, race, region, or comorbidities caused lower therapy use. The study only described billing records, combined physical and occupational therapy, and did not measure function, severity, insurance barriers, or reasons for use.