Current Status and Correlates of Physicians' Referral Diagnoses for Physical Therapy

Todd E. Davenport, Cheryl Resnik, Hugh G. Watts, Kornelia Kulig

DOI: 10.2519/jospt.2005.2050

Study Design: Randomized multicenter retrospective chart review of medical referral diagnoses and corresponding referral, patient, and physician demographic data.

Objective: To examine the information content of medical referral diagnoses provided to outpatient physical therapists with respect to physician and patient characteristics.

Background: Previous studies indicate that physicians commonly provide nonspecific referral diagnoses to physical therapists. The effects of patient and physician characteristics on information contained in referral diagnoses are not well elucidated.

Methods and Measures: A team of blinded raters categorized the information content of referral diagnoses (n = 2183) using a classification system adapted from a previous study.

Results: One third (32%) of analyzed diagnoses were anatomically oriented and reported specific pathology. These specific diagnoses were provided significantly more commonly by specialist physicians (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.7-4.2; P<.001), male physicians (OR, 2.2; 95% CI, 1.6-3.1; P<.001), both early- and late-career physicians (P<.001), and for male patients (OR, 1.3; 95% CI, 1.1-1.6; P<.05).

Conclusion: Physicians frequently provide nonspecific referral diagnoses to physical therapists. The practice of evidence-based physical therapy seems challenged by the high rate of nonspecific referral diagnoses. Physical therapists may also have the responsibility to conduct differential diagnosis of pathology more commonly than formally recognized by many state practice acts and third-party payers. J Orthop Sports Phys Ther. 2005;35(9):572-579.

Key Words: differential diagnosis, direct access, primary care

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