Referral for Imaging in Physical Therapist Practice: Key Recommendations for Successful Implementation

Abstract In recent years, the use of diagnostic imaging in physical therapist practice in the United States (US) has gained considerable interest. In several countries around the world and in the US military, patient direct referral for diagnostic imaging has been considered normative practice for decades. US physical therapy program accreditation standards now stipulate that diagnostic imaging content must be included in physical therapist educational curricula. The American Physical Therapy Association (APTA) has made efforts to pursue practice authority for imaging referral. A recent review of state practice acts and other statutory language concluded that many states have no prohibitions against physical therapists referring for imaging studies. Additionally, physical therapists can now pursue certification as musculoskeletal sonographers. In light of these advances, and with a growing number of PTs serving patients who have not yet seen another healthcare provider, it may be helpful for those who have been actively involved in the use of imaging in PT practice to provide their collective recommendations to serve as a guideline to those interested in incorporating this practice privilege. The purpose of this perspective article is to provide an overview of the key elements necessary for effective implementation of referral for imaging in physical therapist practice while emphasizing the cornerstone of effective communication.

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Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral

Physical Therapy ◽

10.2522/ptj.20050393 ◽

2006 ◽

Vol 86 (12) ◽

pp. 1619-1629 ◽

Cited By ~ 136

Author(s):

Diane U Jette ◽

Kerry Ardleigh ◽

Kellie Chandler ◽

Lesley McShea

Keyword(s):

Physical Therapy ◽

Confidence Interval ◽

Physical Therapists ◽

Physical Therapist ◽

Direct Access ◽

Medical Conditions ◽

Musculoskeletal Conditions ◽

Logistic Regressions ◽

American Physical ◽

Medical Referral

Abstract Background and PurposeOpponents of direct access to physical therapy argue that physical therapists may overlook serious medical conditions. More information is needed to determine the ability of physical therapists to practice safely in direct-access environments. The purpose of this study was to describe the ability of physical therapists to make decisions about the management of patients in a direct-access environment. Subjects. Of a random sample of 1,000 members of the Private Practice Section of the American Physical Therapy Association, 394 participated. Methods. A survey included 12 hypothetical case scenarios. For each case, participants determined whether they would provide intervention without referral, provide intervention and refer, or refer before intervention. The percentage of correct decisions for each group of scenarios was calculated for each participant, and participants were classified as having made correct decisions for 100% of cases or less for each group. Three sets of logistic regressions were completed to determine the characteristics of the participants in relation to the decision category. Results. The average percentages of correct decisions were 87%, 88%, and 79% for musculoskeletal, noncritical medical, and critical medical conditions, respectively. Of all participants, approximately 50% made correct decisions for all cases within each group. The odds of making 100% correct decisions if a physical therapist had an orthopedic specialization were 2.23 (95% confidence interval=1.35–3.71) for musculoskeletal conditions and 1.89 (95% confidence interval=1.14–3.15) for critical medical conditions. Discussion and Conclusion. Physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.

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The Use of Yoga by Physical Therapists in the United States

International Journal of Yoga Therapy ◽

10.17761/1531-2054-27.1.69 ◽

2017 ◽

Vol 27 (1) ◽

pp. 69-79 ◽

Cited By ~ 1

Author(s):

Mary E. Wims ◽

Shayla M. McIntyre ◽

Ann York ◽

Laura G. Covill

Keyword(s):

United States ◽

Physical Therapy ◽

Physical Therapists ◽

The United States ◽

Primary Concern ◽

Health And Wellness ◽

Clinical Practices ◽

Post Discharge ◽

Electronic Communications ◽

American Physical

Abstract How physical therapists (PTs) in the United States currently use yoga in their clinical practices is unknown. The purpose of this study was to determine how PTs in the United States view yoga as a physical therapy (PT) tool and how PTs use yoga therapeutically. The authors conducted a 24-item survey via electronic communications of the Geriatric, Orthopedic, Pediatric, and Women's Health Sections of the American Physical Therapy Association. Participants (n = 333) from 47 states and the District of Columbia replied. Reported use of therapeutic yoga among participants was high (70.6%). Of those participants, nearly a third use asana and pranayama only. Most participants using therapeutic yoga also include additional mindfulness-related elements such as sensory awareness, concentration/focus, and/or meditation. Most participants learned about yoga through personal experiences, with many participants citing lack of familiarity in using yoga in PT practice. Safety is the primary concern of participants when recommending yoga to patients as an independent health and wellness activity. Interdisciplinary communication between PTs, yoga therapists, and yoga teachers is warranted to address the post-discharge needs of clients. Healthcare changes have required PTs to adapt to a biopsychosocial-spiritual model (BPSS) for improved patient outcomes. Therapeutic yoga may provide an opportunity for PTs to expand their role in health and wellness and chronic disease management. There is opportunity for continuing education in therapeutic yoga for PTs.

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Administration and Management Skills Needed by Physical Therapist Graduates in 2010: A National Survey

Physical Therapy ◽

10.2522/ptj.20060003 ◽

2007 ◽

Vol 87 (3) ◽

pp. 261-281 ◽

Cited By ~ 5

Author(s):

D Sue Schafer ◽

Rosalie B Lopopolo ◽

Kathleen A Luedtke-Hoffmann

Keyword(s):

Physical Therapy ◽

Skill Acquisition ◽

Financial Analysis ◽

Physical Therapists ◽

Physical Therapist ◽

Management Skills ◽

Health Care Environment ◽

Doctor Of Physical Therapy ◽

Skill Groups ◽

American Physical

Background and Purpose Administration and management (A&M) skills are essential to physical therapist practice. This study identified which A&M skills will be most critical for future Doctor of Physical Therapy (DPT) graduates to possess upon entry into clinical practice. Subjects and Methods Using a 7-point scale, 435 randomly selected American Physical Therapy Association members (physical therapists) rated 121 A&M skills based on expectation of the level of independence required by a new DPT graduate. Results No differences among respondents based on role, work setting, or experience were found, so the data were combined for factor analyses, producing 16 A&M skill groups. The most independence was expected in skills related to self-management, compliance with rules, ethical behavior, and insurance coding. Skills requiring the most assistance were marketing and strategic planning, financial analysis and budgeting, and environmental assessment. Discussion and Conclusion This study has identified the level of independence for the A&M skills needed by new DPT graduates, provided empirical evidence suggesting which A&M skills should be included in DPT curricula, and suggested a pattern of A&M skill acquisition that applies first to the new therapist and the patient, then to the organization, and finally to the health care environment.

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We Don’t Know our Own Strength: A Survey of Strength Training Attitudes, Behaviors and Knowledge in Physical Therapists and Physical Therapist Students

Physical Therapy ◽

10.1093/ptj/pzab204 ◽

2021 ◽

Author(s):

Reed Handlery ◽

Emma Shover ◽

Thavi Chhoun ◽

Lauren Durant ◽

Kaci Handlery ◽

...

Keyword(s):

Physical Therapy ◽

Strength Training ◽

Professional Education ◽

Physical Therapists ◽

Physical Therapist ◽

The United States ◽

Physical Therapy Students ◽

Physical Therapy Education ◽

Education Participation ◽

Therapy Education

Abstract Objective Strength training is frequently utilized by physical therapists; however, there has been discussion about whether physical therapists utilize strength training adequately. The purpose of this study was to describe and compare the strength training attitudes, behaviors, and knowledge of physical therapists and physical therapy students and to determine how participant characteristics influenced knowledge scores. Methods An anonymous survey was created in 3 rounds. For round 1, researchers used textbooks to create items assessing demographics, attitudes, behaviors, and knowledge regarding strength training. Rounds 2 and 3 consisted of feedback from 7 content experts until 80% consensus was reached; items were added, removed, or edited based on feedback. The final survey was distributed through social media, list servs, and email, targeting physical therapists and students based in the United States. Response frequencies for all items were reported. Overall knowledge scores were calculated by summing correct responses for each item, with a maximum score of 13; scores <70% were considered low. Binomial logistic regression determined which characteristics (demographics, attitudes, or behaviors) influenced whether participants adequately utilized strength training principles (scored ≥70% on knowledge items). Results There were 777 physical therapist and 648 student participants. Nearly 90% of therapists and students reported frequently prescribing strength training. Over 48% of therapists felt their professional education did not prepare them to apply strength training (compared with 24% of students), and 68% believed that strength training is inadequately applied in physical therapy (compared with 40% of students). Sixty-two percent of therapists and 55% of students scored ≥70% for knowledge items. Additional strength training education and regular participation in strength training increased the odds of scoring ≥70% on knowledge items. Conclusions Physical therapists and physical therapy students frequently prescribe strength training, despite similarly low knowledge scores. To increase knowledge, greater emphasis on strength training in professional education, continuing education, participation in strength training, or all 3 is warranted. Impact Strength training is an important intervention used in physical therapy and must be used appropriately to improve the health of patients. According to these findings, strength training education may not currently be optimal, as demonstrated by low knowledge scores by both therapists and students. Further work is needed to determine how knowledge of strength training relates to patient outcomes and also how best to implement strength training in physical therapy education and practice.

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Toward Sensitive Practice: Issues for Physical Therapists Working With Survivors of Childhood Sexual Abuse

Physical Therapy ◽

10.1093/ptj/79.3.248 ◽

1999 ◽

Vol 79 (3) ◽

pp. 248-261 ◽

Cited By ~ 31

Author(s):

Candice L Schachter ◽

Carol A Stalker ◽

Eli Teram

Keyword(s):

Sexual Abuse ◽

Physical Therapy ◽

Childhood Sexual Abuse ◽

Physical Therapists ◽

Physical Therapist ◽

Adult Survivors ◽

The United States ◽

Female Survivors ◽

Semistructured Interviews

Abstract Background and Purpose. The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. Subjects and Methods. Twenty-seven female survivors (aged 19–62 years) participated in semistructured interviews in which they described their reactions to physical therapy. Results. Survivors' reactions to physical therapy, termed “long-term sequelae of abuse that detract from feeling safe in physical therapy,” are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. Conclusions and Discussion. Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor. [Schachter CL, Stalker CA, Teram E. Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse.

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Guide to Physical Therapist Practice

Physical Therapy ◽

10.1093/ptj/77.11.1163 ◽

1997 ◽

Vol 77 (11) ◽

pp. 1163-1650 ◽

Cited By ~ 41

Keyword(s):

Health Care ◽

Physical Therapy ◽

Professional Education ◽

Health Care Services ◽

Physical Therapists ◽

Physical Therapist ◽

Daily Practice ◽

Care Services ◽

Provision Of Services ◽

American Physical

Preface All health care professions are accountable to the various publics that they serve. The American Physical Therapy Association (APTA) has developed Guide to Physical Therapist Practice (“the Guide”) to help physical therapists analyze their patient/client management and describe the scope of their practice. The Guide is necessary not only to daily practice but to preparation of students. It was used as a primary resource by the Commission on Accreditation in Physical Therapy Education (CAPTE) during its revision of evaluative criteria for physical therapist professional education programs and is an essential companion document to The Normative Model of Physical Therapist Professional Education, Version 97. Specifically, the Guide is designed to help physical therapists (1) enhance quality of care, (2) improve patient/client satisfaction, (3) promote appropriate utilization of health care services, (4) increase efficiency and reduce unwarranted variation in the provision of services, and (5) promote cost reduction through prevention and wellness initiatives. The Guide also provides a framework for physical therapist clinicians and researchers as they refine outcomes data collection and analysis and develop questions for clinical research.

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“Choose Physical Therapy” for Neonatal Abstinence Syndrome: Clinical Management for Infants Affected by the Opioid Crisis

Physical Therapy ◽

10.1093/ptj/pzz039 ◽

2019 ◽

Vol 99 (6) ◽

pp. 771-785 ◽

Cited By ~ 3

Author(s):

Dana B McCarty ◽

Jennifer R Peat ◽

Shannon O'Donnell ◽

Elisabeth Graham ◽

William F Malcolm

Keyword(s):

Physical Therapy ◽

Parent Education ◽

Physical Therapists ◽

Physical Therapist ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Safe Alternative ◽

Pharmacological Management ◽

Opioid Crisis ◽

American Physical

Abstract In response to the opioid crisis, the American Physical Therapy Association has strongly advocated for physical therapy as a safe alternative to pharmacological pain management through the “#ChoosePT” campaign and the dedication of a PTJ special issue to the nonpharmacological management of pain. Physical therapists not only play an important role in the rehabilitation of the nearly 2 million adolescents and adults addicted to prescription opioids but also provide care to infants born to mothers with various drug addictions. This Perspective article explores the incidence, pathophysiology, and risk factors for neonatal abstinence syndrome and describes the clinical presentations of withdrawal and neurotoxicity in infants. Discipline-specific recommendations for the physical therapist examination and plan of care, including pharmacological management considerations, are outlined. Nonpharmacological management, including supportive care, feeding, parent education, social aspects of care, and follow-up services, are discussed from a physical therapy perspective. Finally, this article reviews developmental outcomes in infants with neonatal abstinence syndrome and reflects on challenges and future directions of research in this area.

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Preface

Physical Therapy ◽

10.1093/ptj/77.11.1167 ◽

1997 ◽

Vol 77 (11) ◽

pp. 1167-1170

Keyword(s):

Health Care ◽

Physical Therapy ◽

Professional Education ◽

Health Care Services ◽

Physical Therapists ◽

Physical Therapist ◽

Daily Practice ◽

Care Services ◽

Provision Of Services ◽

American Physical

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Navigating the Intersection Between Persistent Pain and the Opioid Crisis: Population Health Perspectives for Physical Therapy

Physical Therapy ◽

10.1093/ptj/pzaa031 ◽

2020 ◽

Vol 100 (6) ◽

pp. 995-1007

Author(s):

Todd E Davenport ◽

Andra C DeVoght ◽

Holly Sisneros ◽

Stephen Bezruchka

Keyword(s):

Physical Therapy ◽

Population Health ◽

Physical Therapists ◽

Physical Therapist ◽

Opioid Use Disorder ◽

Persistent Pain ◽

Opioid Use ◽

Individual Level ◽

American Physical ◽

The Impact

Abstract The physical therapy profession has recently begun to address its role in preventing and managing opioid use disorder (OUD). This topic calls for discussion of the scope of physical therapist practice, and the profession’s role, in the prevention and treatment of complex chronic illnesses, such as OUD. OUD is not just an individual-level problem. Abundant scientific literature indicates OUD is a problem that warrants interventions at the societal level. This upstream orientation is supported in the American Physical Therapy Association’s vision statement compelling societal transformation and its mission of building communities. Applying a population health framework to these efforts could provide physical therapists with a useful viewpoint that can inform clinical practice and research, as well as develop new cross-disciplinary partnerships. This Perspective discusses the intersection of OUD and persistent pain using the disease prevention model. Primordial, primary, secondary, and tertiary preventive strategies are defined and discussed. This Perspective then explains the potential contributions of this model to current practices in physical therapy, as well as providing actionable suggestions for physical therapists to help develop and implement upstream interventions that could reduce the impact of OUD in their communities.

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Use of Standardized Outcome Measures in Physical Therapist Practice: Perceptions and Applications

Physical Therapy ◽

10.2522/ptj.20080234 ◽

2009 ◽

Vol 89 (2) ◽

pp. 125-135 ◽

Cited By ~ 235

Author(s):

Diane U Jette ◽

James Halbert ◽

Courtney Iverson ◽

Erin Miceli ◽

Palak Shah

Keyword(s):

Outcome Measures ◽

Physical Therapists ◽

Physical Therapist ◽

Management Strategies ◽

The United States ◽

Clinical Settings ◽

Rehabilitation Professionals ◽

Participation Restrictions ◽

Specialty Certification ◽

American Physical

Background Standardized instruments for measuring patients' activity limitations and participation restrictions have been advocated for use by rehabilitation professionals for many years. The available literature provides few recent reports of the use of these measures by physical therapists in the United States. Objective The primary purpose of this study was to determine: (1) the extent of the use of standardized outcome measures and (2) perceptions regarding their benefits and barriers to their use. A secondary purpose was to examine factors associated with their use among physical therapists in clinical practice. Design The study used an observational design. Methods A survey questionnaire comprising items regarding the use and perceived benefits and barriers of standardized outcome measures was sent to 1,000 randomly selected members of the American Physical Therapy Association (APTA). Results Forty-eight percent of participants used standardized outcome measures. The majority of participants (>90%) who used such measures believed that they enhanced communication with patients and helped direct the plan of care. The most frequently reported reasons for not using such measures included length of time for patients to complete them, length of time for clinicians to analyze the data, and difficulty for patients in completing them independently. Use of standardized outcome measures was related to specialty certification status, practice setting, and the age of the majority of patients treated. Limitations The limitations included an unvalidated survey for data collection and a sample limited to APTA members. Conclusions Despite more than a decade of development and testing of standardized outcome measures appropriate for various conditions and practice settings, physical therapists have some distance to go in implementing their use routinely in most clinical settings. Based on the perceived barriers, alterations in practice management strategies and the instruments themselves may be necessary to increase their use.

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