Patient Perceptions on their Rehabilitative Improvements, Adherence to Physical Therapy, and Cultural Competency of Physical Therapist

Abstract

Objective: To describe: 1) barriers in access and utilization of physical therapy among Chicago residents; 2) patient perspectives regarding quality-of-care dimensions: perceived cultural competency of the physical therapist, adherence to physical therapy visits, adherence to prescribed home exercise program, change in movement issue, and change in ability to do daily activities; and 3) self-reported changes by region of Chicago (North Side, South Side, West Side, Central Chicago) Methods: Cross-sectional online survey conducted February through April of 2021. The survey was a 33-item tool inquiring about demographics, aspects of the respondents movement issue, and items from the Consumer Assessment of Healthcare Providers and Systems Cultural Competency (CAHPS CC). Inclusion criteria was Chicago residents over the age of 18 who were referred to a physical therapist (PT) or felt a need to see a PT in the past 12 months. Results: Respondents (N=53) represented 24 unique Chicago zip codes (64% North Side, 16% from West Side, 14% South Side, and 16% from West Side). The mean age was 47.0 years old (SD=17.9), 78% were White, and 72% of respondents identified as women. Sixty-four percent had a musculoskeletal movement issue and 23% never saw a PT for this issue. The most commonly reported barriers to seeing a PT were: 1) COVID-19 related (50%), 2) lack of time (33%), and 3) lack of accessible location (25%). Thirty percent of those who saw a PT did not finish all their scheduled visits; the top reason being cost (43%). The mean composite scores for the Cultural Competency Domains of Equitable Treatment, Trust, and Positive Communication were 94%, 83% and 87% respectively (N=41). The majority of respondents were adherent to their home exercise program (85%). Nearly all respondents stated that their movement issue was much improved (54%) or slightly improved (44%) from seeing a PT. Nearly all respondents reported that their ability to do daily activities was much improved (49%) or slightly improved (42%) from seeing a PT. Discussion: COVID-19 was commonly reported as a barrier to PT adherence. Although outpatient PT clinics offered telehealth visits, people may not have known it was an option. Overall, survey respondents perceived their physical therapist to be culturally competent. This may be because the majority of survey respondents were White, and the majority of PTs are also White; this congruency may facilitate cultural understanding. A larger proportion of Central and North Side respondents (which was 83% White) reported their issue and ability to do ADLs much improved compared to a larger proportion of South and West side respondents (which was 68% White) who reported their issue and ability to do ADLs were only slightly improved. Our study adds new information regarding patient perspectives of cultural competency among physical therapists and the relationship with adherence and rehabilitation improvements. Further work is needed to explore this topic among wider and more diverse settings.

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