Development and evaluation of a simple physical therapy triage rule for older acute-care inpatients: a retrospective pre–post study

Purpose/Aims This study aimed to develop the Tenri Physical Therapy Prescription (TPTP) rule, an original triage rule for allocating physical therapy (PT), and to descriptively evaluate changes in function and adverse events following its implementation, using a retrospective pre–post design. Methods Using consecutive sampling, we identified 185 patients aged ≥ 65 years (median age, 78 years; 61% women) admitted to a Japanese tertiary care hospital between February and August 2018 as the intervention group (PT, n = 79; no PT, n = 106), and 342 patients admitted from 2016 to 2017 (median age, 80 years; 57% women) as the control group (PT, n = 190; no PT, n = 152). The TPTP rule withheld PT for severe pre-admission disuse (Barthel Index [BI] ≤ 20), preserved function (BI ≥ 85), or anticipated discharge within 1 week; PT recipients were older in both groups. We compared the change in BI score (ΔBI), PT prescriptions, and adverse events. Results The median ΔBI was 0 [IQR: 0–25] vs. 0 [IQR: 0–10] among patients without PT (rank-biserial correlation = 0.14, p = 0.034) and 17.5 [IQR: 0–40] vs. 10 [IQR: 0–35] among patients with PT (rank-biserial correlation = 0.07, p = 0.366), intervention vs. control. PT prescriptions decreased from 55.6% to 42.7% (odds ratio = 1.68, p = 0.006), with no apparent increase in adverse events such as falls. Conclusion/Implications While preliminary and hypothesis-generating, activities of daily living-based triage may help multidisciplinary staff prioritize limited rehabilitation resources and strengthen interprofessional collaboration in aging societies.