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

ABSTRACT

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.

KEYWORDS:

• Diagnostic imaging
• access to care
• referral and consultation
• health policy
• scope of practice
• procedures and techniques utilization
• health legislation

Acknowledgements

Special thanks to Martin Kifer and Brian McDonald from the High Point University survey research center for their assistance in developing the Qualtrics survey. The authors would like to thank APTA of North Carolina President, Mary Kay Hannah, for her key role in facilitating survey distribution. We would also like to acknowledge the American Academy of Orthopaedic Manual Physical Therapists, the American Physical Therapy Association (APTA) sections including the Academy of Orthopaedic Physical Therapists, The Health Policy and Administration section, and the Federal Section, as well as numerous APTA state chapters that aided in the distribution of this survey.

Disclosure statement

Lance Mabry receives financial compensation for instructing musculoskeletal imaging continuing education courses.

Author contribution statement:

Conception and Design: LMM, DG, AG

Analysis and Interpretation of Data: LMM, NR, BY, AK, DG

Drafting of the Paper: LMM, MR, AK, BY, NR

Revising it critically for intellectual content: LMM, AK, BY, NR, AG, DG, MR

Final approval of the version to be published: LMM

All authors agree to be accountable for all aspects of the work.

Geolocation information:

Latitude: 35.966157/N 35° 57′ 58.164″

Longitude: −79.996518/W 79° 59′ 47.466″

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2296260.

Additional information

Funding

No grant support was attained or utilized in regards to this manuscript. This manuscript was approved by the High Point University Institutional Review Board, Reference Number 202007-952. I affirm that I have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed in an attachment and cited in the manuscript. Any other conflict of interest (i.e., personal associations or involvement as a director, officer, or expert witness) is also disclosed in an attachment. No funding was obtained to support this study.

Notes on contributors

Lance M. Mabry

Lance M. Mabry PT, DPT, OCS, FAAOMPT, is an Assistant Professor in the Department of Physical Therapy at High Point University in North Carolina where he teaches diagnostic imaging and physical therapy primary care. He is a board-certified Orthopedic Clinical Specialist from the American Board of Physical Therapy Specialties and a Fellow of the American Academy of Orthopedic Manual Physical Therapists. Prior to his appointment at High Point University, Dr Mabry retired from the US Air Force after serving in both Operation Iraqi Freedom and Operation Enduring Freedom. Dr Mabry has over 30 published peer-reviewed articles focusing primarily on diagnostic imaging in physical therapy. He serves as the Federal Affairs Liaison for the American Physical Therapy Association of North Carolina, where he regularly engages elected officials on current physical therapy legislative initiatives.

Aaron Keil

Aaron Keil PT, DPT, OCS, serves as a clinical professor at the University of Illinois at Chicago, where he teaches diagnostic imaging in the doctor of physical therapy program. He has spoken at national conferences on the topics of direct access and diagnostic imaging and has provided guidance to several institutions across the country who are pursuing these initiatives. Dr Keil has published on the topic of implementation of diagnostic imaging in physical therapist practice and served on the authorship committee for the APTA-sponsored white paper ‘Diagnostic and Procedural Imaging in Physical Therapist Practice’. He has functioned as a first-contact provider at Georgetown University Hospital in Washington D.C., the Johns Hopkins Hospital in Baltimore, Maryland, and at the University of Illinois at Chicago.

Brian A. Young

Brian A. Young PT, DSc, is currently a Clinical Associate Professor and Interim Chair, Department of Physical Therapy at Baylor University. He received a BA in Psychology from Wabash College, an MS in Physical Therapy from Des Moines University, and a DSc in Physical Therapy from Baylor University. Dr Young is board certified in Orthopedic Physical Therapy, a fellowship trained in orthopedics and manual therapy through the US Army-Baylor University Orthopedic Manual Physical Therapy Fellowship, and served over 21 years in the US Air Force. His research interests include cervical spine disorders, manual therapy, diagnostic imaging, and medical screening.

Nicholas Reilly

Nicholas Reilly PhD, ACSM-CEP, is a Research Scientist contracted through the Geneva Foundation working in conjunction with Fort Liberty Research Institute and Womack Army Medical Center on Fort Liberty, NC. Dr Reilly earned a BS in Kinesiology from Pennsylvania State University in 2016, an MS in Exercise Science from the University of Delaware in 2017, and a PhD in Kinesiology and Rehabilitation with a concentration in Neuroscience and Motor Control from Old Dominion University in 2021. In addition, Dr Reilly has been a clinical exercise physiologist certified through the American College of Sports Medicine (ACSM) since 2017. His research objectives focus on neurophysiological changes contributing to impairments in motor control, postural stability, and subsequent musculoskeletal injury risk following traumatic brain injury (TBI) and the utilization of graded aerobic exercise to examine autonomic nervous system function following TBI in military service members.

Michael D. Ross

Michael D. Ross PT, DHSc, is an Associate Professor in the Physical Therapy Department at Daemen University in Amherst, NY. He is a board-certified Orthopedic Clinical Specialist from the American Board of Physical Therapy Specialties and a Fellow of the American Academy of Orthopedic Manual Physical Therapists. Prior to his appointment at Daemen University, Dr Ross served in the US Air Force for 20 years where he was credentialed as a direct access provider with diagnostic imaging, medical laboratory, specialty physician referral, and pharmacological privileges. Dr Ross maintains an active community-based practice focusing on patients with chronic pain disorders and has published over 150 manuscripts and abstracts related to orthopedic physical therapist practice.

Angela Spontelli Gisselman

Angela Spontelli Gisselman PT, PhD, DPT, is an Assistant Professor and Director of Admissions at Tufts University’s Doctor of Physical Therapy Program in Phoenix, AZ. She received a bachelor’s degree in kinesiology from Miami University and a doctorate in physical therapy from Duke University. She completed an orthopedic clinical residency at the University of North Carolina at Chapel Hill and is an ABPTS-certified Orthopedic Physical Therapy Specialist. She earned her PhD in Physiotherapy from the University of Otago in Dunedin, New Zealand, in 2018 investigating the role of monitoring the autonomic nervous system in the development of overuse musculoskeletal injuries. Her primary area of scholarship focuses on the role of health metrics, such as heart rate variability (an index of the autonomic nervous system, ANS), in understanding the physiological burden of disease on the ANS. She is currently investigating the relationship of HRV in the peripartum period and neonatal abstinence syndrome.

Don Goss

Don Goss PT, PhD, received a direct commission into the US Army in 1995, graduating from the Army Baylor PT program with an MPT in 1997. For 12 years, he served in a variety of assignments including Camp Casey, Korea; Stuttgart, Germany; and Fort Bragg, NC. He completed a PhD in Human Movement Science with a concentration in running biomechanics from the University of North Carolina at Chapel Hill. Dr Goss taught in the Army Baylor Doctoral program in physical therapy from 2012 to 2014. Don served as Program Director and for the West Point Sports Medicine PT Fellowship, from 2014 to 2019. He has been awarded several Department of Defense research grants totaling nearly $10 million to study wearable technology, gait re-training with runners, injury prediction, and injury prevention in military service members. In summer 2019, COL Goss took over as the Officer in Charge of Physical Therapy at Fort Bragg, NC. He retired from the Army in summer 2020, and he accepted a position as Associate Professor at High Point University in the Department of Physical Therapy.