Direct access to physical therapy for the patient with musculoskeletal disorders, a literature review.
Leonardo Piano, Filippo Maselli, Antonello Viceconti and 2 others
PMID 28878484WHAT IT FOUND
Self-referring to physical therapy for musculoskeletal disorders was reported to help patients reach goals, reduce missed work, and lower costs, and to be as safe as physician referral, but this review was not systematic and cannot confirm it.
Key findings
01Direct access to physical therapy for musculoskeletal disorders was reported to produce better outcomes at discharge than physician referral.
0272.6% of direct-access patients fully reached their treatment goals at the end of treatment, compared with 63.3% of referred patients.
03Patients assessed by physical therapists under direct access had no recorded adverse events over 40 months, and the risk of adverse events was reported as equivalent to referral-based care.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The authors state this was not a systematic review, so their study selection could affect the conclusions. The safety evidence comes from studies with methods that were not always up to standard and that measured adverse events in different ways, so the authors say definitive conclusions cannot be taken. The cost analyses assume direct access and referral have the same effectiveness; if outcomes differ, the savings may be misleading. There are no published cost-effectiveness studies directly comparing direct access with referral from a health-system or societal perspective. The authors say the available literature on direct access is not broad or standardized.
Declared interests
The authors declare no competing interests.
The easy way to misread this
Do not conclude that direct access to physical therapy is proven better or safer for every musculoskeletal patient. The authors say this was not a systematic review, and no published cost-effectiveness study has directly compared it with physician referral.