Social needs and social vulnerability are associated with outpatient orthopedic physical therapy outcomes: A prospective cohort study.

BACKGROUND

Social determinants of health may contribute substantially to health outcomes, yet their relationship to outpatient orthopedic physical therapy outcomes remains incompletely understood.

OBJECTIVE

To examine whether individual social needs, community-level social vulnerability, and self-rated health were independently associated with discharge functional status among adults receiving outpatient orthopedic physical therapy after adjustment for baseline function. Secondary exploratory analyses examined associations with baseline function and functional change.

METHODS

A prospective cohort study was conducted among 164 adults receiving in-person, outpatient orthopedic physical therapy within a large urban public hospital system in Houston, Texas between September 2021 and May 2022. Participants completed the Health Leads Screening Tool (HLST), Self-Rated Health Question (SRHQ), and Focus on Therapeutic Outcomes (FOTO) assessment at their initial evaluation. Social Vulnerability Index (SVI) values were assigned using population-weighted census tract estimates aggregated within ZIP codes. Of 164 participants, 112 completed treatment and discharge assessment and were included in outcome analyses. Multiple linear regression examined associations between baseline FOTO, HLST, SRHQ, SVI, and discharge FOTO. Attrition analyses compared completers and non-completers and evaluated predictors of treatment completion.

RESULTS

The primary model explained 61.7% of the variance in discharge functional status. After adjustment for baseline FOTO, greater social need burden was independently associated with lower discharge functional status (B = -2.35, β = -0.329, p < .001). Better self-rated health was associated with higher discharge function (B = 3.13, β = 0.187, p = .006), while greater social vulnerability was associated with lower discharge function (B = -10.88, β = -0.144, p = .018). No baseline variables significantly predicted treatment completion.

CONCLUSION

Greater social need burden, poorer self-rated health, and higher community social vulnerability were independently associated with lower functional status at discharge. Further research is needed to determine the prognostic utility of social needs screening across rehabilitation settings.