Improving Physical Therapy Referrals
Am Fam Physician. 2005 Oct 1;72(7):1183-1184.
Research suggests that “primary care physicians will refer more patients to physical therapists when they have more knowledge about physical therapy, recognize physical therapists’ capabilities to diagnose, and believe in the … effectiveness of physical therapy intervention.”1 One British study2 noted that 94 percent of physical therapy referrals by primary care physicians were related to musculoskeletal diagnoses. However, physical therapists’ expertise often is more extensive. Many physical therapists obtain advanced specialty certification in cardiovascular and pulmonary therapy, clinical electrophysiology, geriatrics, neurology, orthopedics, pediatrics, and sports therapy.
A physical therapist’s scope of practice includes a wide range of interventions. Therapists’ assessment of the skin may include identification of sensory impairment, impairment of skin integrity, and postural or musculoskeletal risks, with prevention focused on education about skin care and proper positioning. Physical therapists can provide advanced wound management when necessary. Aerobic capacity assessment in patients with cardiopulmonary dysfunction helps the physician and patient develop a realistic and achievable plan for exercise and activities of daily living. Job site analysis may include ergonomic assessment of workstations and performance to minimize risk of injury. Clinical subspecialists with advanced training in neurodiagnostics may provide the electrophysiologic testing necessary to identify the causes of neuromusculoskeletal problems so that an appropriate treatment plan may be established.
In physical therapy research, it is difficult to eliminate nonspecific effects such as the patient’s internal motivation for improvement and the personal attention a patient receives during a therapy program. Thus, using levels of evidence to guide physical therapy referrals is problematic because of the limited number of well-designed studies to assess its effectiveness.3 The American Physical Therapy Association has developed “Hooked on Evidence,” a database to help therapists understand the quality and availability of evidence in physical therapy practice. Physicians may access the database online at http://www.hookedonevidence.com (a subscription is required).
Physical therapy referrals are facilitated when physicians take the following steps:
Recognize the capabilities of physical therapists to help patients maximize their physical function for daily living.4 Physical therapy may be useful in caring for patients with chronic illnesses, cardiopulmonary diagnoses, and musculoskeletal disorders.
Know the specializations of local physical therapists.
Partner with physical therapists to provide communication and education about physical therapy.
Understand that because individual motivation is important to the success of physical therapy treatment programs, it is critical that patients approach physical therapy as “something you do, not something you get.” Education and communication are more likely to prompt appropriate physical therapy referrals by primary care physicians and to encourage active patient participation in the treatment program.
Provide information to the therapist, including medical diagnoses and special precautions, when referring a patient. The physical therapist will complete a thorough evaluation, initiate treatment if appropriate, and communicate directly with the referring physician.
JENNIFER JOYCE, M.D., is assistant professor of family practice and community medicine at the University of Kentucky College of Medicine, Lexington.
JANICE KUPERSTEIN, M.S.ED., P.T., is associate professor of rehabilitation services at the University of Kentucky College of Medicine.
Address correspondence to Jennifer Joyce, M.D., University of Kentucky College of Medicine, Department of Family Practice and Community Medicine, K302 Kentucky Clinic, Lexington, KY 40536–0284 (e-mail: firstname.lastname@example.org). Reprints are not available from the authors.
1. Hendriks E, Kerssens J, Nelson R, Oostendorp R, van der Zee J. One-time physical therapist consultation in primary health care. Phys Ther. 2003;83:918–31.
2. Akpala CO, Curran AP, Simpson J. Physiotherapy in general practice: patterns of utilisation. Public Health. 1988;102:263–8.
3. Hendriks HJ, Oostendorp RA, Bernards AT, Van Ravensberg CD, Heerkens YF, Nelson RM. The diagnostic process and indication for physiotherapy: a prerequisite for treatment and outcome evaluation. Phys Ther Rev. 2000;5:29–47.
4. Carter RH, Densley JA, Galley CM, Holland A, Jones LE, Dunn CD. Factors associated with GP referrals to physiotherapy. Br J Ther Rehabil. 2001;8:454–9.
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