An Analysis of Student Physical Therapist Musculoskeletal-Based Clinical Practice

Abstract

Background: The direct access model of practice allows patients to avail of physical therapy services without a physician referral. Despite legislative approval in most states, this primary contact model of practice has yet to be fully adopted. Objective: To assess clinical practice activities and readiness of entry-level physical therapists to provide high quality health-care in a primary care setting. Design and Methods: A cross-sectional survey was administered to final year Northeastern Doctor of Physical Therapy (DPT) students. Survey data included questions on general demographics, clinical reasoning skills, techniques used in clinical practice and direct access to patients. Students were asked to fill out one survey for each outpatient clinical experience, (n=206). Results: The response rate was 38%(n=78). Clinics were dispersed among 19 states and were classified as suburban(67%), urban(23%), and rural(10%). The majority were in culturally diverse locations(72%). The majority of students reported performing medical screening techniques before initiating treatment and on average reported their clinical reasoning and differential diagnosis skills at the advanced intermediate level. 22(30%) reported using joint manipulation techniques and 71(97%) joint mobilization. 40(49%) of participants reported direct access to patients, with the primary barrier to direct access being reimbursement related. Conclusions: Northeastern University DPT students practice in diverse environments and are confident in their clinical reasoning and differential diagnosis skills. The main barriers to direct patient access are insurance reimbursement and clinic policies. Further research is needed to compare these findings to other PT programs and assess their implications for curricular planning and health care policy.