Safe Administration and Low Healthcare Utilization Following Musculoskeletal Corticosteroid Injections by U. S. Military Physical Therapists

Abstract

ABSTRACT Introduction Musculoskeletal (MSK) injuries make up a significant proportion of conditions treated by military healthcare providers during wartime. Though many common MSK injuries may benefit from corticosteroid injection (CSI), a shortage of qualified military clinicians has led to diminished access to appropriate care. Longer wait times to receive treatment pose detrimental effects on military readiness and have garnered the attention of military leaders. One solution was the development of advanced training for United States Air Force physical therapists (USAF PTs) to gain clinical privileges in administering CSI. The objectives of this study were to determine in USAF PTs (1) the prevalence of those with privileges to administer CSI; (2) the type and (3) safety of MSK CSI administered; (4) incidence of CSI complications; (5) healthcare utilization following CSI; and (6) barriers to obtaining and practicing CSI privileges. Materials and Methods United States Air Force PTs with CSI privileges received instructions to follow a link to an anonymous Google survey. Electronic medical record reviews were conducted by three USAF PTs to determine the occurrence and severity of CSI complications provided by USAF PTs and advanced healthcare providers (AHPs). The principal investigator conducted further review of the patients’ electronic medical records to calculate healthcare utilization following CSI administered by USAF PTs. A hospital administrator selected cases of similar diagnoses treated with CSI by USAF AHPs. The number selected cases treated by AHPs are similar to the number of CSI cases treated by USAF PTs. Results Eleven USAF PTs held CSI privileges. No major complications associated with CSI were recorded. Of the 95 CSI cases treated by USAF PTs, 27 (28.4%) reported increased pain compared to 24 (27.9%) of 86 CSI cases treated by AHPs (P = .94). Healthcare utilization for the number of follow-up visits, imaging, and additional laboratory tests following CSI by USAF PTs was lower compared to AHPs (chi-square; P < .0069). Conclusion Nine percentage of USAF PTs held CSI privileges. United States Air Force PTs were equally safe as AHPs who administered CSI and associated with a lower rate of healthcare utilization following the intervention. Training USAF PTs to administer CSI could be the standard for all USAF PTs who meet qualification requirements. Adoption of similar training and credentialing policies for civilian PTs warrants further exploration.