As early as 3000 BC, the first writings about how exercise could relieve pain came from China.1 “Researchers have found evidence of the application of heat, cold, water, exercise, massage and sunlight to abate physical afflictions…even during prehistoric times.” (1)
Physical therapy (PT) had its emergence in the US around 1916, due to the Polio epidemic and the First World War. Medicine was advancing and surgeons were now able to save maimed soldiers that had lost limbs.(1,2) At that same time, there was an influx of children that had become crippled from the epidemic. There was a desperate need for aid in rehabilitation, so women with experience in exercise and massage, were gathered to help and became known as “Reconstructive Aides”.(1) In 1921, under the leadership of Mary McMillan, the Physical Therapy Association was formed, consisting initially of only women.(1,2,3) Men were allowed in the following year.(2,3) Since its early formation to well over 95,000 members in the United States today, physical therapy has truly made its mark.(3,4)
Physical therapists have been there to assist us in the most difficult of times….a literal ray of light in the face of serious injury. Whether holding onto us, as we take our first steps back to recovery, or guiding us with empowerment. The physical therapist is there every step of the way, throughout the recovery process. Deservedly, physical therapy celebrates a month of recognition!
The educational requirements have also evolved through the years. In1929 the minimal standard was a graduate degree from a physical education or nursing college and an additional 9 months of specific schooling in physical therapy.(1) Today, however, a Doctorate in Physical Therapy is required and the student must also pass a national exam.4 Many therapists choose to further achieve a specialty certification, in such areas as: orthopedics, pediatrics, geriatrics, neurology, hand, vestibular, mechanical diagnosis – to name a few.(4)
Many patients are unaware that physical therapists are allowed to practice without a prescription. This process is known as Direct Access.(4) Surveys show that most consumers are unaware that they can skip the doctor and go directly to physical therapy.**
Not only is direct access convenient, but numerous research articles have shown positive results.(5-12) These results include: decreased length of the condition, decreased cost, decreased visits, decreased opioid prescriptions, and decreased unnecessary radiographic exams.(5-12) With health care costs out of control, it is a wonder why more insurance companies are not pushing direct access.
Musculoskeletal Disorders (MSDs) are the aches and pains that we feel in our muscles and joints from an injury or for no apparent reason. Physical therapists are schooled in assessing and treating these disorders, ranging from low back pain to ankle sprains.(4) The question is, why is the standard protocol to first go to a physician and get a referral for physical therapy? The physical therapist is the specialist in treating muscle and joint problems, so if you are in pain you should be able to go directly to a specialist for that pain. On average the length of time to see a physical therapist by prescription from a physician is 62 days, and only 25% of those in pain from a musculoskeletal problem actually see a physical therapist.(12) Maybe this is part of the reason that musculoskeletal disorders cost over 20 billion dollars per year.
A comparison would be Allegra – for years it was required that you go to a doctor and get an antihistamine prescription. Now, it is sold over the counter, because it was found to be safe for consumers. To treat your seasonal allergies, you simply visit the local pharmacy without seeing your primary physician. Thus, saving time, money and stress.
Is Direct Access safe for the consumer?
One hesitancy of removing the physician may be the fear of missing a medical diagnosis. But research has shown that physical therapists were comparable to orthopedists in the knowledge of musculoskeletal disorders and above other physicians and medical students.(5,6) Strep throat, ear infections, influenza, and similar conditions are not musculoskeletal, and you would go to your primary care physician at the onset for treatment. Malignancies, infections, fractures, inflammatory diseases are all medical ailments for which the physical therapist would not diagnose. Instead, the patient would be referred back to a physician for diagnosis and treatment. This would remain true for anything outside the scope for which the therapist has been trained.
Recently, physical therapy has reached into the telemedicine platform. You are now able to see a physical therapist via a secure video conference. One such company is Virtual Physical Therapists LLC, available in both the iTunes and Google Play stores. According to Aideen Turner, CEO, “Healthcare as we know it is changing, because of advances in technology and consumer demands. The consumer of today wants the ability to direct their own healthcare. They are able to search the internet for information related to their ailment and are also looking for more convenient ways to access specialists. Our company has built a platform that connects a patient suffering from a muscle or joint problem to a specialty trained clinician, via direct access. Our patients love having instant access to a musculoskeletal specialist, at their convenience while at home or at work. This saves not only travel time, but also money because of the high deductibles and large co-pays that are now more commonly seen in our commercial plans. Direct Access is essential in restructuring our healthcare system. Not only will it aide in reducing costs, but more importantly early access to a specialist will aide in reducing the length of the musculoskeletal condition, and unnecessary prescriptions, surgeries and reducing the progression to chronic conditions.”
During the month of October give a “thumbs up” to your favorite PT, like them on your social media and spread the word about direct access.
*The states of Alabama, Illinois, Mississippi, Missouri, Texas and Wyoming continue to have significant restrictions.
*Insurance coverage: Workers compensation, Motor vehicle and Medicare require a prescription for payment – defeating the convenience of direct access.
A statement from the American Physical Therapy association on their website (http://www.apta.org/StateIssues/DirectAccess/)
“As of January 1, 2015, all 50 states, the District of Columbia, and the US Virgin Islands allow patients to seek some level of treatment from a licensed physical therapist without a prescription or referral from a physician. However, in many jurisdictions, such treatment is limited by arbitrary restrictions in state law. These restrictions do not recognize the professional training and expertise of the licensed physical therapist, nor do they serve the needs of those patients who require physical therapy but whose care is unnecessarily interrupted or prevented by these restrictions.”
1. Development of the Physical Therapy Profession http://samples.jbpub.com/9780763781309/81309_CH01_FINAL.pdf (Accessed 10/09/2017)
2. Development of the Field of Physical Therapy. http://beckerexhibits.wustl.edu/mowihsp/health/PTdevel.htm (Accessed 10/09/2017)
3. http://www.apta.org/History/ (Accessed 10/09/2017)
4. http://www.apta.org (Accessed 10/09/2017)
5. Childs, et al. A description of physical therapists’ knowledge in managing musculoskeletal conditions. BMC Musculoskeletal Disorders.2005:6(32).
6. Moore J, Goss D, Baxter R, et al. Clinical Diagnostic Accuracy and Magnetic Resonance Imaging of Patients Referred by Physical Therapists, Orthopaedic Surgeons, and Nonorthopaedic Providers. JOSPT. 2005:35(2)67-71.
7. Piano, et al. Direct access to physical therapy for the patient with musculoskeletal disorders, a literature review. J Phys Ther Sci. 2017:29,1463–1471.
8. Pendergast, et al. A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Sev Res 2012. 47(2): 633–654.
9. Childs, et al. Knowledge in Managing Musculoskeletal Conditions and Educational Preparation of Physical Therapists in the Uniformed Services. Military Med. 2007:4,440.
10. More et al., Risk Determination for Patients with Direct Access to Physical Therapy in Military Health Care Facilities. JOSPT.2005:35(10)674-8.
11. Boyles, et al. Physical Therapist Practice and the Role of Diagnostic Imaging. JOSPT. 2011:14(11),829-837.
12. Does Unrestricted Direct Access to Physical Therapy Reduce Utilization and Health Spending? http://www.healthcostinstitute.org/files/HCCI-Issue-Brief-Unrestricted-Access-to-Physical-Therapy.pdf (Accessed 10/08/2017)