Feasibility of Physical Thearpy in a Child to Adult Primary Care Transitional Clinic

Purpose/Hypothesis: Transitioning young adults with complex medical needs from child to adult based medical services is challenging due to the multifaceted management of the patient. Challenges include communication among unfamiliar medical providers, equipment stipulations, insurance coverage and available resources. As a result, transition can lead to increased caregiver burden, frequent hospital readmissions, and poor quality of life. Recently, an interdisciplinary transitional clinic that includes physical therapy (PT) as part of the primary care team was implemented at UAB. The goal of the clinic is to create a bridge to facilitate effective interdisciplinary care, decrease barriers for both caregivers and young adults with chronic medical conditions, as well as hospital admission rates. PT impacts these goals by performing functional screens, providing education, facilitating outpatient services, and referring for equipment needs. The purpose of this study is to assess the feasibility and impact of PT as part of the primary care team during the first year of a transitional clinic for young adults with complex medical needs.

Number of Subjects: 112

Materials/Methods: A feasibility study was conducted over the first year of a transitional clinical for medically complex young adults to assess the impact of PT in a primary care setting. A prospective cohort design was used to track number of patients seen, referrals, referral areas, changes in caregiver burden scores, as well as clinical outcomes. Findings and recommendations are discussed with the team to facilitate interdisciplinary care. Reassessments are performed at follow-up appointments to evaluate changes and adherence.

Results: 210 patients were referred to clinic and of those, 112 (53.33%) were seen by PT. Of the 112 patients screened, 22 (19.64%) were referred to outpatient-based PT services. 32 (28.57%) referrals were made to wheelchair seating clinics. 11 (0.10%) referrals were made for equipment. 34 (30.4%) patients were referred to community-based resources local to Birmingham. Patients additionally received education on home exercise and positioning programs, pain relief, caregiver education, as well as other strategies to improve the patient’s quality of life. Data from caregiver burden scores and adherence to referrals are currently being collected as patients return for follow-up.

Conclusions: PT in a primary care transitional clinic for young adults with complex medical needs is feasible and allows for screening that can provide education, refer for needed therapy services, equipment, improve quality of life and potentially decrease caregiver burden. This is particularly important as many young adults have not had therapy services since childhood or have missed school services due to the pandemic.

Clinical Relevance: Clinics that focus on transition of young adults with chronic complex medical needs from child to adult based services are rare with only three established clinics in the United States. PT can have an important role in primary care clinics to improve functional outcomes from a physical and affective perspective.