Direct Access Compared With Referred Physical Therapy Episodes of Care

Direct Access Compared With Referred Physical Therapy Episodes of Care

Evidence indicates that physical therapy via direct access could help aid in decreasing costs and improve patient outcomes compared with physical therapy by physician referral. Therefore, the authors conducted this systematic review of the literature on patients with musculoskeletal injuries and compared the health care costs and patient outcomes in episodes of physical therapy by direct access compared with referred physical therapy. Ovid MEDLINE, CINAHL (EBSCO), Web of Science, and PEDro were searched using terms related to physical therapy and direct access. Included articles were hand searched for additional references. Included studies compared data from physical therapy by direct access with physical therapy by physician referral, studying cost, outcomes, or harm. The studies were appraised using the Centre for Evidence-Based Medicine (CEBM) levels of evidence criteria and assigned a methodological score. Of the 1,501 articles that they screened, 8 articles at levels 3 to 4 on the CEBM scale were included. They found statistically significant and clinically meaningful findings across studies that satisfaction and outcomes were superior, and numbers of physical therapy visits, imaging ordered, medications prescribed, and additional non-physical therapy appointments were less in cohorts receiving physical therapy by direct access compared with referred episodes of care. They did not find evidence for harm. They found evidence consistent with a grade B CEBM level of recommendation that physical therapy by direct access compared with referred episodes of care is associated with improved patient outcomes and decreased costs. Their primary limitations were lack of group randomization, potential for selection bias, and limited generalizability.

They concluded that physical therapy through direct access may reduce or limit health care costs and promote high-quality health care, adding that third-party payers should consider paying for physical therapy by direct access to decrease health care costs and encourage optimal patient outcomes.

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