In the US, rising numbers of patients who misuse illicit or prescribed opioids provides opportunities for physical therapists (PTs) to be engaged in their care. Prior to this engagement, it is necessary to understand the perceptions of patients who access physical therapy services about their PTs playing such a role. This project examined patients’ perceptions of PTs addressing opioid misuse.
Methods:
We surveyed patients, newly encountering outpatient physical therapy services in a large University-based healthcare setting, via anonymous, web-based survey. Within the survey, questions were rated on a Likert scale (1 = completely disagree to 7 = completely agree) and we evaluated responses of patients who were prescribed opioids versus those who were not.
Results:
Among 839 respondents, the highest mean score was 6.2 (SD = 1.5) for “It is OK for physical therapists to refer their patients with prescription opioid misuse to a specialist to address the opioid misuse.” The lowest mean score was 5.6 (SD = 1.9) for “It is OK for physical therapists to ask their patient why they are misusing prescription opioids.” Compared to those with no prescription opioid exposure while attending physical therapy, patients with prescription opioid exposure had lower agreement that it was OK for the physical therapist to refer their patients with opioid misuse to a specialist (β = −.33, 95% CI = −0.63 to −0.03).
Conclusions:
Patients attending outpatient physical therapy seem to support PTs addressing opioid misuse and there are differences in support based on whether the patients had exposure to opioids.
CarterSKRizzoJA. Use of outpatient physical therapy services by people with musculoskeletal conditions. Phys Ther. 2007;87(5):497-512.
2.
SharpeJMartinBFritzJM, et al. Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis. Fam Pract. 2020;38:203-209.
3.
ZhengPKaoMCKarayannisNVSmuckM. Stagnant physical therapy referral rates alongside rising opioid prescription rates in patients with low back pain in the United States 1997-2010. Spine. 2017;42(9):670-674.
4.
KhojaSSAlmeidaGJFreburgerJK. Recommendation rates for physical therapy, lifestyle counseling, and pain medications for managing knee osteoarthritis in ambulatory care settings: a cross-sectional analysis of the National Ambulatory Care Survey (2007-2015). Arthritis Rheum. 2020;72:184-192.
5.
LieberzDRegalRConwayP. Observational study: predictors of a successful functional outcome in persons who receive physical therapy for knee osteoarthritis. Eval Health Prof. 2022;45:137-146.
6.
ChildsJDFritzJMWuSS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015;15:150.
7.
SullivanMDEdlundMJFanMYDevriesABrennan BradenJMartinBC. Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study. Pain. 2010;150(2):332-339.
MagelJKietrysDKrugerESFritzJMGordonAJ. Physical therapists should play a greater role in managing patients with opioid use and opioid misuse. Subst Abus. 2021;42(3):255-260.
10.
GordonAJBroylesLM. A physician-centered approach to addiction identification and treatment misses the opportunity for interdisciplinary solutions. Subst Abus. 2014;35(2):108-109.
11.
MagelJJCochranGWestNFritzJMBishopMDGordonAJ. Physical therapists’ attitudes are associated with their confidence in and the frequency with which they engage in prescription opioid medication misuse management practices with their patients. A cross-sectional study. Subst Abus. 2022;43:433-441.
12.
American Physical Therapy Association. Standards of Practice for Physical Therapy. 2020.
13.
GoodmanCCSnyderTEK. In: HeickJLazarouRT, eds. Interviewing as a Screening Tool. Differential Diagnosis for Physical Therapists. 6th ed: Elsevier; 2017.
14.
D’OnofrioGNadelESDegutisLC, et al. Improving emergency medicine residents’ approach to patients with alcohol problems: a controlled educational trial. Ann Emerg Med. 2002;40(1-2):50-62.
15.
HanBComptonWMBlancoCCraneELeeJJonesCM. Prescription opioid use, misuse, and use disorders in U.S. Adults: 2015 national survey on drug use and health. Ann Intern Med. 2017;167(5):293-301.
16.
EysenbachG. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34.
17.
HarrisPATaylorRThielkeRPayneJGonzalezNCondeJG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
18.
Rodgers-BonaccorsyRA. Rehabilitation counselor attitudes toward counseling individuals with substance use disorders. Rehabilitation Education. 2010;24(3 & 4):135-148.
19.
HamiltonLC. Statistics With Stata. Updated for Version 9. Thompson Brooks/Cole; 2006.
20.
StataCorp. Stata Statistical Software: Release 17. Statcorp LLC; 2022.
21.
O’KeeffeMCullinanePHurleyJ, et al. What influences patient-therapist interactions in musculoskeletal physical therapy? Qualitative systematic review and meta-synthesis. Phys Ther. 2016;96(5):609-622.
22.
KinneyMSeiderJBeatyAFCoughlinKDyalMClewleyD. The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: a systematic review of the literature. Physiother Theory Pract. 2020;36(8):886-898.
23.
MagelJKimJThackerayAHawleyCPetersenSFritzJM. Associations between physical therapy continuity of care and health care utilization and costs in patients with low back pain: a retrospective cohort study. Phys Ther. 2018;98(12):990-999.
24.
FritzJMHunterSJTracyDMBrennanGP. Utilization and clinical outcomes of outpatient physical therapy for medicare beneficiaries with musculoskeletal conditions. Phys Ther. 2011;91(3):330-345.
25.
FuentesJArmijo-OlivoSFunabashiM, et al. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Phys Ther. 2014;94(4):477-489.
26.
FerreiraPHFerreiraMLMaherCGRefshaugeKMLatimerJAdamsRD. The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Phys Ther. 2013;93(4):470-478.
27.
BabatundeFMacDermidJMacIntyreN. Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature. BMC Health Serv Res. 2017;17(1-2):375.
28.
BeneciukJMBrown-TaylorLAlodaibiFKarehaSHolmesRFritzJ. Patient- and physical therapist-level predictors of patient-reported therapeutic alliance: an observational, exploratory study of cohorts with knee and low back pain. Arch Phys Med Rehabil. 2021;102(12):2335-2342.
29.
LawfordBJBennellKLCampbellPKKaszaJHinmanRS. Therapeutic alliance between physical therapists and patients with knee osteoarthritis consulting via telephone: a longitudinal study. Arthritis Care Res. 2020;72(5):652-660.
30.
HswenYZhangAFreifeldCBrownsteinJS. Evaluation of volume of news reporting and opioid-related deaths in the United States: comparative analysis study of geographic and socioeconomic differences. J Med Internet Res. 2020;22(7):e17693.
31.
Kennedy-HendricksALevinJStoneEMcGintyEEGollustSEBarryCL. News media reporting on medication treatment for opioid use disorder amid the opioid epidemic. Health Aff. 2019;38(4):643-651.
32.
PetrikMLMcNamaraPJMoeschlerSMBlairBD. Communication of recommendations for the disposal of unused prescription opioid medications by stakeholders in the news media. Pain Med. 2019;20(9):1711-1716.
DassieuLHeinoADevelayE, et al. Conversations about opioids: impact of the opioid overdose epidemic on social interactions for people who live with chronic pain. Qual Health Res. 2021;31(9):1657-1669.
35.
DassieuLHeinoADevelayE, et al. “They think you’re trying to get the drug”: qualitative investigation of chronic pain patients’ health care experiences during the opioid overdose epidemic in Canada. Can J Pain. 2021;5(1-2):66-80.
36.
RombergARRathJMMiller LoEJ, et al. Young adults’ opioid prescription history and opioid misuse perceptions. Am J Health Behav. 2019;43(2):361-372.
37.
VinaERQuinonesCHausmannLRMIbrahimSAKwohCK. Association of patients’ familiarity and perceptions of efficacy and risks with the use of opioid medications in the management of osteoarthritis. J Rheumatol. 2021;48(12):1863-1870.
38.
Peacock-ChambersEFeinbergESenn-McNallyM, et al. Engagement in early intervention services among mothersin recovery from opioid use disorders. Pediatrics. 2020;145(2):e20191957.
39.
HookerSAShermanMDLonergan-CullumMNisslyTLevyR. What is success in treatment for opioid use disorder? Perspectives of physicians and patients in primary care settings. J Subst Abuse Treat. 2022;141:108804.
40.
Bou MalhamPSaucierG. The conceptual link between social desirability and cultural normativity. Int J Psychol. 2016;51(6):474-480.
