Article

Evidence suggests that physical therapy through direct access may
help decrease costs and improve patient outcomes compared with physical therapy
by physician referral.
The purpose of this study was to conduct a
systematic review of the literature on patients with musculoskeletal injuries and
compare health care costs and patient outcomes in episodes of physical therapy by
direct access compared with referred physical therapy.
DATA SOURCES: Ovid
MEDLINE, CINAHL (EBSCO), Web of Science, and PEDro were searched using terms
related to physical therapy and direct access. Included articles were hand
searched for additional references. STUDY SELECTION: Included studies compared
data from physical therapy by direct access with physical therapy by physician
referral, studying cost, outcomes, or harm. The studies were appraised using the
Centre for Evidence-Based Medicine (CEBM) levels of evidence criteria and
assigned a methodological score. DATA EXTRACTION: Of the 1,501 articles that were
screened, 8 articles at levels 3 to 4 on the CEBM scale were included. There were
statistically significant and clinically meaningful findings across studies that
satisfaction and outcomes were superior, and numbers of physical therapy visits,
imaging ordered, medications prescribed, and additional non-physical therapy
appointments were less in cohorts receiving physical therapy by direct access
compared with referred episodes of care. There was no evidence for harm. DATA
SYNTHESIS: There is evidence across level 3 and 4 studies (grade B to C CEBM
level of recommendation) that physical therapy by direct access compared with
referred episodes of care is associated with improved patient outcomes and
decreased costs. LIMITATIONS: Primary limitations were lack of group
randomization, potential for selection bias, and limited generalizability.
CONCLUSIONS: Physical therapy by way of direct access may contain health care
costs and promote high-quality health care. Third-party payers should consider
paying for physical therapy by direct access to decrease health care costs and
incentivize optimal patient outcomes.

Langue : ANGLAIS