scholarly journals Direct Access to Physical Therapy: Should Italy Move Forward?

2022 ◽  
Vol 19 (1) ◽  
pp. 555
Author(s):  
Filippo Maselli ◽  
Leonardo Piano ◽  
Simone Cecchetto ◽  
Lorenzo Storari ◽  
Giacomo Rossettini ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Musculoskeletal Disorders ◽  
General Practitioners ◽  
Physical Therapist ◽  
Care Pathway ◽  
Scientific Evidence ◽  
Historical Context ◽  
Healthcare Systems ◽  
Direct Access ◽  
Academic Paths

Direct access to physical therapy (DAPT) is the patient’s ability to self-refer to a physical therapist, without previous consultation from any other professional. This model of care has been implemented in many healthcare systems since it has demonstrated better outcomes than traditional models of care. The model of DAPT mainly focuses on the management of musculoskeletal disorders, with a huge epidemiological burden and worldwide healthcare systems workload. Among the healthcare professionals, physical therapists are one of the most accessed for managing pain and disability related to musculoskeletal disorders. Additionally, the most updated guidelines recommend DAPT as a first-line treatment because of its cost-effectiveness, safety, and patients’ satisfaction compared to other interventions. DAPT was also adopted to efficiently face the diffuse crisis of the declining number of general practitioners, reducing their caseload by directly managing patients’ musculoskeletal disorders traditionally seen by general practitioners. World Physiotherapy organization also advocates DAPT as a new approach, with physical therapy in a primary care pathway to better control healthcare expenses. Thus, it is unclear why the Italian institutions have decided to recognize new professions instead of focusing on the growth of physical therapy, a long-established and autonomous health profession. Furthermore, it is unclear why DAPT is still not fully recognized, considering the historical context and its evidence. The future is now: although still preliminary, the evidence supporting DAPT is promising. Hard skills, academic paths, scientific evidence, and the legislature argue that this paradigm shift should occur in Italy.

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

2006 ◽  
Vol 86 (12) ◽  
pp. 1619-1629 ◽  
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.

scholarly journals Direct access to physical therapy for the patient with musculoskeletal disorders, a literature review

2017 ◽  
Vol 29 (8) ◽  
pp. 1463-1471 ◽  
Author(s):  
Leonardo Piano ◽  
Filippo Maselli ◽  
Antonello Viceconti ◽  
Silvia Gianola ◽  
Aldo Ciuro
Keyword(s):  
Physical Therapy ◽  
Literature Review ◽  
Musculoskeletal Disorders ◽  
Direct Access

scholarly journals BACK TO THE GRASS ROOT

2014 ◽  
Vol 3 (2) ◽  
pp. 41-43
Author(s):  
Ali Farhad ◽  
Saad Saleem ◽  
Zainab Abdul Razzak
Keyword(s):  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Direct Access ◽  
Self Assessment ◽  
Professional Advancement ◽  
Health Networks ◽  
Grass Root

Profession is, not to squeak like a grateful and apologetic mouse, but to roar like a lion out of pride1. Throughout a professional vocation, professionals change the span of their skill, through becoming more specific, through inspiring into recently emergent areas of professional work, or by taking on administration or enlightening positions. They will also be continually developing the quality of their work in a number of areas, beyond the level of proficiency of one’s ability or skill. Professional advancement inculcates a process of incessant development, long-term knowledge, and augmentation, which allow professionals to get better in their practices so as to better serve patients, clients, associations, the profession, and society2. A physical therapist has an enduring professional accountability for maintaining proficiency through ongoing self-assessment, education, and augmentation of information and skills. Physical Therapy, by 2020, will offer such Physiotherapist who are doctors of Physical Therapy and who may be board–licensed experts3. Clients will have direct access to Physical Therapists in all milieus for patient/client management, expectation, and wellness services. Physiotherapist will be practitioners of choice in clients’/patients’ health networks and will hold all rights of autonomous practice4. Physical Therapists may be assisted by Physical Therapy assistants, who are erudite and qualified to provide Physical Therapist–directed and controlled, components of intervention. Physical Therapy profession in Pakistan is rising with a great pace. Every passing minute brings extraordinary revolution in this field and now it is a high time to have some institution takes the responsibility on its shoulder to curtail the nourishing elements of quackery and bring autonomy and sovereignty to the field.

scholarly journals A Global View of Direct Access and Patient Self-Referral to Physical Therapy: Implications for the Profession

2013 ◽  
Vol 93 (4) ◽  
pp. 449-459 ◽  
Author(s):  
Tracy J. Bury ◽  
Emma K. Stokes
Keyword(s):  
Physical Therapy ◽  
Online Survey ◽  
Response Rate ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Medical Profession ◽  
Good Practice ◽  
Clinical Effectiveness ◽  
Direct Access ◽  
Policy Makers

BackgroundInternational policy advocates for direct access, but the extent to which it exists worldwide was unknown.ObjectiveThe purpose of this study was to map the presence of direct access to physical therapy services in the member organizations of the World Confederation for Physical Therapy (WCPT) in the context of physical therapist practice and health systems.DesignA 2-stage, mixed-method, descriptive study was conducted.MethodsA purposive sample of member organizations of WCPT in Europe was used to refine the survey instrument, followed by an online survey sent to all WCPT member organizations. Data were analyzed using descriptive statistics, and content analysis was used to analyze open-ended responses to identify themes.ResultsA response rate of 68% (72/106) was achieved. Direct access to physical therapy was reported by 58% of the respondents, with greater prevalence in private settings. Organizations reported that professional (entry-level) education equipped physical therapists for direct access in 69% of the countries. National physical therapy associations (89%) and the public (84%) were thought to be in support of direct access, with less support perceived from policy makers (35%) and physicians (16%). Physical therapists' ability to assess, diagnose, and refer patients on to specialists was more prevalent in the presence of direct access.LimitationsThe findings may not be representative of the Asia Western Pacific (AWP) region, where there was a lower response rate.ConclusionsProfessional legislation, the medical profession, politicians, and policy makers are perceived to act as both barriers to and facilitators of direct access. Evidence for clinical effectiveness and cost-effectiveness and examples of good practice are seen as vital resources that could be shared internationally, and professional leadership has an important role to play in facilitating change and advocacy.

scholarly journals Dermatomyositis: Evolution of a Diagnosis

2003 ◽  
Vol 83 (10) ◽  
pp. 932-945 ◽  
Author(s):  
Joshua A Cleland ◽  
Jane Walter Venzke
Keyword(s):  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Short Form ◽  
Exercise Program ◽  
Signs And Symptoms ◽  
Care Physician ◽  
Direct Access ◽  
Home Exercise ◽  
Diagnostic Process

Abstract Background and Purpose. As direct access evolves, physical therapists will increasingly encounter patients with pathology that might have an underlying systemic origin. The purpose of this case report is to describe the diagnostic process that led a patient's physical therapist to recognize signs and symptoms of dermatomyositis. Case Description. The patient was an 18-year-old woman who was referred for physical therapy by her primary care physician on 3 occasions with 3 separate musculoskeletal diagnoses. During the third episode, the physical therapist recognized signs and symptoms that could be indicative of dermatologic disease and referred the patient to a dermatologist. Outcomes. A rheumatologist diagnosed the patient's condition as dermatomyositis and referred her for physical therapy. The physical therapy plan of care focused on strengthening and stretching, with an emphasis on a home exercise program. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) indicated that the patient continually made functional improvements over an 18-month period. Discussion. Although diagnosis of diseases such as inflammatory myopathies is not within a physical therapist's scope of practice, this case demonstrates the role a physical therapist can play in recognition of underlying systemic pathology by using the diagnostic process.

Cost-Effectiveness and Outcomes of Direct Access to Physical Therapy for Musculoskeletal Disorders Compared to Physician-First Access in the United States: Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Sandra Hon ◽  
Richard Ritter ◽  
Diane D Allen
Keyword(s):  
United States ◽  
Health Care ◽  
Cost Effectiveness ◽  
Physical Therapy ◽  
Musculoskeletal Disorders ◽  
Functional Outcomes ◽  
Cost Effective ◽  
The United States ◽  
Effect Sizes ◽  
Direct Access

Abstract Objective Direct access to physical therapy provides an alternative to physician-first systems for patients who need physical therapy for musculoskeletal disorders (MSDs). Direct access across multiple countries and the United States (US) military services has produced improved functional outcomes and/or cost-effectiveness at clinical and health care system levels; however, data remain scarce from civilian health care systems within the United States. The purpose of this study was to compare evidence regarding costs and clinical outcomes between direct access and physician-first systems in US civilian health services. Methods A database search of PubMed, CINAHL, Cochrane Reviews, and PEDro was conducted through May 2019. Studies were selected if they specified civilian US, physical therapy for MSDs, direct access or physician-first, and extractable outcomes for cost, function, or number of physical therapy visits. Studies were excluded if interventions utilized early or delayed physical therapy access compared with physician-first. Five retrospective studies met the criteria. Means and standard deviations for functional outcomes, cost, and number of visits were extracted, converted to effect sizes (d) and 95% CI, and combined into grand effect sizes using fixed-effect or random-effects models depending on significance of the Q heterogeneity statistic. Results Direct access to physical therapy showed reduced physical therapy costs (d = −0.23; 95% CI = −0.35 to −0.11), total health care costs (d = −0.19; 95% CI = −0.32 to −0.07), and number of physical therapy visits (d = −0.17; 95% CI = −0.29 to −0.05) compared to physician-first systems. Disability decreased in both direct access (d = −1.78; 95% CI = −2.28 to −1.29) and physician-first (d = −0.89; 95% CI = −0.92 to −0.85) groups; functional outcome improved significantly more with direct access (z score = 0.89; 95% CI = 0.40 to 1.39). Conclusions Direct access to physical therapy is more cost-effective in fewer visits than physician-first access in the United States, with greater functional improvement. Impact These findings within civilian US health care services support a cost-effective health care access alternative for spine-related MSDs and can inform health care policy makers.

scholarly journals Direct Access to Physical Therapy in the Netherlands: Results From the First Year in Community-Based Physical Therapy

2008 ◽  
Vol 88 (8) ◽  
pp. 936-946 ◽  
Author(s):  
Chantal J Leemrijse ◽  
Ilse CS Swinkels ◽  
Cindy Veenhof
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
The Netherlands ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Information Service ◽  
Direct Access ◽  
Number Of Patients ◽  
Quality Aspects ◽  
Nationally Representative

BackgroundIn 2006, direct access to physical therapy was introduced in the Netherlands. Before this policy measure, evaluation and treatment by a physical therapist were only possible following referral by a physician.ObjectiveThe objectives of this study were to investigate how many patients use direct access and to establish whether these patients have a different profile than referred patients.MethodsElectronic health care data from the National Information Service for Allied Health Care (LiPZ), a nationally representative registration network of 93 Dutch physical therapists working in 43 private practices, were used.ResultsIn 2006, 28% of the patients seen by a physical therapist came by direct access. Patients with non–further-specified back problems, patients with nonspecific neck complaints, and higher-educated patients were more likely to refer themselves to a physical therapist, as were patients with health problems lasting for less than 1 month. Younger patients made more use of direct access. In addition, patients with recurring complaints more often referred themselves, as did patients who had received earlier treatment by a physical therapist. Patients with direct access received fewer treatment sessions. Compared with 2005, there was no increase in the number of patients visiting a physical therapist.LimitationsData came only from physical therapists working on general conditions in general practices. Severity of complaints is not reported.ConclusionsA large, specific group of patients utilized self-referral, but the total number of patients seen by a physical therapist remained the same. In the future, it is important to evaluate the consequences of direct access, both on quality aspects and on cost-effectiveness.

Direct Access to Physical Therapy in Michigan is Overdue

2013 ◽  
Vol 3 (1) ◽  
pp. 013-016
Author(s):  
Kevin Patterson ◽  
Rachel Patterson
Keyword(s):  
Physical Therapy ◽  
Direct Access

scholarly journals Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

2013 ◽  
Vol 93 (7) ◽  
pp. 975-985 ◽  
Author(s):  
Heidi J. Engel ◽  
Shintaro Tatebe ◽  
Philip B. Alonzo ◽  
Rebecca L. Mustille ◽  
Monica J. Rivera
Keyword(s):  
Quality Improvement ◽  
Physical Therapy ◽  
San Francisco ◽  
Physical Therapist ◽  
Medical Center ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Icu Admission ◽  
Number Of Patients

Background Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. Objective The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. Design This study was a 9-month retrospective analysis of a quality improvement project. Methods An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. Results From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. Limitations This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. Conclusions The improvements in outcomes demonstrated the value and feasibility of a physical therapist–led early mobilization program.

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