Delay in Time to Physical Therapy After Orthopaedic Treatment

<b>Background:</b> Pediatric patients are often prescribed physical therapy following an orthopaedic diagnosis or surgical procedure; however, many children experience delays, which can consequently prolong recovery. The purpose of this study was to identify the factors that delay the patient's ability to receive timely care after referral to physical therapy (PT). <b>Methods:</b> Pediatric patients who were ordered physical therapy after orthopaedic treatment were prospectively recruited to participate in this study. Patients were administered a demographic questionnaire upon enrollment. Data collected included initial referral, date of authorization, and date of first PT appointment. A delay was defined as a wait of 2 weeks or more between the referral and first physical therapy appointment. <b>Results:</b> Of 100 orthopaedic patients enrolled, 60% (60/100) had government insurance and 40% (40/100) had private insurance. Significant differences were revealed between insurance type (p=0.005), ethnicity (p=0.005), and site of injury (p=0.02) in time to first appointment. Patients with government insurance were 3.4 times more likely than patients with private insurance to experience a delay to physical therapy (95% CI: 1.5, 8.2). Only 27% (11/40) of patients with private insurance experienced a delay as compared to 57% (34/60) of patients with government insurance. Ten percent (6/60) of the patients with public insurance were never able to see a physical therapist while all privately insured patients were ultimately seen in PT. In multivariable analysis, Hispanic ethnicity and hip conditions were associated with delay in receiving PT. <b>Conclusion:</b> Patients with government insurance were over three times more likely to experience a delay in attending a physical therapy appointment than patients with private insurance, and 10% of patients with public insurance never saw a physical therapist. Insurance type may directly influence access to care or may be associated with demographic and socioeconomic factors decreasing the ability to utilize care. <b>Level of Evidence:</b> III <b>Key Concepts</b>•There is a delay in time to PT based on insurance type, ethnicity, and site of injury.•Patients with government insurance were over three times more likely to experience a delay in their initial physical therapy appointment than patients with private insurance.