While her academic passion is improving patient access to health care, Bove also has a passion for trivia which earned her an appearance on Jeopardy in 2022
Assistant Professor Allyn Bove (SHRS ’20) became interested in studying health disparities while observing the needs of patients in a free New York City medical clinic during her physical therapy education at Columbia University. After returning to Pittsburgh and working in a private practice that offered frequent pro bono physical therapy services to uninsured patients, she became passionate about the topic and decided to pursue a PhD at the University of Pittsburgh School of Health and Rehabilitation Sciences (SHRS). The program combined her interests in arthritis and joint replacement with her growing dedication to understand and address health disparities.
Bove explains, “I became interested in understanding and studying health disparities after repeatedly observing how two patients could clinically present with the same findings, but have really different outcomes based on things like their income and whether they could afford to attend their physical therapy (PT) visits, or whether they felt comfortable going outside in their neighborhood to exercise. Now it has become more common to teach health professional students about the social determinants of health, but it was less common back then, so as a new clinician I wasn't necessarily expecting to see these disparities and certainly didn't have many tools to address them.”
Addressing Rehabilitation Disparities
Since joining the Pitt Department of Physical Therapy faculty in 2015, Bove helped to initiate the department’s pro bono physical therapy services at the Birmingham Free Clinic and served as the primary supervisor of the department’s work there from 2016-2020. At the Birmingham Free Clinic, Pitt PT students and faculty provide free services to patients who are uninsured and underinsured and help to improve access to care for all individuals who need physical therapy.
Bove’s dissertation in the SHRS Rehabilitation Science PhD program was supported with grants from the Foundation for Physical Therapy Research and the UPMC Rehabilitation Institute, and her primary advisor was Professor Kelley Fitzgerald in the Department of Physical Therapy. In this work, she examined racial differences in the locations where patients receive physical therapy after knee replacement surgery and interviewed groups of patients about their experiences receiving post-operative rehabilitation. The results showed that Black patients tend to receive more home health physical therapy after knee replacement, while white patients tend to receive more outpatient physical therapy.
“So far, it isn't clear whether or how these differences impact the patients long-term,” she says, “but it is a bit concerning that the rehabilitation pattern seems to differ according to race. In my current work, I'm studying the relationship between those rehabilitation patterns and patients' functional recovery.”
Collaborative Research Efforts
Bove’s current work is supported by the National Institutes of Health-funded Comprehensive Opportunities for Rehabilitation Research Training (CORRT) program. In this research, she is examining the provision of rehabilitation care and improvements in physical function among more than 30,000 patients who underwent knee or hip replacement surgery. Collaborators include Professor Janet Freburger, Physical Therapy, Professor Lauren Terhorst, Occupational Therapy, SHRS Dean Anthony Delitto, Dr. Jared Magnani, School of Medicine, Dr. Brian Klatt, School of Medicine and Division Chief of Adult Joint Reconstruction at UPMC, and Dr. Kelli Allen, University of North Carolina and Durham VA Medical Center,. The work is also supported by two current Doctor of Physical Therapy students, Parker Denny and Sean Repage. The team is exploring the relationship between the exact timing and locations of physical therapy following knee and hip replacement and trajectory of improvement in physical function. Bove hopes that this work will lead to a future project designed to optimize the post-operative rehabilitation course for all patients, thereby maximizing function and reducing disparities in functional outcomes after joint replacement.
“Joint replacement is a really common surgery and it's highly successful for most patients who receive it, but it's important that we do everything we can to make sure that every patient who undergoes joint replacement has equal opportunity to achieve a positive outcome and return to the activities that they enjoyed before their arthritis began to limit them. I hope that this work will move us toward more equitable outcomes for folks who undergo joint replacement surgery.”
Watch this video to learn why telerehabilitation research being done by the Rural Access to Physical Therapy for Osteoarthritis Rehabilitation (RAPTOR) project is so important to patients in rural areas.
Bove is also currently collaborating with Fitzgerald and Department of Health Informatics Chair and Professor Bambang Parmanto on a study exploring the feasibility of a hybrid in-person and telerehabilitation approach for individuals in rural areas with knee osteoarthritis. This study, called RAPTOR (Rural Access to Physical Therapy for Osteoarthritis Rehabilitation), seeks to understand if a hybrid approach can be effective for people who live in more remote areas and may have difficulty traveling to an outpatient physical therapy clinic for frequent visits.
“I grew up in a rural part of Cambria County,” Bove says, “so I am from the area in which we're conducting this study. Although there are some excellent rehabilitation providers and clinics in the area, for some folks they are a 40-minutes or more drive from their homes. Traveling that far to see a physical therapist multiple times a week just isn't feasible for people who work long hours, have children or other family to take care of, etc."
“Telerehabilitation could be a great solution to that, but historically insurance companies have not been willing to cover telerehabilitation services. That has been improving since the COVID-19 pandemic began because of the necessary shifts in how health care is delivered, but we still don't have a lot of high-quality evidence to support the use of telerehabilitation for many common conditions. It's especially important to study this in rural areas, where it's more likely that patients may have limitations in wireless service and broadband access, so there may be more technological challenges that need to be addressed in order to provide high-quality telerehabilitation services.”
The RAPTOR study is currently recruiting, so individuals with knee arthritis who live in the Pennsylvania counties of Bedford, Fulton, Huntingdon, Blair and Cambria are encouraged to reach out to the study team at pittraptorstudy@gmail.com for more information.
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Published September 26, 2023