Rehabilitation Underutilization: Using a Model of Rheumatoid Arthritis to Illustrate Unmet Needs.
Chris Y Lane, Alexander J Maturino, Lauren Mihalek and 4 others
PMID 42326593WHAT IT FOUND
25% of 309 adults with rheumatoid arthritis had moderate to severe limits in everyday physical function but had never used physiotherapy or occupational therapy for it.
Underuse was most common in people on Medicaid or Medicare, without insurance, and on lower incomes.
Key findings
0125% of the sample (76 of 309) had moderate to severe functional limitation and had never used rehabilitation for their rheumatoid arthritis, which is how the study defined rehabilitation underutilization.
0234% had used physical therapy and 15% occupational therapy for their rheumatoid arthritis; 37% had used one or both.
03After adjusting for age, disease duration and joint replacement, underuse of rehabilitation was more likely in people with Medicaid, Medicare or no insurance than with private insurance, and in people with lower income, less education, disabled work status, obesity or another major medical condition. Race and ethnicity, and gender, showed no association.
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
Only about 20% of eligible patients completed the survey, and those who did were more likely to have some college education and to say they were financially comfortable. The authors say this probably makes the real rate of underuse higher, not lower. Function and rehabilitation use were both self-reported. There were no objective measures of physical function, and people may have forgotten whether previous therapy was for their arthritis or for something else. Everyone was treated at one academic medical centre, which may not reflect other clinic types. That clinic had no standard practice of referring patients for rehabilitation. The design was cross-sectional, so it can show what goes together but not what causes what. The authors had no information on whether a rehabilitation referral was ever made, only on whether the person had attended. The survey existed only in English, and the numbers of people in some racial groups and in the 'other gender identity' group were too small to analyse, so no conclusions apply to them. An error in the naming of the physical function questionnaire's response options was found after data collection; the authors judged that its effect on this analysis was minimal. Counting only people with at least moderate limitation as needing rehabilitation is described by the authors as conservative and may underestimate how many people were missing out.
Declared interests
The supplied article text contains no funding statement and no conflict-of-interest declaration, so there is nothing to report about who paid for or influenced the work.
The easy way to misread this
Do not conclude from this that these patients were never referred or that they turned rehabilitation down. The study asked only whether they had ever attended therapy, and collected no information about referrals, so it cannot tell you where along the pathway the gap opens. It is also a single-clinic survey, so the percentages describe that group rather than predicting your own caseload.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →