Predictors of physical therapy use in patients with rheumatoid arthritis

Although physical therapy (PT) improves function and reduces disability in patients with RA, PT services are underutilized. To identify factors associated with receipt of PT services we conducted a prospective study of 772 patients who completed questionnaires and received a physical examination at baseline and completed a 12-month follow-up survey. Measures included: demographics, self-efficacy, social support (BSNI), function (MDHAQ), quality of life (EuroQoL), disease activity (RADAI) and self-reported PT service use (yes/no) at 12-months. Descriptive statistics characterized the sample and bivariate comparisons identified potential variables for logistic regression analysis. Using a modified liseral approach, variables were selected and entered into the model in groups, to develop a parsimonious set of predictors. Most of patients were Caucasians (93.6%), female (82.3%), married (64.7%) with a mean age of 56.29 (+/-13.57) years. Using bivariate analysis, factors most predictive of PT services were: disability, RADAI, income, EuroQoL, co-morbidities, MDHAQ and BSNI. In multivariate analysis, the most significant predictors were RADAI (OR=1.14 95%CI=1.02-1.28) co-morbidities (OR=1.5 95%CI=1.04-2.07) EuroQoL (OR=0.06 95%CI=0.01-0.32), BSNI (OR=1.05 95%CI=1.01-1.10) and disability (OR=2.00 95%CI=1.01-3.93). Patients with greater disease activity, co-morbidities and disability and who reported lower quality of life and greater social support were more likely to receive PT services. This model explained 86% of the variance in PT service use.