Physical therapy utilization among firearm injury survivors: an analysis of linked trauma database and medical claims data

IMPORTANCE: Firearm injury in the United States disproportionately affects marginalized and disadvantaged communities and results in high rates of functional limitations, mobility impairments, and chronic pain. Despite the high rates of firearm injury and impact on function, few studies have examined access to rehabilitation care after firearm injury. OBJECTIVE: This study analyzed the use of physical therapy after firearm injuries compared to other traumatic injuries. DESIGN: A retrospective cohort study was performed using medical claims data from a statewide All Payer Claims Database (APCD) linked with an institutional trauma registry (2013-2022). SETTING: The setting was a Level I trauma center. PARTICIPANTS: Patients were identified from our institution's trauma registry to obtain initial injury information, and trauma registry data were linked to the Washington State APCD to identify physical therapy service use. EXPOSURE: The exposure was mechanism of injury (firearm vs other trauma). MAIN OUTCOMES AND MEASURES: The main outcome was the use of physical therapy services in any setting in the year after hospital or emergency department discharge, and the secondary outcome was the total number of physical therapist visits. Covariates included sociodemographic factors (race, ethnicity, insurance, age, and gender) and clinical characteristics indicating the need for physical therapy (injury region, injury severity, and hospital length of stay). Multivariable Poisson regression with robust SEs was used to evaluate the effect of firearm mechanism on outcomes. RESULTS: Among 25,404 patients, the overall rate of physical therapist service use was 37.2%. Firearm injury survivors were less likely to use physical therapy services than survivors of other trauma (21.3% vs 38.4%; adjusted relative risk = 0.79; 95% CI = 0.71-0.88). Firearm injury survivors had fewer total physical therapy visits (8.0 [SD = 11.4] vs 11.9 [SD = 13.8]; adjusted relative risk = 0.79; 95% CI = 0.76-0.82). CONCLUSIONS: Despite a high incidence of serious and disabling physical conditions after firearm injury, there was less use of physical therapy services after firearm injury than after other mechanisms of injury in this single-institution sample. RELEVANCE: Insufficient use of physical therapy services after firearm injury may affect recovery and long-term outcomes among firearm injury survivors, and interventions are needed to support improved access to rehabilitation in this population.