Low socioeconomic status may be associated with missed physical therapy appointments
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Key takeaways:
- Patients from socioeconomic deprived areas may be more likely to miss scheduled physical therapy appointments.
- Socioeconomic status was measured with the area deprivation index tool.
Published results showed patients from socioeconomic deprived areas may be more likely to miss scheduled physical therapy appointments after arthroscopic labral repair for shoulder instability.
Misty Suri, MD, from the department of orthopedic surgery at the Ochsner Clinic Foundation in New Orleans, and colleagues performed a single-center, retrospective cohort comparison of data from 73 patients (mean age, 24 years) who underwent arthroscopic labral repair for shoulder instability between 2019 and 2023.
Suri and colleagues assessed patients’ socioeconomic status with the area deprivation index (ADI), a validated tool that uses U.S. census data to quantify socioeconomic deprivation areas. They analyzed demographic information, insurance type, missed physical therapy appointments and return to play.
Among the cohort, 63% of patients were white, 27.8% were Black and 8.2% were either Hispanic or Asian. Most of the patients were men. Suri and colleagues noted 75.3% of patients had private insurance and 24.7% of patients had Medicaid.
Overall, the average ADI of the cohort was 55. Suri and colleagues found missed physical therapy appointments increased as ADI increased (P = .035). However, they found no association between ADI and return to play times. Suri and colleagues also found no association between insurance type and missed appointments or return to play times.
“Patients from a disadvantaged socioeconomic neighborhood may face difficulties in accessing health care services or managing intricate health care systems,” Suri and colleagues wrote in the study. “Health care providers can use ADI to stratify patients and implement additional measures such as organizing transport to attend physical therapy sessions.”
“Surgeons may be able to use ADI as a tool to flag patients preoperatively and implement measures proactively to improve physical therapy compliance,” Suri and colleagues concluded.
Perspective
Back to TopTyler M. Hauer, MD, and James P. Bradley, MD
From our experience in Pittsburgh, we have not noticed barriers to attending scheduled physical therapy appointments following shoulder stabilization surgery based on a patient’s socioeconomic status. We have not specifically calculated the ADI among our patients, but we do serve numerous athletes of low socioeconomic status. Physical therapy gets approved regardless of insurance provider, and we feel that our patients adhere to their postoperative protocols.
We have not specifically calculated missed physical therapy appointments among our patients, but we have not noticed differences in progression of rehabilitation and timing of return to play. This is consistent with the author’s findings in that no differences were observed in return to play with relation to socioeconomic status.
The author mentions that it may be difficult to access physical therapy appointments due to lack of transportation in the lower socioeconomic group. We would also add that the higher frequency of missed physical therapy appointments in the lower socioeconomic status group may be related to the required co-pay at the time of the physical therapy visit.
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