Utilization of rehabilitation therapy services in Parkinson disease in the United States

Michelle E Fullard¹, Dylan P Thibault², Andrew Hill², Joellyn Fox², Danish E Bhatti², Michelle A Burack², Nabila Dahodwala², Elizabeth Haberfeld², Drew S Kern², Olga S Klepitskava², Enrique Urrea-Mendoza², Phillip Myers², Jay Nutt², Miriam R Rafferty², Jason M Schwalb², Lisa M Shulman², Allison W Willis²; Parkinson Study Group Healthcare Outcomes and Disparities Working Group

Affiliations

¹ From the Departments of Neurology (M.E.F., D.P.T., A.H., N.D., A.W.W.) and Biostatistics and Epidemiology (D.P.T., A.H., A.W.W.), University of Pennsylvania School of Medicine; Dan Aaron Parkinson's Rehabilitation Center (J.F.), Leonard Davis Institute of Health Economics (A.W.W.), and Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania, Philadelphia; Department of Neurobiological Sciences (D.E.B.), University of Nebraska Medical Center, Omaha; Department of Neurology (M.A.B.), University of Rochester, NY; Department of Neurology (E.H.), Temple University, Philadelphia, PA; Department of Neurology (D.S.K., O.S.K.), University of Colorado, Aurora; Greenville Health System (E.-U.M.), SC; Parkinson's Disease Foundation Advocate Group (P.M.), Lakeport, CA; Department of Neurology (J.N.), Oregon Health Sciences University, Portland; Center for Education in Health Sciences (M.R.R.), Northwestern University, Evanston, IL; Department of Neurosurgery (J.M.S.), Henry Ford Medical Group, Detroit, MI; Department of Neurology (L.M.S.), University of Maryland School of Medicine, Baltimore. Michelle.Fullard@uphs.upenn.edu.
² From the Departments of Neurology (M.E.F., D.P.T., A.H., N.D., A.W.W.) and Biostatistics and Epidemiology (D.P.T., A.H., A.W.W.), University of Pennsylvania School of Medicine; Dan Aaron Parkinson's Rehabilitation Center (J.F.), Leonard Davis Institute of Health Economics (A.W.W.), and Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania, Philadelphia; Department of Neurobiological Sciences (D.E.B.), University of Nebraska Medical Center, Omaha; Department of Neurology (M.A.B.), University of Rochester, NY; Department of Neurology (E.H.), Temple University, Philadelphia, PA; Department of Neurology (D.S.K., O.S.K.), University of Colorado, Aurora; Greenville Health System (E.-U.M.), SC; Parkinson's Disease Foundation Advocate Group (P.M.), Lakeport, CA; Department of Neurology (J.N.), Oregon Health Sciences University, Portland; Center for Education in Health Sciences (M.R.R.), Northwestern University, Evanston, IL; Department of Neurosurgery (J.M.S.), Henry Ford Medical Group, Detroit, MI; Department of Neurology (L.M.S.), University of Maryland School of Medicine, Baltimore.

PMID: 28835397
PMCID: PMC5595277
DOI: 10.1212/WNL.0000000000004355

Utilization of rehabilitation therapy services in Parkinson disease in the United States

Michelle E Fullard et al. Neurology. 2017.

. 2017 Sep 12;89(11):1162-1169.

doi: 10.1212/WNL.0000000000004355. Epub 2017 Aug 23.

Authors

Affiliations

¹ From the Departments of Neurology (M.E.F., D.P.T., A.H., N.D., A.W.W.) and Biostatistics and Epidemiology (D.P.T., A.H., A.W.W.), University of Pennsylvania School of Medicine; Dan Aaron Parkinson's Rehabilitation Center (J.F.), Leonard Davis Institute of Health Economics (A.W.W.), and Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania, Philadelphia; Department of Neurobiological Sciences (D.E.B.), University of Nebraska Medical Center, Omaha; Department of Neurology (M.A.B.), University of Rochester, NY; Department of Neurology (E.H.), Temple University, Philadelphia, PA; Department of Neurology (D.S.K., O.S.K.), University of Colorado, Aurora; Greenville Health System (E.-U.M.), SC; Parkinson's Disease Foundation Advocate Group (P.M.), Lakeport, CA; Department of Neurology (J.N.), Oregon Health Sciences University, Portland; Center for Education in Health Sciences (M.R.R.), Northwestern University, Evanston, IL; Department of Neurosurgery (J.M.S.), Henry Ford Medical Group, Detroit, MI; Department of Neurology (L.M.S.), University of Maryland School of Medicine, Baltimore. Michelle.Fullard@uphs.upenn.edu.
² From the Departments of Neurology (M.E.F., D.P.T., A.H., N.D., A.W.W.) and Biostatistics and Epidemiology (D.P.T., A.H., A.W.W.), University of Pennsylvania School of Medicine; Dan Aaron Parkinson's Rehabilitation Center (J.F.), Leonard Davis Institute of Health Economics (A.W.W.), and Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania, Philadelphia; Department of Neurobiological Sciences (D.E.B.), University of Nebraska Medical Center, Omaha; Department of Neurology (M.A.B.), University of Rochester, NY; Department of Neurology (E.H.), Temple University, Philadelphia, PA; Department of Neurology (D.S.K., O.S.K.), University of Colorado, Aurora; Greenville Health System (E.-U.M.), SC; Parkinson's Disease Foundation Advocate Group (P.M.), Lakeport, CA; Department of Neurology (J.N.), Oregon Health Sciences University, Portland; Center for Education in Health Sciences (M.R.R.), Northwestern University, Evanston, IL; Department of Neurosurgery (J.M.S.), Henry Ford Medical Group, Detroit, MI; Department of Neurology (L.M.S.), University of Maryland School of Medicine, Baltimore.

PMID: 28835397
PMCID: PMC5595277
DOI: 10.1212/WNL.0000000000004355

Abstract

Objective: To examine rehabilitation therapy utilization for Parkinson disease (PD).

Methods: We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST).

Results: Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30-1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization.

Conclusions: This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not.

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Figures

**Figure. Receipt of rehabilitation therapies by state**
The prevalence of physical therapy (PT) and occupational therapy (OT) utilization over 3 years is shown by state. *Low supply of rehabilitation therapy providers indicates the state was in the lowest tertile for provider supply. PD = Parkinson disease.

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Comment in

Reader response: Utilization of rehabilitation therapy services in Parkinson disease in the United States.
Bryant MS, Protas EJ. Bryant MS, et al. Neurology. 2018 Apr 24;90(17):812. doi: 10.1212/WNL.0000000000005368. Neurology. 2018. PMID: 29686120 No abstract available.
Author response: Utilization of rehabilitation therapy services in Parkinson disease in the United States.
Fullard ME, Willis AW. Fullard ME, et al. Neurology. 2018 Apr 24;90(17):813. doi: 10.1212/WNL.0000000000005367. Neurology. 2018. PMID: 29686121 Free PMC article. No abstract available.

References

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Utilization of rehabilitation therapy services in Parkinson disease in the United States

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Utilization of rehabilitation therapy services in Parkinson disease in the United States

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