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Self-reported Systems Review by Oregon Direct-Access Physical Therapists

1 May 2004


Background & Purpose: Physical Therapists in the United States are seeking to gain recognition as health care providers who can examine and treat patients without a physician’s referral. The Guide to Physical Therapy Practice (“The Guide”) recommends that physical therapists perform a comprehensive systems review when performing an examination. This study first reviews the practice with regard to systems review as intended by the Guide and also reviews current practice by other health care professionals. It then examines the extent to which physical therapists perform this part of the examination in reality. Subjects & Methods: All 594 Oregon physical therapists, who are certified to provide directaccess physical therapy, and who are likely to treat patients in Oregon were invited to participate in the study. The subjects were mailed a written questionnaire of 23 questions. Results: Useable surveys were received back from 336 respondents (57.2 %). Over 85.6 % reported to work mainly in outpatient settings. 96.7 % of all respondents reported to have easy access to a sphygmomanometer, but only 41.7 % had more than one cuff size available. Only 22 % reported to “usually” or “always” check blood pressures of patients and almost 21 % reported to “usually” or “always” check the heart rate. In comparison over 98 % “usually” or “always” checked the musculoskeletal system and 91 % the neuromuscular system. Therapists in outpatient practice did worse than others with performing a systems review. However, there were no significant differences in the performance of a systems review for therapists with a different educational level, specific school, or whether they treated many or few patients in direct-access. Almost 79 % of the respondents indicated to use a written questionnaire to obtain a patient’s health history and an additional 13.8 % were able to glean the information from other sources (such as the medical chart). Less than 1 % indicated that they had no systematic way (written or otherwise) of obtaining a health history from their patient. Conclusions and Discussion: It is clear that physical therapists, certified to practice in directaccess in Oregon, are not overwhelmingly doing a systems review as recommended by the Guide. A comparison was made with the study by Frese et al. and it appeared that the therapists in our study did slightly better than in that study 2 years ago. This study contains a number of recommendations.


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