The Impact of Fried Frailty Status on Physical Therapy Utilization in the Acute Care Setting

Introduction: While frail patients are at increased risk for worsened morbidity and mortality, the association with inpatient physical therapy (PT) utilization remains poorly understood. This study aimed to identify factors associated with PT utilization among frail patients undergoing major surgery. Review of Literature: The Fried Frailty score, validated for identifying patients at risk of frailty, includes criteria such as unintentional weight loss, weakness, and low physical activity. While PT improves postoperative functional outcomes, few studies have evaluated whether objective frailty metrics drive PT referral in acute care. Subjects: We included 507 adults who underwent inpatient surgery between 2012 and 2023 with preoperative Fried Frailty scoring. Methods: Patient characteristics, PT utilization, and AM-PAC “6-Clicks” scores were retrospectively collected. Patients were categorized as nonfrail, prefrail, or frail. Univariable and multivariable logistic regression evaluated factors associated with PT use. Correlations between Fried Frailty score and PT metrics were assessed. Results: Of 507 patients, 50 (9.9%) were frail, 234 (46.2%) prefrail, and 223 (44.0%) nonfrail. Older age (OR, 1.03; p = .001), weight loss (OR, 1.71; p = .040), and longer hospital length of stay (OR, 1.47; p < .001) were independently associated with PT utilization, yet frailty was not. Fried Frailty score correlated with longer PT session times but not with session number/mobility changes. Discussion and Conclusion: The Fried Frailty score was not associated with PT utilization. These findings suggest frail patients may be underreferred. Incorporating objective frailty metrics in referral work-flows may help identify frail patients who could benefit from early rehabilitation.