Post-fracture rehabilitation pathways and association with mortality among adults with cerebral palsy.
Daniel G Whitney, Tao Xu, Dayna Ryan and 4 others
PMID 36039504WHAT IT FOUND
In adults with cerebral palsy discharged home after a fracture, starting outpatient physical or occupational therapy within 6 months was associated with lower 1-year mortality.
Each additional week of therapy correlated with a 13% unadjusted and 16% adjusted reduction in mortality risk.
Key findings
0174.0% of adults with cerebral palsy with an incident fragility fracture were discharged home without inpatient or skilled nursing facility admission.
02Among the home discharge cohort, 43.1% initiated outpatient physical or occupational therapy within 6 months post-fracture.
03For every 1 week of cumulative physical or occupational therapy exposure, the unadjusted and adjusted mortality rate was 13% and 16% lower, respectively.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study relied on administrative claims data, which cannot capture the severity of cerebral palsy, functional capacity, or the quality and specific type of therapy provided. It was not possible to characterize rehabilitation use for the inpatient/skilled nursing facility cohort, so findings apply primarily to those discharged home. Home-based exercises provided by clinicians without claims documentation were not captured, potentially underestimating therapy exposure. As an observational study, unmeasured confounding is possible, although several proxies for medical complexity were included in the adjustment models.
Declared interests
None declared. The study used Medicare fee-for-service claims data.
The easy way to misread this
Do not assume that simply initiating therapy guarantees the survival benefit seen in the cumulative exposure analysis. The binary comparison of 'initiated vs. not initiated' therapy showed non-significant mortality reductions. The benefit was associated with the duration or intensity of therapy exposure over time, not just its occurrence.