Racial Disparities in PT and Rehab Outcomes

A female PT talks with a male older patient.
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Health care disparities due to race are a common problem seen in America. Across the board, people of color tend to have worse health outcomes when they become ill or injured. The recent worldwide COVID-19 health care pandemic has seen a disproportionate number of Black citizens become infected and severely ill. People of color suffer worse outcomes from cardiovascular disease and diabetes management. For physical therapy (PT) patients, that’s no different.

People of color tend to have worse outcomes when they are referred to physical therapy after an injury or illness that causes limited functional mobility. Many do not attend physical therapy in any setting, be it outpatient therapy, inpatient rehab, or home care physical therapy.

Racial Differences in Physical Therapy Outcomes

Research indicates that, in some cases, Black Americans suffer from worse rehabilitation outcomes when compared to white, non-Hispanic counterparts.

One study found that after inpatient rehabilitation for hip fracture, Black Americans had a longer length of stay, worse functional scores on the Functional Independence Measure, and were more likely to be discharged home rather than continue their rehab in a sub-acute rehab facility.

A study in the American Journal of Surgery examined utilization of rehabilitation services after hospital discharge from a trauma event. The researchers found that Black Americans were significantly less likely to access rehab services, like outpatient PT, when compared to their white counterparts after a visit to the hospital after trauma.

This failure to access post-discharge rehab services may lead to poorer functional outcomes, which are often seen in the Black population.

Why do people of color have worse health outcomes when it comes to PT (and other areas of health care)? The answer likely has many variables and may include factors related to trust in the health care system, systemic racial bias among health care practitioners, and insurance coverage (or lack thereof) in certain populations.

Referrals and Attendance

So do patients experience different outcomes from PT and rehab due to a referral problem? Are doctors' referral patterns to PT different based on implicit and internal bias due to race?

Research finds that people of color and whites are referred to rehab at equal rates; Black Americans tend to simply attend PT less. And it does not matter which setting the referral is made to. People of color attend PT less in outpatient therapy settings, inpatients settings, and in-home care.

A 2017 study published in the Journal of Racial and Health Disparities found that about 8% of Americans with self-reported arthritis have at least one in-office PT visit each year. Hispanic and Black Americans have reduced odds of a therapy visit, while PT services in an outpatient setting seem to be attended mostly by whites. When variables like insurance, income, and education level are corrected, however, only the Black population continued with reduced odds of a therapy visit.

So if a referral to PT is made, why would Black Americans not attend therapy? Since racial disparities are so widespread and may be dependent on a host of factors, there is likely no single factor that leads Blacks to have fewer therapy visits each year. Reasons for reduced outpatient PT visits for Black Americans may include:

  • Lack of availability of outpatient physical therapists who can meet the needs of Black Americans
  • Location of PT offices may affect accessibility for Black Americans
  • Hours of operation and ease of scheduling office visits for PT may not fit the needs of Black Americans
  • Family responsibilities, lack of time, or lack of child care in Black Americans
  • Lack of trust in the health care system

By understanding the factors that may present a barrier to outpatient PT services for people of color, changes can be made to ensure that therapy services are available to all people who may likely benefit from them.

Equal Access to Physical Therapy

Perhaps one of the best ways to help improve the ability of Black Americans to enjoy the benefits PT has to offer is to provide education.

Outreach to Black communities may help to improve the dialogue between physical therapists (a profession made up of mostly white people) and people of color. Teaching people how to best access PT and its expected benefits may be key.

Education for physicians may also be helpful. Teaching doctors and mid-level providers about referral patterns in the Black community may help those who are referring people to PT understand the barriers to attendance to PT.

Next Steps

So what can be done to improve access to PT services and to ensure positive outcomes for people of color? The U.S. Centers for Disease Control recommends a multi-pronged approach to attacking racial disparity in health care, including:

  • Federal government intervention to collect and analyze data and to ensure health and social programs address the needs of the Black community
  • The use of public health officials to connect providers, educators, transportation, and service organizations to help improve health access and outcomes in the Black community
  • The use of community organizations to connect people of color to appropriate medical services and to help remove barriers to those services
  • Education of health care providers to the specific needs of Black Americans and to create collaborative models of care across the health care spectrum

In the physical therapy profession, this means acting on the federal and local levels to ensure access to our profession is in place and that equal, unbiased care is provided to all.

A Word From Verywell

America has a problem with systemic racism. It invades every aspect of our culture, and it has created a situation where people of color consistently realize barriers to certain aspects of our society.

Unfortunately, Black Americans attend PT less, and they are less likely to have a positive functional outcome when compared to others. Understanding that there is racial bias in health care is the first step to curing the problem. But it is not enough.

Health care providers must take positive action to ensure barriers to care are removed, education about beneficial services is delivered, and racial bias in care is squashed. When this occurs, the true benefit of the PT profession can be realized and enjoyed equally by all.

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