The Effectiveness of the Physical Therapist Assistant in the Acute Rehabilitation Setting

University of Minnesota Ph.D. dissertation. November 2015. Major: Health Services Research, Policy and Administration. Advisor: Robert Kane. 1 computer file (PDF); vii, 78 pages.Background and Purpose: Physical therapy care is delivered by physical therapists (PTs) as well as physical therapist assistants (PTAs) and other support personnel. There is very little published evidence describing patient outcomes when physical therapy care is directed to the PTA. This study investigates if higher utilization of PTAs affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA) or following bilateral total knee replacements (TKR). Methods: Retrospective data was gathered on subjects admitted to five inpatient acute rehabilitation facilities following CVA and bilateral TKR from 2008-2010. High PTA use was defined as greater than or equal to 20% of the physical therapy visits being provided by the PTA for an episode of care. Analysis of baseline characteristics was used to determine case mix similarities and differences between high and low PTA use groups. Multivariate regression techniques were used to examine differences in functional outcome (Motor FIM score change), discharge location, and length of stay between high and low PTA use groups. Propensity scoring methods were used to supplement findings of the regression analyses. All data analysis was performed with IBM®SPSS® Statistics Version 22. Outcomes: Of the 1561 subjects following CVA, 496 (32%) had high PTA involvement. Of the 242 subjects following bilateral TKR, 91 (38%) had high PTA involvement. Baseline subject characteristics such as age, gender, baseline motor function and clinical co-morbidities were generally evenly distributed between high and low PTA use groups for both diagnostic groups. After controlling for patient characteristics, rehabilitation facility and year, there were no significant differences in functional outcome, discharge location or length of stay between groups with high and low PTA utilization for either diagnosis. The sample size was adequate to detect a small effect size of 0.2. Conclusion: In the acute rehabilitation setting following CVA or bilateral TKR, subjects who had higher PTA involvement were similar in clinical severity as well as demographic characteristics to subjects who had lower PTA involvement. Higher PTA involvement in the rehabilitation of patients following CVA or bilateral TKR did not adversely affect functional outcome, increase length of stay or reduce the likelihood of discharge to home