Friday, January 04, 2019 From PTJ: Could Impaired Physical Performance Predict Hospitalization Risk? Routine assessments of mobility level by a physical therapist (PT) can help better identify older adults at highest risk for hospitalization, according to a new study in the January issue of PTJ (Physical Therapy). Authors write that their findings "suggest a future role for [PTs] in designing effective screening and intervention programs for older adults participating in…community-based long-term care programs." A team of researchers at University of Colorado, led by APTA member Jennifer Stevens-Lapsley, PT, PhD, analyzed data from both electronic medical records and hospital claims for over 1,000 patients participating in the Program of All-Inclusive Care for the Elderly (PACE) in the Denver area. Sponsored by the US Centers for Medicare and Medicaid Services (CMS), PACE is designed for dual Medicare/Medicaid-eligible adults as a way to provide community-based long-term care services from an interdisciplinary team of health professionals, including PTs. The program brings participants to a community day facility, where they participate in social activities and receive health services. Authors hoped to identify relationships between physical performance scores, using the Short Physical Performance Battery (SPPB) conducted through PACE, and both all-cause and potentially avoidable hospitalizations. "All-cause" hospitalization covered conditions such as heart disease, fractures, and infections, while "potentially avoidable" hospitalizations included incidents such as falls, congestive heart failure, and poor glycemic control. Researchers found that lower SPPB scores were associated with higher rates of hospitalization. Patients with the lowest scores were 1.87 times as likely as those with the highest scores to experience all-cause hospitalization, and 2.27 times as likely to experience potentially avoidable hospitalization. Patients with scores in the middle range were 1.40 times and 1.76 times as likely as the high-score group to experience all-cause and potentially avoidable hospitalization, respectively. While having a greater number of chronic conditions also predicted hospitalization, impaired mobility was a significant and independent risk factor for hospitalization, according to the study. "It is likely that impairments in physical performance constitute a valuable biomarker to identify PACE participants that are vulnerable to hospitalization," authors write. The study's findings come in the wake of a CMS proposal to include potentially avoidable hospitalizations as a quality metric for postacute and long-term care facilities. Authors of the study note that despite the emphasis on avoidable hospitalizations, there has been little research that looks at the relationship between impaired physical performance and a later hospital visit. "The results of this study illustrate the importance of routinely assessing mobility within long-term care settings," said APTA member and lead author Jason R. Falvey, PT, DPT, PhD, a board-certified clinical specialist in geriatric physical therapy. "The study also further supports the role of physical therapists as part of the primary care team for medically complex older adults." In addition to Falvey and Stevens-Lapsley, APTA member Allison Gustavson, PT, DPT, was a coauthor of the study. [Editor's note: for an in-depth look at PTs in primary care teams, check out "A Perspective: Exploring the Roles of Physical Therapists on Primary Care Teams," a paper produced by APTA. For more on this study, listen to a recent PTJ podcast featuring the study's lead author.] Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.