Direct Access Physical Therapy

Direct Access Physical Therapy

Francois A. Prizinski, DPT, OCS, COMT, FAAOMPT, DAC

Francois A. Prizinski

As recent as May 2012, The American Physical Therapy Association issued a press release regarding early access to Physical Therapy for patients suffering from acute low back pain. The article was published in the 2012 May issue of Spine by Fritz, et al: “Primary Care Referral of Patients with Low Back Pain to Physical Therapy: Impact on Future Healthcare Utilization and Costs.” As congress continues to debate the best way to reform healthcare, a study like this comes out. Data was collected on 32,070 patients with a new primary care low back pain consultation and categorized based on time of Physical Therapy care. Those patients that got physical therapy within 2 weeks from the onset were associated with decreased risk of advanced imaging, additional physician visits, surgery, injections, and opioid medications as compared to delayed Physical Therapy. Furthermore, those patients who had HMO or managed care insurance plans were not as likely to get Physical Therapy as quickly as patients with a PPO or an out of network plan. This interestingly points to Direct Access. When patients are given more autonomy and choice with their healthcare they are more involved in the “healing” process. Dr. Julie Fritz provided an explanation that physical therapists can contribute to promoting a greater sense of self-reliance in managing LBP and confidence in a positive outcome. “If a physical therapist’s treatment assists in developing self-efficacy, it is reasonable to expect it would have greater impact when implemented very early, before negative expectations have become reinforced and entrenched.” Direct Access Physical Therapy gives the patient control to manage a movement-based problem. According to the World Confederation for Physical Therapy, patients who refer themselves to physical therapy are more proactive, more autonomous in making health decisions, take less time off work, more interested in self-management, and are more likely to complete a course of treatment. Direct Access is nothing new to the World of Physical Therapy or should I say Physiotherapy. In fact, over 18 countries are involved with international policies on Direct Access Physical Therapy with the World Confederation. As our profession continues to mount evidence, Post Graduate Programs like Sports Medicine of Atlanta’s Orthopaedic Residency, Primary Care Physical Therapy, and Manual Therapy Fellowship Tracks are all ways to sharpen skills needed to meet these demands and achieve these types of outcomes. Sports Medicine of Atlanta even offers a Direct Access Certification (DAC), which involves rigorous coursework and the format to refer back to medicine when necessary. Americans spend at least $50 billion each year on back pain alone and is the second most common reason for visits to a physician. This statistic has risen approximately 65% in the past decade and pain persists!? Fritz et al 2012 found that if a patient is seen by a physical therapist within 2 weeks of an acute episode of low back pain an average $2736.23 in unnecessary medical costs would be saved. These numbers will most certainly scratch chins and raise eyebrows in congress.


Francois A. Prizinski, DPT, OCS, COMT, FAAOMPT, DAC

Board Certified in Orthopaedics and Fellow of the American Academy of Orthopaedic Manual Physical Therapists

Clinical Faculty of Sports Medicine of Atlanta’s Fellowship Program



1.)   Fritz, JM, Childs JD, Wainner RS, Flynn TW. 2012. Primary care referral of patients with low back pain to physical therapy: Impact on future healthcare utilization and costs. Spine, May 18

2.)   World Confederation for Physical Therapy. 2012. Direct access and patient self-referral to physical therapy.

3.)   DuVall. Sports Medicine of Atlanta Orthopaedic Manual Therapy Fellowship Program.

4.) 2008. U.S. back pain costs rise but pain still there.

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