Physical or Occupational Therapy Utilization in Systemic Sclerosis: A Scleroderma Patient-centered Intervention Network Cohort Study
Abstract
Objective Systemic sclerosis (SSc) is characterized by significant disability due to musculoskeletal involvement. Physical and occupational therapy (PT/OT) have been suggested to improve function. However, the rate of PT/OT utilization has been shown to be low in SSc. We aimed to identify demographic, medical, and psychological variables associated with PT/OT use in SSc.
Methods Participants were patients with SSc enrolled in the Scleroderma Patient-centered Intervention Network Cohort. We determined the rate and indication of PT/OT use in the 3 months prior to enrollment. Multivariable logistic regression was used to identify variables independently associated with PT/OT utilization.
Results Of the 1,627 SSc patients included in the analysis, 23% used PT/OT in the preceding 3 months. PT/OT use was independently associated with higher education (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.12), having moderately severe small joint contractures (OR 2.09, 95% CI 1.45 – 3.03), severe large joint contractures (OR 2.33, 95% CI 1.14 – 4.74), fewer digital ulcerations (OR 0.70, 95% CI 0.51 – 0.95), and higher disability (OR 1.54, 95% CI 1.18 – 2.02) and pain (OR 1.04, 95% CI 1.02 – 1.06) scores. The highest rate of PT/OT utilization was reported in France (43%) and lowest in the USA (17%).
Conclusion Despite the potential of PT/OT interventions to improve function, less than 1 in 4 SSc patients enrolled in a large international cohort used PT/OT services in the last 3 months. Patients who utilized PT/OT had more severe musculoskeletal manifestations and higher pain and disability.