Physical Therapy: A Doctoring Profession

1. Physical Therapy:A Doctoring Profession Christina Brashares Steven Marano Jeff Moore Simki Patel Bravo Group Upper Extremity Management Course

2. The Physical Therapy Profession1 “Physical therapy is a dynamic profession with an established theoretical and scientific base with widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function.”

3. The Physical Therapy Profession1 • “As physical therapists, our scope of practice allows us to effectively: • Diagnose and manage movement dysfunction and enhance physical and functional abilities. • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health. • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.”

4. Physical Therapy & Our Role In Musculoskeletal Disorders It was concluded that physical therapists demonstrated higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and most physician specialists except for orthopaedists.2, 3, 4

5. Evidence To Support Direct Access • Physical therapists ability to accurately diagnose patients is up to par with orthopaedic surgeons • A study by Moore et al5compared the clinical diagnostic accuracy for musculoskeletal injuries of physical therapists, orthopaedic surgeons, and non-orthopaedic providers • clinical diagnoses were compared to MRI findings • Results of diagnostic accuracy: • PTs 74.5% • orthopaedicsurgeons 80.8% • non-orthopaedicproviders 35.4% • Significant difference noticed between non-orthopaedic providers and PTs/ortho surgeons • No significant difference between PTs and orthopaedic surgeons

6. Evidence To Support Direct Access • Lower costs and fewer service visits for patients with direct access versus care requiring physician referral • A study by Mitchell & de Lissovoy6compared direct access (n=252) versus physician referral (n=353) paid claims data from 1989-1993 from BCBS of Maryland • Therapists with direct access had utilized fewer service visits (7.6 versus 12.2) • Lower costs were associated with direct access ($1,004 versus $2,236)

7. Barriers Against Direct Access Currently 47 states allow some form of direct access for physical therapists. The 3 states that are yet to adopt direct access legislation are the following: Michigan, Indiana, and Oklahoma. To take a closer look at the barriers to implementation in these states, a review entitled “Direct Consumer Access to Physical Therapy in Michigan7” was performed this year which Identified major barriers in this particular state which gives us a better understanding of barriers nationwide.

8. Barriers Against Direct Access7 • Physical therapy has a limited constituency of direct access supporters. • The Michigan Physical Therapy Association has been the only group supporting direct access during each successive attempt to adopt the legislation. • Underfunding: With reference to PAC funding, the above opponents of direct access have been in a much stronger position than physical therapists during the past efforts to introduce and adopt this legislation.

9. Barriers Against Direct Access7 • There were two primary opponents of direct access for physical therapists: Physicians including the Michigan State Medical Society (MSMS) and the Michigan Orthopedic Society. Joining the physicians in opposition is the profession of Chiropractic. Physicians cited three core arguments against adopting direct access. • Threat to the physician-physical therapist relationship within the health care team • Increased utilization and cost • Public safety

10. Conclusions The profession of physical therapy provides us the tools to adequately discern the difference between appropriate musculoskeletal pathologies and those that require further medical attention. Allowing direct access has a strong correlation to lowering health care costs for consumers and results in fewer visits to physicians.

11. References Guide to Physical Therapist Practice. Rev 2nd ed. Alexandria, Va: American Physical Therapy Association; 2003. Childs et.al. A Description of Therapists’ Knowledge in Managing Musculoskeletal Conditions: BMC. Musculoskeletal Disorders. 6:32, 2005 Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone Joint Surg Am. 1998;80:1421–1427 MatzkinE, Smith ME, Freccero CD, Richardson AB. Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am. 2005;87-A:310–314. doi: 10.2106/JBJS.D.01779. Moore JH, Goss DL, Baxter RE, et al. Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers. JOSPT. 2005;35:67-71. Mitchell JM & de Lissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. PhysTher. 1997;77:10-18. Shoemaker MJ. Direct consumer access to physical therapy in Michigan: challenges to policy adoption. Physical therapy. 2012;92(2):236–50. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22033072.