Background: The optimal quantity of physical therapy provided to hospitalized patients is unknown. It has been hypothesized that the costs of additional physical therapy might be outweighed by a decrease in length of stay. A prior meta-analysis done by the same authors was inconclusive; subsequently, additional large trials were published, prompting the authors to repeat their meta-analysis.
Dr. Bryan Huang
Study design: Meta-analysis.
Setting: Literature review of English-language studies conducted worldwide.
Synopsis: A total of 24 randomized controlled trials with a total of 3,262 participants was included in this meta-analysis. The primary finding was that additional physical therapy was associated with a 3-day reduction in length of stay in subacute settings (95% confidence interval, –4.6 to –0.9) and a 0.6-day reduction in acute care settings (95% CI, –1.1 to 0.0). Furthermore, additional physical therapy was associated with small improvements in self-care and activities of daily living. One trial included an economic analysis that suggested additional physical therapy was cost effective.
Of note, there was no standard definition of “additional physical therapy” across the heterogeneous group of trials analyzed in this meta-analysis. In all studies, the experimental group received more physical therapy than the control group, either by increased frequency or duration of sessions. Nonetheless, hospitals may consider increasing physical therapy services as a cost-effective means of reducing length of stay.
Bottom line: Additional physical therapy in acute and subacute care settings results in a decreased length of stay and may be cost effective.
Citation: Peiris CL et al. Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and subacute conditions: an updated systematic review and meta-analysis. Arch Phys Med Rehab. 2018;99(11):2299-312.
Dr. Huang is a physician adviser and associate clinical professor in the division of hospital medicine at the University of California, San Diego.