保险类型最重要：城市人群前交叉韧带重建术后物理治疗依从性差的风险因素分析
简介
一项针对128例城市人群ACL重建术后患者的回顾性队列研究显示，35.9%的患者错过超过15%的康复疗程，依从性差与政府资助保险显著相关，而既往认为的AD I、非英语语言及无车等因素并非风险。虽然93%的患者认可康复必要性，但时间、交通、费用及保险问题仍是主要障碍。该结果提示，保险类型可作为识别ACL术后康复依从性风险的重要临床指标。
英文摘要
INTRODUCTION: Physical therapy (PT) after anterior cruciate ligament (ACL) reconstruction is critical for recovery. Despite this, adherence to PT protocols remains inconsistent, and although socioeconomic barriers are thought to influence PT attendance, there are a paucity of data quantifying compliance rates and the influence of these proposed barriers. METHODS: A total of 128 consecutive patients who underwent ACL reconstructions between January 2023 and December 2024 at a single urban academic medical center were studied. Three months postoperatively, patients completed a questionnaire regarding their PT compliance. Demographic, socioeconomic, and behavioral factors were collected. RESULTS: 35.9% of patients missed >15% of sessions. Reported barriers included time commitments (58.6% of respondents), transportation (50%), appointment availability (46.1%), cost (36.7%), and insurance issues (21.9%). Despite difficulties, 93.0% of patients thought PT was necessary. Government-sponsored insurance was associated with poor PT adherence (P = 0.006). By contrast, historically described barriers to healthcare access, including Area Deprivation Index (ADI) (P = 0.195), primary language other than English (P = 1.0), and lack of car ownership (P = 0.690), were not associated with poor attendance. CONCLUSION: Having state-sponsored/government-sponsored insurance is an independent risk factor for poor PT adherence, despite near unanimous strong desire of patients to attend therapy. Previously described barriers including higher ADI, primary language other than English, and not owning a car were not notable risk factors.