As physical therapists become doctors of physical therapy, direct access making legislative gains in most states and the public loathing the current insurance system, is there a role reversal change in healthcare to improve status of PTs?

There are quite a few physical therapists out there who feel we can be more on the forefront of musculoskeletal issues and change the framework of patient care.  This can be made in possible annual visits to the therapist as most go to eye doctors & dentists or even musculoskeletal examinations to those without pain for prevention?

Physical therapy is by largely established in rehabilitation from injuries/surgery, but where do we stand as clinical diagnosticians and consultants?  Can physical therapists not only be more cost effective, but accurate in addressing orthopedic disorders?

A great study by JOSPT (that even won the Excellence in Research Award) by Moore JH, et al in 2005 demonstrated the clinical diagnostic accuracy by physical therapists.  By comparing various peripheral and spinal musculoskeletal injuries diagnosis to MRI, the authors found that PTs can make independent decisions away from a physician referral.

The following numbers state the accuracy of clinical diagnosis between:

-Physical therapists: 74.5%

-Orthopedic Surgeons: 80.8%

-Non-orthopedic providers: 35.4%

Bottom line, significant difference was found between physical therapists and non-orthopedic surgeons and no difference was found between physical therapists and orthopedic surgeons.  Not that shabby of a study and very shocking results.

Another article I want to bring up is Daker-White et al in J Epidemiol Community Health in 1999, entitled “A randomised controlled trial.  Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments”.

The study randomly assigned patients with musculoskeletal problems into two groups:

– Fellowship Junior Orthopedic Surgeons

– Or Specially Trained Physiotherapists working as an extended role (this was an overseas study).

Main measures studied between the two groups:

-Patient-centered pain measures

-Functional disability

-Perceived handicap

The following were the key findings:

-New referrals to orthopedic outpatient centers can be completed just as well as suitably trained physiotherapists as sub-consultant surgeons

-Physiotherapist’s patients reported greater level of satisfaction compared to those seen by surgeon at follow-up

-Initial direct hospital costs for the NHS were lower when seen by physiotherapist.

The first key point is the main conclusion the authors determined and agrees with past studies addressing similar topics. Based on the discussion, the main difference is that surgeons ordered more radiograph imaging (which is larger part of their training), however, the extended role physiotherapists were also trained in radiograph analysis and radiological protection.  Bottom line, are radiographs really needed??

Other than military physical therapists (who have privileges to practice in primary orthopedic care), I don’t know any physical therapists are capable of being in the article described “extended role”, but

aren’t we almost there in most parts with the DPT (includes radiology and pharmacology), growing numbers of Fellowships/Residencies and OCS (orthopedic specialists)?

What are your thoughts on the growth of PTs based on these article conclusions?  Do you have any other literature agreeing or differing with the results?  Do you think we, as a profession, are ready to extend our roots?

Daker-White et al. A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments. J Epidemiol Community Health. 1999 Oct;53(10):643-50.

Moore JH, et al.  Clinical Diagnostic Accuracy and Magnetic Resonance Imaging of Patients Referred by Physical Therapists, Orthopaedic Surgeons and Nonorthopedic Providers. JOSPT.  2005. February; 5 (2):67-71.

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3 comments

  1. Harrison,

    With the advent of preventive care, insurance providers are the ones taking a proactive role as it pertains to changing the definition of what “care” is and who can provide it. For example, whereas orthopedic assessment and medical massage was not usually covered in basic benefits before, in many plans the insurance provider will at the very least subsidize those things if not pay for them outright without pre-existing conditions or injuries being present.

    Sadly, because of the inaction of our government on the DEFINITION of medical care (instead choosing to focus on who pays for what), this is left up to the free market to decide whether or not administered treatment and diagnosis such as the type given in the field of physical therapy is legitimate. It is a sad day when a radical variable like the economy can choose the laws and ethics of medicine.

    1. Kim,
      You may know of more examples than I do of insurance companies who are paying for preventative medicine but from what I see, its not common. I would like to see it more often but as a society, we don’t pursue it as a proactive role. It isn’t understood by many that healthy living through exercise and diet prevents heart disease, etc. so I really don’t see it happening anytime soon that citizens will take advantage of preventative medicine when they don’t do the daily changes needed for healthy lifestyle. We think a magic pill is available for everything…sadly but true.

      Benjamin Franklin was right long ago:
      “An ounce of prevention is worth a pound of cure”

      Unless the golden shackles of insurance makes it happen, I don’t see Americans pursuing preventative medicine personally.

      -Harrison

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