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Physiotherapy Works for Rehabilitation

Physiotherapy rehabilitation is a clinically sound and cost effective intervention for those patients whose life has been adversely changed by injury, illness, or disease.

What is rehabilitation?

Physiotherapy rehabilitation aims to optimize patient function and well being, it helps the patient get back to daily activities, work, and leisure. It focuses on reducing disability and lifestyle restrictions.1 Rehabilitation can be used for recovery from injury or disease and also for management of long-term conditions (e.g., Parkinson’s disease and multiple sclerosis).

Rehabilitation should start as soon as possible to speed recovery. The programs that combine many different components are more likely to be effective.2 Nineteen minutes additional exercise a day in an acute or rehabilitation setting is all that is required to achieve:

  • Improved mobility and activity levels
  • Shorter length of stay in hospital
  • Significantly improved quality of life3

Musculoskeletal disorders (MSDs)

Early intervention by physiotherapists for non-traumatic musculoskeletal disorders (such as low back strain, tennis elbow or knee pain) can reduce pain and decrease disability as well as shorten wait times for assessment and treatment.

A recent study of physiotherapy practice in 10 emergency departments (from rural to urban teaching centers) found patients seen by physiotherapists had consistent reductions in waiting time, treatment time, and time to discharge, across all sites.4

A stratified process for assessment streaming and treatment targeting found that patients receiving early access to physiotherapists had less disability and pain as well as a better quality of life and fewer days off work at both the four and 12 month follow-up.5

MSDs

  • Repetitive strain injuries (a type of MSD) affect approximately 15% of Canadians (4.5 million people).6
  • MSDs are the most common reason for repeat consultations with general practitioners.7

Chronic Obstructive Pulmonary Disease (COPD)

A study in 2010 evaluating the effect of pulmonary rehabilitation delivered post COPD exacerbation showed a reduction in re-admissions of 26% with cost effectiveness demonstrated.8

Likewise, results of a randomized controlled trial found that for patients chronically disabled by COPD, an intensive outpatient rehabilitation program, including physiotherapy, decreased hospital length of stay in the long term.9

COPD

  • COPD has highest admission rate of all chronic diseases in Canada. In addition, 18% are readmitted once within the first year, 14% are readmitted a second time the same year.10
  • In 2008, COPD admissions were estimated at $1.5 billion annually in Canada.10

Falls

The Public Health Agency of Canada recommendations specify that all older people with recurrent falls, or at increased risk of falling, to be considered for individualized multifactorial rehabilitation including strength and balance training, home hazard assessment and intervention.12

Physiotherapy-led falls prevention programs are cost effective. A recent review found that for seniors over 65 years of age, the net benefit was $121.85 per participant and the ROI was 36% per dollar invested. For those aged 80 and older, the net benefit was $429.18 and the ROI was 127%.13

Falls

  • One in three seniors over 65 years of age fall each year.11
  • 85% of seniors’ injury related hospitalizations in Canada is due to a fall.11
  • Falls cost Canada more than any other injury. The total economic burden in 2010 (direct and indirect costs) for falls was over $6 billion annually.11

Stroke

Rehabilitation at home or in the community rather than in hospital has been shown to be cost effective when combined with stroke unit care. Early supported discharge can reduce long-term dependency and admission to institutional care as well as releasing hospital beds by reducing length of stay.14 Physiotherapists are ideally placed to support individuals in working towards reablement and recovery.

Stroke

  • The total economic cost of stroke in Canada is $3.6 billion annually in health-care professional services, hospital costs, lost wages, and decrease productivity.15
  • Every year in Canada over 50,000 people have a stroke. About 426,000 Canadians are living with the effects of a stroke.15

Ackowledgement  

Adapted and used with permission of the Chartered Society of Physiotherapy

References

  1. Canadian Physiotherapy Association. Description of physiotherapy in Canada 2012; 1-15 https://physiotherapy.ca/sites/default/files/site_documents/dopen-en.pdf
  2. Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, Ebrahim S. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. The Lancet. 2008;371(9614):725-35
  3. Peiris C, Taylor N, Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review. Arch Phys Med Rehabil 2011 Sep;92(9):. 2011;92(9):1490-500
  4. Bird S, Thompson C, Williams KE.  Primary contact physiotherapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: an observational study. Journal of Physiotherapy. 2016; 62 (4) 209-214.
  5. Hill J C, Whitehurst D G, Lewis M, Bryan S, Dunn K M, Foster, N E et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. 2011;378(9802),1560–1571.
  6. Statistics Canada. Canadian Community Health Survey: combined data 2013/2014. http://www.statcan.gc.ca/daily-quotidien/150624/dq150624b-eng.htm
  7. Petrella R, Davis P. Improving management of musculoskeletal disorders in primary care: the joint adventures program. Clin Rheumatol. 2007; 26:1061-1066.Doi 10.1007/s10067-006-0446-4
  8. Seymour JM, Moore L, Jolley CJ, Ward K, Creasey J, Steier JS, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010 May;65(5):423-8
  9. Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000 Jan 29;355(9201):362-8
  10.     Benady S. The human and economic burden of COPD: a leading cause of hospital admission in Canada.  Canadian Thoracic Society. 2010, Feb.  https://www.lung.ca/file/309/download?token=KnAuJ7t7
  11.     Department of Health. Falls and fractures. Effective interventions in health and social care. London: Department of Health 2009
  12.     Public Health Agency of Canada. Seniors falls in Canada: second report. 2014. http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf
  13.     Carande –Kulis V, Stevens JA, Florence CS, Beattie BL, Arias I. A cost-benefit analysis of three older adult fall prevention interventions. J Safety Res. 2015 Feb; 52:65-70. doi: 10.1016/j.jsr.2014.12.007. epub 2015 Jan 6
  14. Saka O, Serra V, Samyshkin Y, McGuire A, Wolfe CC. Cost-effectiveness of stroke unit care followed by early supported discharge. Stroke. 2009 Jan;40(1):24-9  Ontario Stroke Network. Stroke stats and facts 2015 https://ontariostrokenetwork.ca/information-about-stroke/stroke-stats-and-facts/