Musculoskeletal Imaging for Low Back Pain in Direct Access Physical Therapy Compared to Primary Care: An Observational Study.
Michael S Crowell, John S Mason, John H McGinniss
PMID 35136693WHAT IT FOUND
Direct-access physical therapists ordered imaging within 28 days of low back pain diagnosis in 3.3% of visits, compared to 18.0% in primary care.
They waited significantly longer before imaging but showed no difference in clinically significant findings or specialist referrals.
Key findings
01Physical therapists had a much higher compliance rate with guidelines against early imaging (96.7% compliant) compared to primary care providers (82.0% compliant).
02Physical therapists waited an average of 26.4 days and saw patients for 3.8 visits before ordering imaging, whereas primary care providers waited 7.6 days and 1.1 visits.
03There were no statistically significant differences in the rate of clinically significant abnormal findings or specialist referrals between the two groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was conducted in a military setting with young, athletic patients (aged 18-24), so results may not generalize to older or civilian populations. The sample size for the detailed imaging review was small (92 PT and 50 PC cases), leading to low statistical power for detecting differences in abnormal findings and referrals. As a retrospective review, data quality depended on electronic records, which may not capture verbal recommendations or nuances in care. Physical therapists reviewed the PT imaging data, which introduces potential bias in the assessment of findings.
Declared interests
The authors declared no relevant or material financial interests.
The easy way to misread this
Do not conclude that physical therapists are more accurate at identifying serious pathology. The study found no significant difference in clinically significant findings or referrals, and the small sample size for the imaging review means it was underpowered to detect differences in these specific outcomes.