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Pre-operative Insurance Mandated Physical Therapy does not Prevent the Need for Shoulder Arthroplasty in Patients with Glenohumeral Osteoarthritis
Journal article   Open access   Peer reviewed

Pre-operative Insurance Mandated Physical Therapy does not Prevent the Need for Shoulder Arthroplasty in Patients with Glenohumeral Osteoarthritis

Brendan M. Patterson, Grant E. Garrigues, Gregory N. Lervick, Maria F. Bozoghlian, Arden Shen, James V. Nepola, Jay D. Keener and Jason E. Hsu
JSES international, Vol.9(5), pp.1616-1622
09/2025
DOI: 10.1016/j.jseint.2025.04.031
PMCID: PMC12490597
PMID: 41049690
url
https://doi.org/10.1016/j.jseint.2025.04.031View
Published (Version of record) Open Access

Abstract

Introduction Glenohumeral osteoarthritis (GHOA) is a common cause of shoulder pathology for many patients. Non-surgical treatment options for advanced GHOA are limited, and there are currently no high-level studies supporting the use of physical therapy (PT) to treat advanced cases of GHOA. Despite this, there has been an increasing requirement for insurance-mandated PT prior to shoulder arthroplasty. The purpose of this study was to investigate patients with shoulder arthritis who were denied shoulder arthroplasty by their insurance carriers based on the lack of preoperative PT. We further sought to assess healthcare provider's perception regarding frequency, duration, and overall impact of the peer-to-peer (P2P) process. Methods This was a multicenter case series of patients with moderate to severe GHOA who were denied shoulder arthroplasty by their insurance carrier due to lack of preoperative PT. The cohort was followed to assess if a P2P took place and if patients were required to perform formal preoperative PT prior to shoulder arthroplasty. Variables collected included demographic data, insurance carrier status, preoperative range of motion, preoperative Patient Reported Outcome Measures (PROMs), and post-physical therapy PROMs. A survey was administered to assess healthcare provider's perception of the frequency, duration, and overall impact of the P2P process. Results A total of 12 patients were included for analysis. Eleven patients (92%) ultimately underwent the indicated shoulder arthroplasty, and one patient was performing mandated PT at the time of analysis. Ten of the 12 cases (75%) underwent a P2P. Six P2P appeals (60%) were unsuccessful, and five of those patients were required to undergo a course of preoperative PT. Two cases did not undergo a P2P process but were still required to perform PT. A total of seven patients (58%) were required to undergo formal preoperative PT and six of those seven patients (86%) ultimately underwent shoulder arthroplasty. Results from the survey show that almost half of healthcare respondents spend between 40 to 60 minutes on P2P appeals. Conclusion Despite the lack of evidence to support PT for the treatment of GHOA, many patients indicated for shoulder arthroplasty are denied the surgery by their insurance due to lack of preoperative PT. Insurance-mandated preoperative physical therapy in this cohort did not significantly improve ROM, pain, or prevent the need for shoulder arthroplasty. Results of this study highlight a significant burden to providers and to patients who are denied a shoulder arthroplasty in the setting of moderate to advanced GHOA.

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