JB JS Open Access. 2026 Jul 24;11(3):e26.00192. doi: 10.2106/JBJS.OA.26.00192. eCollection 2026 Jul-Sep.
ABSTRACT
BACKGROUND: Physical therapy (PT) is essential to recovery after orthopaedic surgery, yet predictors of postoperative PT utilization across procedure types remain poorly understood. This study aimed to identify demographic and clinical predictors of PT utilization after 8 common orthopaedic procedures using a diverse national cohort.
METHODS: Patients undergoing 8 orthopaedic procedures were identified from the National Institutes of Health All of Us Research Program. The primary outcome was PT utilization within 180 days of surgery. Sequential multivariable logistic regression evaluated predictors of PT utilization, adjusting for demographics, comorbidities, insurance, employment, preoperative PT, 0- to 14-day postoperative opioid prescriptions, and procedure type. Procedure-stratified analyses were performed. Statistical significance was set as p < 0.050.
RESULTS: Among 12,666 patients (59% female; mean age, 58 ± 13 years), including 1,531 (12%) Hispanic/Latino and 1,445 (11%) Black patients, overall postoperative PT utilization was 44%. Female sex was associated with lower odds of PT utilization compared with male sex (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.78 to 0.92; p < 0.001), an effect that persisted after full adjustment. Preoperative PT (aOR, 8.91; 95% CI, 7.75-10.23; p < 0.001) and 0- to 14-day postoperative opioid prescriptions (aOR, 1.66; 95% CI, 1.50-1.83; p < 0.001) were independently associated with higher PT utilization. The association between female sex and lower PT utilization reached statistical significance in the total knee arthroplasty subgroup only in procedure-stratified analyses (aOR, 0.78; 95% CI, 0.67-0.91; p = 0.001). PT utilization was associated with lower 90-day emergency department visits (aOR, 0.67; 95% CI, 0.59-0.76; p < 0.001).
CONCLUSIONS: Preoperative PT and early postoperative opioid prescriptions were the strongest predictors of postoperative PT utilization. Female sex was associated with lower PT utilization after comprehensive adjustment, although structural and unmeasured factors may partially account for this finding. These findings identify factors associated with rehabilitation access after orthopaedic surgery. Preoperative PT engagement, equitable opioid-prescribing practices, and strategies to address insurance-related barriers warrant further investigation as potential approaches to improve postoperative rehabilitation access.
LEVEL OF EVIDENCE: Level III, Prognostic. See Instructions for Authors for a complete description of levels of evidence.
PMID:42488892 | PMC:PMC13391136 | DOI:10.2106/JBJS.OA.26.00192
