Fall 2013 – Direct Access to Physical Therapy in Michigan is Overdue

Direct Access to Physical Therapy in Michigan is Overdue.
Kevin C. Patterson1*, Rachel A. Patterson2
1College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
2College of Health Professions, Grand Valley State University, Grand Rapids, MI, USA


Full Text Article PDF

*Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com
Key Words: Direct Access; Physical Therapy; Primary Care; Healthcare; Utilization
Direct access to physical therapists (PTs), the ability for a patient to seek care from a PT without physician referral, has been contested for many years. The traditional gatekeeper model of access to physical therapy has changed throughout the nation and only two states remain without direct access. Michigan is one of those states, and the state legislature has not advanced direct access legislation despite numerous opportunities over the past 12 years. However, no evidence exists to show that direct access causes harm to patients and the healthcare system and, on the contrary, easy and early access to physical therapy by patients has been shown to improve outcomes and decrease costs of care. Direct access to physical therapy is long overdue in Michigan and should be reconsidered in order to better serve our patients and the healthcare system.
Published: September 30, 2013
Senior Editor: N/A
Junior Editor: N/A
Patterson KC, Patterson RA. Direct Access to Physical Therapy in Michigan is Overdue. Medical Student Research Journal. 2013;3(Fall):13-16.
1. Brooks G, Dripchak S, Vanbeveren P, Allaben S. Is a prescriptive or an open referral related to physical therapy outcomes in patients with lumbar spine-related problems?
J Orthop Sports Phys Ther. 2008; 38(3):109-15. http://dx.doi.org/10.2519/jospt.2008.2591.

2. American Physical Therapy Association (2013). Direct access at the state level. Available from: http://www.apta.org/ StateIssues/DirectAccess. [cited 20 September 2013].

3. American Physical Therapy Association (2013). Who are physical therapists? Available from: http://www.apta.org/AboutPTs [cited 20 September 2013].

4. Rose SJ. Physical therapy diagnosis: role and function. Phys Ther. 1989; 69:535-7. http://physther.net/content/69/7/535.short.

5. Shah N, Nakamura Y. Case report: schizophrenia discovered during the patient interview in a man with shoulder pain referred for physical therapy. Physiother Can. 2010; 62:308-15. http://utpjournals.metapress.com/content/31rt02094252713t/.

6. Stowell T, Cioffredi W, Greiner A, Cleland J. Abdominal differential diagnosis in a patient referred to a physical therapy clinic for low back pain. J Orthop Sports Phys Ther. 2005; 35(11):755-64. http://dx.doi.org/10.2519/jospt.2005.35.11.755.

7. Boissonnault WG, Ross MD. Physical therapists referring patients to physicians: a review of case reports and series. J Orthop Sports Phys Ther. 2012; 42(5):446-54. http://dx.doi.org/10.2519/jospt.2012.3890.

8.Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists’ knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord. 2005; 6:7. http://dx.doi.org/10.1186/1471-2474-6-32.

9. Davenport TE, Watts HG, Kulig K, Resnik C.
Current status and correlates of physicians’ referral diagnoses for physical therapy. J Orthop Sports Phys Ther. 2005; 35(9):572-9. http://dx.doi.org/10.2519/jospt.2005.35.9.572.

10. Davenport TE, Sebelski CA. The physical therapist as a diagnostician: how do we, should we, and could we use information about pathology in our practice? Phys Ther. 2011; 91(11):1694-5. http://dx.doi.org/10.2522/ptj.2011.91.11.1694.

11. Moore JH, McMillian DJ, Rosenthal MD, Weishaar MD. Risk determination for patients with direct access to physical therapy in military health care facilities. J Orthop Sports Phys Ther. 2005; 35(10):674-8. http://dx.doi.org/10.2519/jospt.2005.35.10.674.

12. Pinnington MA, Miller J, Stanley I. An evaluation of prompt access to physiotherapy in the management of low back pain in primary care. Fam Pract. 2004; 21(4):372-80. http://dx.doi.org/10.1093/fampra/cmh406.

13. Hendriks EJM, Kerssens JJ, Dekker J, Nelson RM, Oostendorp RAB, van der Zee J. One-time physical therapist consultation in primary health care. Phys Ther. 2003; 83(10):918-31. http://www.physther.org/content/83/10/918.short.

14. Nordeman L, Nilsson B, Moller M, Gunnarsson R. Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial. Clin J Pain. 2006; 22(6):505-11. http://dx.doi.org/10.1097/01.ajp.0000210696.46250.0d.

15. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy impact on future health care utilization and costs. Spine. 2012; 37(25):2114-121. http://dx.doi.org/10.1097/BRS.0b013e31825d32f5.

16. Donato EB, DuVall RE, Godges JJ, Zimmerman GJ, Greathouse DG. Practice analysis: defining the clinical practice of primary contact physical therapy. J Orthop Sports Phys Ther. 2004; 34(6):284-304. http://dx.doi.org/10.2519/jospt.2004.34.6.284.

17. Mitchell JM, deLissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997; 77(1):10-18. http://www.physther.org/content/77/1/10.short.

18. Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Serv Res. 2012; 47(2):633-54. http://dx.doi.org/10.1111/j.1475-6773.2011.01324.x.

19. Holdsworth LK, Webster VS, McFadyen AK, Scottish Physiotherapy Self R. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial. Physiotherapy. 2007; 93(1):3-11. http://dx.doi.org/10.1016/j.physio.2006.05.005.

20. Holdsworth LK, Webster VS. Direct access to physiotherapy in primary care: now and into the future? Physiotherapy. 2004; 90(2):64-72. http://dx.doi.org/10.1016/j.physio.2004.01.005.

The following two tabs change content below.

Kevin Patterson

Executive Editor
Kevin Charles Patterson is a fourth year medical student at Michigan State University’s College of Human Medicine. He is in his eighth year at MSU after graduating with a B.S. in Human Biology and a B.S. in Microbiology, both in 2010. He is considering a career in internal medicine with a combined scientist training program in residency; after residency, his plans include the possibility of a fellowship and the ultimate goal of practicing academic medicine. Editor Note (2013-14): Kevin graduated, matched, and is a resident in Internal Medicine at Ohio State University Wexner Medical Center.