Outlooks and Opinions of Practicing Physical Therapists Regarding Direct Access in Indiana

Abstract

Introduction: Indiana is one of the remaining states that requires by state law a referral to initiate treatment by a licensed physical therapist (PT) and therefore does not allow consumers direct access to physical therapy services. In 2009, the Indiana Chapter of the American Physical Therapy Association (APTA) and Indiana University jointly funded a study to investigate the opinions of licensed physical therapists on direct access to physical therapy services. Purpose: The study investigated physical therapists opinions residing in the state of Indiana on four main issues: Direct access—desire for and willingness to achieve Scope of care—differential diagnosis and clinical skills Liability—perceived impact of direct access Manipulation practices—competence and confidence Methods: The researchers used an online program, SurveyMonkey©, to design an 18-question survey. The sample was recruited via a mailing list from the Indiana State Board of Health which included all the licensed physical therapists within the state of Indiana. A letter explaining the purpose of the study including a hyperlink to the survey and a hard copy of the survey was mailed to 3,350 physical therapists. The survey respondents could either choose to complete the survey online via the hyperlink or on the hard copy provided and return via a provided selfaddressed stamped envelope for survey return. Results: There were 1,379 respondents which accounted for a 42% return rate. APTA membership was analyzed with 39.5% of the respondents being APTA members and the remaining 60.5% being non-members. The collective responses to specific questions were reported by a five-level Likert response scale. The majority of respondents want direct access in the state of Indiana, with the average response being 4.13/5.00. However, proportionately the willingness of respondents to be actively involved is much lower, with the average response being 3.23/5.00. The majority (61%) believed their liability would increase with direct access. The terminal degrees for the respondents surveyed were varied with the majority, 48.6%, holding a Bachelor’s degree. The responses of participants were significantly influenced by their degree/level of training with higher levels of training being consistently associated with more favorable attitudes to direct access issues. Discussion /Clinical Relevance: The high return rate and passionate responses confirm these issues are important to PT’s practicing in Indiana and the majority of those surveyed are in favor of direct access to physical therapy services without compromise of the current scope of care. The results of this study may have implications for health policy regarding direct access to physical therapy services within the state of Indiana. In particular to help redirect efforts toward dispelling myths, promoting grassroots efforts and encouraging teamwork in our peers.