Physical therapy use in treated and untreated children and adults with spinal muscular atrophy (SMA): A descriptive analysis using US claims


Clinical Management

Poster Number: S101


Kristina Kelly, PT, DPT, MS, EDM, NCS, CPT, PE, University of Missouri, Columbia, Missouri, USA, Manjiri Dahdul, University of Southern California, Los Angeles, California, USA, Leslie Nelson, PT, PhD, UT Southwestern Medical Center, Dallas, Texas, USA, Sally Dunaway Young, PT, DPT, Stanford University, Elise L. Townsend, PT, DPT, PhD, PCS, MGH Institute of Health Professions, Boston, Massachusetts, USA, Kyle Reedy, Advent Health Sports Medicine and Rehabilitation, Orlando, Florida, USA, Tina Duong, PT, PhD, Stanford University Medical Center, Alexandra DiDonato, Biogen, Cambridge, Massachusetts, USA, David J. Marmion, PhD, Biogen, Cambridge, Massachusetts, USA, Queeny Ip, Komodo Health, San Francisco, California, USA, Ahmed Noman, Komodo Health, San Francisco, California, USA, Ethan Yung, Komodo Health, San Francisco, California, USA, Eishdeep Cattry, Biogen, Cambridge, Massachusetts, USA, Jamie Johansen, PhD, Biogen, Cambridge, Massachusetts, USA, Nicole B. Johnson, Biogen, Cambridge, Massachusetts, USA, Kori Hack, PharmD, Biogen, Cambridge, Massachusetts, USA

Background: SMA is a clinically diverse disorder. A multidisciplinary approach to managing patients with SMA is crucial to achieving the best possible outcomes. Insight from practitioners suggests limited involvement of physical therapists in the routine care plan for these patients and disparities in care among treated and untreated individuals. Here we analyzed de-identified administrative claims from 1 Jan 2016 through 30 Sep 2022 for US patients with SMA with ≥12 continuous months of medical/pharmacy data, and 2 claims for SMA at least 30 days apart, using Komodo’s Healthcare Map.
Objectives: To report patient characteristics and the most common healthcare personnel (HCP) referrals and intervention, and to assess physical therapy (PT) services among treated and untreated patients (never received disease-modifying therapies).
Results: This retrospective analysis included 1187 treated and 2977 untreated patients with SMA. Most patients were adults (36% treated; 83% untreated) and lived in the South (44% treated; 37% untreated). Managed Medicaid was the most common payer in both groups (49% treated; 38% untreated). Over 1 year, the most common HCP seen across both treated and untreated groups were diagnostic radiologists (by 64% and 49%, respectively). More treated than untreated patients saw a neurologist (31% vs 19%). Visits to a specialist in Child Neurology were reported by 52% of treated pediatric patients; none was reported by untreated patients. More treated patients (72%) had ≥1 visit to a physical therapist vs untreated patients (31%). When analyzed by age, PT was used by 35% of treated vs 23% of untreated pediatric patients (aged 0–5 years); 28% of treated vs 0% untreated school-aged patients (6–17 years); and 9% of treated vs 0% untreated adults (≥18 years). Reasons for disparities in PT care between treated and untreated patients may include proximity to multidisciplinary care centers and disease severity. Additional expert perspectives on these results and the possible challenges to PT access among patients with SMA will be presented.
Conclusions: These data showed a decreasing trend in PT use across ages and highlighted disparities in care among treated vs untreated patients. Use of PT as routine care remains low, particularly for untreated patients, with limited access a potential major barrier. Efforts to incorporate PT should be considered as it is a critical complement to medical treatment. Study Support: Biogen.