School-Based Physical Therapy Services: Predicting the Gap Between Ideal and Actual Embedded Services.
Valerie D Clevenger, Lynn M Jeffries, Susan K Effgen and 2 others
PMID 32218069WHAT IT FOUND
School-based PTs estimate they provide fewer embedded services than they believe are ideal, especially for students with moderate disabilities.
Billing practices, district contracts, and inferred family preferences predict this gap, suggesting administrative and social factors limit practice more than clinical need.
Key findings
01Disability severity, billing practices, contracts, and family preferences were the four variables that predicted the gap between ideal and actual embedded services.
02PTs reported the largest gap between ideal and actual practice for students with moderate disabilities, while providing services to students with severe disabilities closer to their ideal levels.
03The study relied on PTs estimating what families and teachers preferred, rather than asking families and teachers directly.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study relies on self-reported estimates of ideal and actual practice, which may be subject to recall bias or social desirability. Family and teacher preferences were inferred by the PTs, not reported by the families or teachers themselves. 36% of those who started the survey were excluded because they did not complete at least 50% of it, potentially biasing the sample toward those with stronger opinions or more time. The survey used respondent-driven sampling (snowball technique), which may result in participants with similar views and limit generalizability.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institutes of Health (NIH) and the U.S. Government (Non-P.H.S.).
The easy way to misread this
Do not interpret the 'gap' as a measure of clinical quality or student outcome. This study reports on therapists' perceptions of service location and frequency, not on whether embedded services actually improved student participation or function.