Does Patient Race Affect Physical Therapy Treatment Recommendations?

Abstract

Background: Racial disparities in the medical treatment of adults with arthritis are well-documented. Disparities with physical therapy treatment have yet to be thoroughly evaluated.

Objective: To investigate the association of patient's race with physical therapy treatment recommendations for patients with arthritis.

Design: Online survey.

Methods: Physical therapists, physical therapist assistants, student physical therapists, and student physical therapist assistants within a Southern California county completed an online survey that presented a case vignette with a randomly assigned photograph of a White or Black woman. Recommendations for the plan of care included frequency of visits and number of exercises in the home exercise program (HEP), referrals to other healthcare professionals, and explicit ranking of how patient characteristics impacted the treatment planning were compared between respondents who viewed the Black or White patient.

Results: Eighty-three participants completed the survey, and all participants reported that the patient was appropriate for physical therapy. Most participants (66.3%) reported that they would recommend a frequency of therapy of 2-3 times weekly. All participants recommended including a HEP. There were no statistically significant differences by patient race in recommendations for treatment frequency or referrals to other healthcare team members. HEP prescription was a median of four exercises, but participants who viewed the Black patient were more likely to recommend fewer exercises than those who viewed the White patient (p = 0.03). Explicitly, 96.1% of participants reported that race did not impact their treatment recommendations.

Conclusions: In most aspects of treatment planning, the patient's race did not impact recommendations by physical therapy professionals. The lower exercise prescription assigned to the Black patient may represent a disparity that merits further attention.

Keywords: African-American; Arthritis; Disparity; Rehabilitation; Total knee arthroplasty.