A more recent study by Antonova et al 10 used a large commercial health care claims database to examine OPT use in the United States the year following tibial shaft fractures in adults (aged ≥18 years) and found that 44% used OPT. Also, this study did not distinguish between OPT and inpatient physical therapy, which have different goals and likely have different use patterns. Physical therapy use was ascertained through interviews with participants and was therefore subject to recall bias. This study comprised patients with severe open tibial fractures, which limits the generalizability of these results to those with less severe injuries.
In a study using data from LEAP, Castillo et al 9 reported that of 202 patients with tibial fractures, 66% received physical therapy within 2 years of injury, and patients attended an average of 30 visits. Although evidence suggests that physical therapy improves clinical outcomes such as range of motion, gait speed, and function, 8 little is known about OPT use after tibial fractures. Patients with these types of injuries are commonly referred to outpatient physical therapy (OPT) after acute injury management. 4 Other studies have found that patients with tibial fractures report low levels of physical activity and exhibit impairments in gait speed, balance, and strength compared with healthy individuals. 4 In addition, only about half of these patients reported returning to work 7 years postinjury. 3, 4 Physical health was measured by the Sickness Impact Profile (SIP), and at 7 years, nearly 50% of participants had a SIP score of 10 or greater, indicative of severe disability. The Lower Extremity Assessment Project (LEAP), a seminal study of over 500 patients aged 18 to 69 years with traumatic injuries, found that participants, including those with tibial fractures, reported significantly worse physical health at 7 years compared with 2 years after injury. 2 Tibial fractures often lead to long-term impairment and physical disability. Tibial fractures are the most common long bone fractures in young adults, 1 with an estimated 104,550 surgical repairs for tibial and fibular fractures performed in the United States annually.
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