Physical therapist awareness of diagnostic imaging referral jurisdictional scope of practice: an observational study.

OBJECTIVES: To examine physical therapist awareness and utilization of imaging referral privileges in the United States (US) and how it relates to direct access frequency. METHODS: This study utilized survey data collected in 2020-2021 from US physical therapists. Subjects were asked about imaging referral jurisdictional authority in their state. Responses were analyzed for accuracy and compared to the level of jurisdictional authority and its impact on imaging referral. Analysis of imaging skills performance and imaging referral practices were compared to direct access frequency. RESULTS: Only 42.0% of physical therapists practicing in states that allow imaging referral were aware of this privilege. Those practicing where imaging referral was allowed via state legislation were significantly more likely (p < 0.01) to be aware of this privilege (71.4%) compared to those granted by the state board (25.2%). Those aware of their imaging referral scope were more likely (p < 0.01) to practice imaging referral (44.5%) compared to those who were unaware (3.2%). Direct access frequency was positively associated with imaging skill performance and imaging referral practice (p < 0.01). Doctors of Physical Therapy, residency/fellowship-trained physical therapists, and board-certified physical therapists all reported practicing greater frequency of direct access (p < 0.01). DISCUSSION/CONCLUSION: There is a striking lack of awareness of imaging privileges among physical therapists as influenced by the level of jurisdictional scope. These results suggest that the lack of awareness may have a dampening effect on diagnostic imaging referrals. The American Physical Therapy Association should consider engaging with state boards to raise imaging privilege awareness.

Physical Therapists Are Routinely Performing the Requisite Skills to Directly Refer for Musculoskeletal Imaging: An Observational Study.

OBJECTIVES: To explore if physical therapists are practicing skills necessary to refer patients for musculoskeletal imaging. METHODS: An expert panel established a list of nine requisite skills to refer for musculoskeletal imaging. A blinded expert panel validated the list using a 5-point Likert scale. The skills list was examined via an electronic survey distributed to United States physical therapists. RESULTS: 4,796 respondents were included. Each of the nine skills were routinely performed by a majority of the respondents (range: 54.52-94.72%). Respondents routinely performed 6.95 (± 0.06) skills, with 67.41% routinely performing seven or more skills. Doctors of physical therapy routinely performed more imaging skills (7.15 ± 0.06) compared to their masters- (6.44 ± 0.19) and bachelors-trained (5.95 ± 0.21) counterparts (p < 0.001). Residency/fellowship-trained physical therapists were more likely to routinely perform more imaging skills (7.60 ± 0.11 vs. 6.79 ± 0.07, p < 0.001). Imaging skill performance was greater among board-certified physical therapists (7.39 ± 0.09 vs. 6.71 ± 0.08, p < 0.001) and APTA members (7.06 ± 0.07 vs. 6.65 ± 0.12, p < 0.001). CONCLUSION: Physical therapists are routinely practicing the requisite imaging skills to directly refer to a radiologist for musculoskeletal imaging.

Referral for Imaging in Physical Therapist Practice: Key Recommendations for Successful Implementation.

In recent years, the use of diagnostic imaging in physical therapist practice in the United States has gained considerable interest. In several countries around the world and in the US military, patient direct referral for diagnostic imaging has been considered normative practice for decades. US physical therapy program accreditation standards now stipulate that diagnostic imaging content must be included in physical therapist educational curricula. The American Physical Therapy Association has made efforts to pursue practice authority for imaging referral. A recent review of state practice acts and other statutory language concluded that many states have no prohibitions against physical therapists referring for imaging studies. Additionally, physical therapists can now pursue certification as musculoskeletal sonographers. In light of these advances, and with a growing number of physical therapists serving patients who have not yet seen another health care provider, it may be helpful for those who have been actively involved in the use of imaging in physical therapist practice to provide their collective recommendations to serve as a guideline to those interested in incorporating this practice privilege. The purpose of this perspective article is to provide an overview of the key elements necessary for effective implementation of referral for imaging in physical therapist practice while emphasizing the cornerstone of effective communication.

Referral patterns for surgical consult in the management of patients with foot drop due to acute lumbar disc herniation: a survey study of physical therapists in the United States.

BACKGROUND: There is a lack of consensus for optimal management of patients with foot drop due to acute lumbar disc herniation (LDH) with lumbar radiculopathy (LR), which is a clinical scenario that may be encountered by physical therapists. Consequently, it is important to explore physical therapists' referral practice patterns for surgical consult. Currently, physical therapist referral patterns for surgical consult in this patient population are unknown. OBJECTIVES: To describe physical therapist referral patterns for immediate neurosurgical consult in patients with foot drop due to suspected acute LDH with LR. DESIGN: Cross-sectional descriptive research design using an electronic, internet-based survey that utilized two clinical vignettes. METHOD: An electronic survey was developed by an expert peer review panel. Survey participants were licensed physical therapists in the United States and members of the Orthopedic Section of the American Physical Therapy Association. RESULTS: Of the individuals receiving the survey invitation, 2172 completed the survey. Depending on the severity of foot drop, 34-61% were likely to refer for immediate neurosurgical consult. Presence of imaging to confirm suspected clinical diagnosis slightly affected the likelihood of referral (4-12% increase) for immediate neurosurgical consult. CONCLUSION: In patients with foot drop due to suspected acute LDH with LR, this study found that physical therapist referral patterns for immediate neurosurgical consult varied and are likely influenced by the severity of weakness and availability of MRI findings. Further research regarding the optimal management of this patient population and potential reasons for variation in practice is warranted.

Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis.

BACKGROUND: Significant progress has been made in implementing direct access. As more therapists transition into direct access roles, it seems prudent to consider how additional resources common to other first-contact providers might impact patient care. OBJECTIVES: Direct referral for diagnostic imaging by physical therapists is relatively rare in the civilian setting and little has been published on the subject. The primary objective of this study was to examine the appropriateness of diagnostic imaging studies referred by civilian physical therapists at an academic medical center. Secondary objectives were to track reimbursement data and overall use rates. DESIGN: This was a single-center, retrospective practice analysis of 10 physical therapists over a period of nearly 5 years. METHODS: The electronic medical record was reviewed for each patient who had an imaging referral placed by a physical therapist. Relevant clinical exam findings and patient history were provided to a radiologist who then applied the American College of Radiology Appropriateness Criteria to determine appropriateness. Reimbursement data and therapist use rates were also evaluated. RESULTS: Of the 108 total imaging studies, 91% were considered appropriate. Overall, use rates per direct access evaluation were 9% for plain film x-rays and 4% for advanced imaging. Reimbursement was 100%. LIMITATIONS: This study was limited to 10 physical therapists at 1 practice location. Appropriateness was evaluated by 1 radiologist. The educational background of referring therapists was not evaluated. CONCLUSIONS: Physical therapists demonstrated appropriate use of diagnostic imaging in the vast majority of cases (91%). They were judicious in their use of imaging, and there were no issues with reimbursement. These findings could be useful for physical therapists interested in acquiring diagnostic imaging referral privileges.

Cervical Myelopathy Presenting as Bilateral Upper Extremity Weakness.

A 57-year-old man with insidious onset of progressive bilateral upper extremity weakness was referred to physical therapy by his primary care physician. Following examination, the physical therapist referred the patient back to his primary care physician with a request for cervical magnetic resonance imaging (MRI) and neurology consultation. Cervical radiographs demonstrated multilevel degenerative changes, while cervical spine MRI revealed compressive myelopathy, significant spinal canal stenosis, and severe spondylosis J Orthop Sports Phys Ther 2017;47(9):691. doi:10.2519/jospt.2017.7287.

Integrated approaches to physical Therapy education: a new comprehensive model from the University of Illinois Chicago.

Demand for physical therapists in the United States (U.S.) is currently robust and expected to grow further. There are currently 228 physical therapy programs accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), and 30 more are in development in the U.S.; 29,246 students are currently enrolled in these programs (2014-2015 data). A shortage of physical therapy faculty with an advanced doctoral degree (i.e., PhD, EdD, DSc) is a primary concern for these programs. Specialized residency and fellowship training in physical therapy continue to expand, preparing professionals to deliver advanced clinical care. The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) reports that there are currently 179 accredited residency programs and 35 accredited fellowship programs in the U.S. A number of academic physical therapy programs also currently operate a clinical faculty practice. Currently, these aspects and trends in physical therapy education, advanced training, and clinical practice, for the most part, lack synergy and connectivity, in both planning and implementation amongst the various components. This professional theoretical article describes a novel model for academic physical therapy, with potential transformative implications for entry-level physical therapy education, advanced clinical training, and academic preparation.

US hospital-based direct access with radiology referral: an administrative case report.

BACKGROUND AND PURPOSE: Legislative gains in the US allow physical therapists to function in expanded scopes of practice including direct access and referral to specialists. The combination of direct access with privileges to order imaging studies directly offers a desirable practice status for many physical therapists, especially in musculoskeletal focused settings. Although direct access is legal in all US jurisdictions, institutional-based physical therapy settings have not embraced these practices. Barriers cited to implementing direct access with advanced practice are concerns over medical and administrative opposition, institutional policies, provider qualifications and reimbursement. This administrative case report describes the process taken to allow therapists to see patients without a referral and to order diagnostic imaging studies at an academic medical center. Nine-month implementation results show 66 patients seen via direct access with 15% referred for imaging studies. Claims submitted to 20 different insurance providers were reimbursed at 100%. DISCUSSION: While institutional regulations and reimbursement are reported as barriers to direct access, this report highlights the process one academic medical center used to implement direct access and advanced practice radiology referral by updating policies and procedures, identifying advanced competencies and communicating with necessary stakeholder groups. Favorable reimbursement for services is documented.