Trends of Physical and Occupational Therapy Utilization in ICU Patients Undergoing Mechanical Ventilation in the United States: 2008-2021.

Abstract

Background: Physical and occupational therapy (PT/OT) during invasive mechanical ventilation (IMV) may improve outcomes, however, utilization patterns are understudied.

Objectives: Determine trends over time and by hospital in PT/OT utilization.

Design: Retrospective study.

Setting: Premier Healthcare Database hospitals (2008-2021).

Patients: Adults beginning IMV by hospitalization day 3 and receiving IMV continuously for 3-14 days.

Interventions: None.

Measurements and main results: The primary outcome was PT/OT usage within the first 3 days of IMV (early PT/OT). Cochran-Armitage tests were used to evaluate unadjusted trends across discharge years. A multilevel multivariable logistic regression model was then created with discharge hospital as a random effect and clinical, sociodemographic, and hospital characteristics as covariables. The median odds ratio (mOR) was calculated to quantify the association of discharge hospital with PT/OT utilization. Across 814 hospitals, 1,228,909 early IMV hospitalizations were identified. Of those, 118,662 (9.7%) had early PT/OT. Frequency of early PT/OT rose from 2008 to 2019 (8.5-10.8%; ptrend < 0.001) before declining in 2020 (9.5%) and 2021 (8.9%). Across hospitals, median early PT/OT usage was 5.4% (interquartile range, 2.9-11.0%). After multivariable adjustment, patients were increasingly more likely to get early PT/OT every year until 2016 (adjusted odds ratio [aOR] for 2016 vs. 2008, 1.52; 95% CI, 1.46-1.59). Use then remained relatively flat until 2020 when it began to decline (aOR for 2020, 1.23; 95% CI, 1.18-1.29 and aOR for 2021, 1.20; 95% CI, 1.15-1.26). The odds of receiving early PT/OT in higher use hospitals was nearly three-fold higher than in lower use hospitals (mOR, 2.82; 95% CI, 2.67-2.97).

Conclusions: Early PT/OT usage rose during the early period, before declining significantly in 2020 and 2021. However, use in 2020 and 2021 remained higher than in 2008. Individual hospital of discharge was an important factor in determining who got PT/OT during IMV.