Research Article| Volume 11, ISSUE 1, P32-38, January 1998

Download started.


Determinants of use of outpatient rehabilitation services following upper extremity injury

      This paper is only available as a PDF. To read, Please Download here.


      This study documents the utilization of outpatient therapy services following upper extremity injury and identifies factors that influence the use of services. One hundred twelve patients admitted to a hand center for treatment of upper extremity injury were followed prospectively for 7 months to determine their utilization of therapy services and their perceptions of unmet need. Eighty percent of the patients used therapy services following their injury. Those who were more severely injured, were female, had health insurance, or obtained disability compensation made more visits than other subjects. One third of the patients reported that they did not have an adequate number of therapy visits. Subjects cited various reasons (e.g., lack of insurance, transportation difficulties) for unmet need. These findings suggest that the variation in utilization of rehabilitation services depends on not only the severity of the injury but other patient characteristics and resources as well.


        • Graves EJ
        Detailed Diagnoses and Procedures: National Hospital Discharge Survey, 1992. National Center for Health Statistics, Hyattsville, MD1994
        • Kreiger N
        • Kelsey JL
        • Harris C
        • Pastides H
        Injuries to the upper extremity: patterns of occurrence.
        Clin Plast Surg. 1981; 8: 13-19
        • Oleske DM
        • Hahn JJ
        Work-related injuries of the hand: data from an occupational injury/illness surveillance system.
        J Community Health. 1992; 17: 205-219
        • Committee on Injury Scaling
        The Abbreviated Injury Scale 1990 Revision. Association for the Advancement of Automotive Medicine, Des Plaines, IL1990
        • MacKenzie EJ
        Injury severity scales: overview and directions for future research.
        J Emerg Med. 1984; 2: 537-549
        • Selker LG
        Human resources in physical therapy: opportunities for service in a rapidly changing health system.
        Phys Ther. 1995; 75: 31-37
        • Evans RL
        • Haselkorn JK
        • Bishop DS
        • Hendricks RD
        Factors influencing the decision to rehabilitate: an initial comparison of rehabilitation candidates.
        Soc Sci Med. 1991; 33: 801-806
        • Haas JF
        Admission to rehabilitation centers: selection of patients.
        Arch Phys Med Rehabil. 1988; 69: 329-332
        • Jette AM
        • Smith K
        • Haley SM
        • Davis KD
        Physical therapy episodes of care for patients with low back pain.
        Phys Ther. 1994; 74: 101-115
        • Engelhardt Jr, HT
        • Rie MA
        Intensive care units, scarce resources, and conflicting principles of justice.
        JAMA. 1986; 255: 1159-1164
      1. Klonoff EA, Landrine H: Sex roles, occupational roles, and symptom-reporting: a test of competing hypotheses on sex differences. J Behav Med. 192;15:355–64.

        • Cleary PD
        • Mechanic D
        • Greenley JR
        Sex differences in medical care utilization: an empirical investigation.
        J Health Soc Beahv. 1982; 23: 106-109
        • Verbrugge L
        Sex differences in complaints and differences in complaints and diagnoses.
        J Behav Med. 1980; 3: 327-356
        • Andersen R
        • Chen M
        • Aday LA
        • Cornelius L
        Health status and medical care utilization.
        Health Affairs. 1987; : 136-156
        • Stoddard JJ
        • St Peter RF
        • Newacheck PW
        Health insurance status and ambulatory care for children.
        N Engl J Med. 1994; 330: 421-425
        • Friedman E
        Money isn't everything.
        JAMA. 1994; 271: 1535-1538
        • Brook RH
        Health, health insurance, and the uninsured.
        JAMA. 1991; 265: 2998-3002
        • Jette AM
        • Davis KD
        A comparison of hospital-based and private outpatient physical therapy practices.
        Phys Ther. 1991; 71: 366-381
        • Mitchell JM
        • Scott E
        Physician ownership of physical services: efects on charges, utilization, profits, and service characteristics.
        JAMA. 1992; 268: 2055-2059
        • Murtaugh CM
        • Cooney LM
        • DerSimonian RR
        • Smits HL
        • Fetter RB
        Nursing home reimbursement and the allocation of rehabilitation therapy resources.
        Health Serv Res. 1988; 23: 467-493
        • Murdock K
        • MacKenzie EJ
        Use of physical therapy following lower extremity fracture. 1996 (Manuscript in preparation)
        • Cleary PD
        • Jette AM
        The validity of self-reported physician utilization measures.
        Med Care. 1984; 22: 796-803
        • Marquis KH
        • Marquis MS
        • Newhouse JP
        The measurement of expenditures for outpatient physician and dental services: methodological findings from the Health Insurance Study.
        Med Care. 1976; 14: 913-931
        • Jette AM
        Using health-related quality of life measures in physical therapy outcomes research.
        Phys Ther. 1993; 73: 528-537