Health disparities in adherence with prescribed rehabilitation following surgical treatment of knee injuries in pediatric patients

Background: Rehabilitation is paramount to recovery following surgery for ligamentous and meniscal knee injuries, but there exists little research regarding adherence with rehabilitation in pediatric populations, especially how this relates to health disparities in this population. Hypothesis/Purpose: Our study aimed to evaluate the effect of patient socioeconomic/demographic factors on adherence with physical therapy appointments following surgical repair or reconstruction of knee injuries. This information would be used to raise awareness of health disparities and potentially develop a set of predictors for a higher risk of non-adherence with prescribed rehabilitation. Methods: This study was a retrospective chart review of patients under the age of 18 who underwent physical therapy at the authors’ institution following initial surgical repair or reconstruction of a knee injury (ACL, MCL, LCL, PCL, meniscus, patellar tendon, and tibial eminence injuries included). Surgeries from 1 January 2015 to 31 December 2016 were considered, with physical therapy being considered for dates extending to 1 January 2018. Rate of adherence with physical therapy, reasons for lack of attendance, and socioeconomic/demographic variables were gathered. Data was evaluated utilizing bivariate and separate hierarchical linear regression analyses. Results: Our study population was comprised of 108 individuals with a mean age of 15.15 ± 2.04 years and a mean compliance rate with physical therapy of 80.2 ± 11.8%. Bivariate analysis revealed Hispanic/Latino patients were more likely to cancel/no show (18 ± 22.82) than non-Hispanic/Latino patients (7.55 ± 6.88, p = 0.010). Logistic regression revealed patients were significantly less likely to attend 85% of rehabilitation visits if in single-parent households ( p = 0.024). The interaction of insurance type and residence stability (maintaining a single residence during treatment) found patients with public insurance and stable housing were less likely to reach the 85% compliance threshold (Table 1). At trend level, linear regression revealed an inverse relationship with distance and physical therapy attendance ( p = 0.082), in addition to linear regression showing unstable residence ( p = 0.052) and public insurance ( p = 0.067) as significant at trend level of patients not reaching 85% compliance. Conclusion: Our study revealed single-parent households and Hispanic/Latino patients were significantly correlated with lower rehabilitation adherence, in addition to trends showing distance to physical therapy, unstable housing, and public insurance correlated with lower compliance. Our work highlights potential predictors of rehabilitation noncompliance and allows for targeted efforts to increase adherence in patients with these factors. [Table: see text]