The value of integrating physical therapists into primary care, including patient outcomes and health care costs: a scoping review

Alyson M Cavanaugh; Micah Wong; Katie O’Bright; Dylan Lewis

doi:10.1093/ptj/pzag052

. 2026 May 11;106(6):pzag052. doi: 10.1093/ptj/pzag052

The value of integrating physical therapists into primary care, including patient outcomes and health care costs: a scoping review

Alyson M Cavanaugh ^1,^✉, Micah Wong ², Katie O’Bright ³, Dylan Lewis ⁴

PMCID: PMC13310092 PMID: 42113601

Abstract

Objective

Physical therapists have served in primary care roles in the United States military, but the model has yet to be widely adopted in US private, non-governmental health care settings. This review aims to map existing literature regarding the implementation and variations of primary care physical therapy (PCPT) models, assessing health care utilization and patient outcomes.

Data Sources, Study Selection, Data Extraction, and Synthesis

We searched 3 electronic databases (PubMed, CINAHL, and Scopus) for studies published from 2014 to 2023 in English language. Studies that evaluated health care utilization/costs or patient outcomes while comparing PCPT with the traditional medical primary care model were included.

Main Outcomes and Measures

Main outcomes included study characteristics (population, setting, and model of PCPT), and reported outcomes relevant to health care utilization/costs and patient outcomes.

Results

Of the 3565 publications identified, 39 were included in the scoping review. Seventeen studies contained sufficient detail to describe the integration of physical therapists into primary care, and included approaches such as team-based care, co-location of physical therapists in a primary care clinic, and the use of a formalized triage system at the primary care clinic that directed patients to schedule with a physical therapist first. PCPT models have been described in multiple countries internationally. In the United States, PCPT is largely described in unique payor systems including the military, Veterans Affairs, and employee health settings. PCPT may be associated with lower health care costs and utilization compared to traditional medical primary care, particularly in terms of reduced imaging (17 out of 19 studies) and medication use (11 out of 17 studies), including opioid use (5 out of 5 studies). Patient outcomes appeared similar between PCPT and medical primary care pathway, but less robust evidence is available on the topic.

Conclusions and Relevance

This scoping review found a variety of PCPT models used in governmental, including military, and civilian settings in the United States and internationally, with evidence suggesting that integrating physical therapists in primary care may result in reduced health care utilization with non-inferior patient outcomes.

Keywords: Physician extender, advanced practice, extended scope

Introduction

The shortage of primary care providers (PCP) in the United States (US) is projected to reach 32,000 physicians by year 2030.¹ PCPs are confronted with high caseloads and a fragmented health care system that complicates the ability to adequately care for patients, contributing to PCP burnout.² Innovations in health care service delivery are needed to meet the needs of the population and provide high-quality patient care.

In the US, physical therapists are doctoral-trained health care providers that specialize in the evaluation and treatment of neuromuscular conditions, with education in differential diagnosis and medical screening to prepare for effective management and recognition when referral is appropriate.³^,⁴ For decades, many military treatment facilities have used a health care delivery model where patients presenting with musculoskeletal concerns are directed first to a physical therapist, who assumes the role of primary care manager for the patient.⁵^,⁶ This approach allows patients to be seen by the right provider, at the right time allowing efficiency in health care delivery for the active-duty population. However, in US private health care systems, few facilities have adopted this model of health care delivery.⁵^,⁷ Internationally, in contrast, the integration of physical therapists into primary care is more widespread. Terminology for this integrative practice model varies by geographic region, with terms such as advanced practice, first contact, and extended scope physiotherapy used to describe similar approaches in various international settings. In its Advanced Physiotherapy Practice policy statement, World Physiotherapy noted a lack of a common understanding of this health care model, including the absence of standardized definitions and globally agreed-upon competencies.⁸ Despite this variability, the World Physiotherapy organization recognized that these models are well established in several countries as a strategy to address physician shortages and prolonged wait times in primary care, particularly for populations with musculoskeletal complaints, but also for pelvic health, pediatric, geriatric, and neurologic populations.

In the US, this health care delivery model is most commonly referred to as primary care physical therapy (PCPT), for which a consensus definition has been published.⁹ PCPT is defined as a professional practice area in which physical therapists provide first contact and ongoing, broad spectrum preventive and reactive health management services as an integral member of the primary health care team.⁹ Physical therapists’ primary area of expertise is to address pain, disability, function, health, and wellness in order to optimize participation in life activities.¹⁰ The care is person-centered, team-based, and community-aligned, with the goal of achieving improved health with higher quality care at lower costs. PCPT should not be considered synonymous with direct access to physical therapy, which allows patients to seek care from a physical therapist without a medical referral. In contrast, PCPT is a deliberate integration of physical therapists into the primary care pathway, ensuring patients with physical and functional needs who seek care in primary care settings have access to physical therapist consultation within their initial visit and on an ongoing basis as their health needs may require. PCPT is a model of health care delivery that can be operationalized in multiple formats. These include co-locating physical therapists within primary care clinics, virtually integrating physical therapists within a primary care visit, or using a formalized triage system at primary care clinics that directs patients, based on an established algorithm, to see a physical therapist as their first point of contact for their episode of care.¹¹

While PCPT is not a new concept,⁵^,¹²^,¹³ primary care physician shortages and the rising prevalence of musculoskeletal and chronic diseases may contribute to a heightened relevance of this model. There has been a growing interest in this approach in recent years.^14–16 Key questions remain about how PCPT can implemented, where it is being implemented, and why PCPT should be implemented. For these reasons, we chose to conduct a scoping review to explore the various approaches to PCPT and to examine their reported value in terms of cost savings and patient outcomes. Given the anticipated scarcity of data from US private, non-governmental health care settings, the scope of this review was broad and included studies from both the US and international settings, encompassing private non-governmental and governmental, including military, health care systems.

Methods

A protocol for this scoping review was registered with OSF Registries on December 10, 2023.¹⁷ We performed an electronic search of the literature in the following databases: PubMed, CINAHL, and Scopus using keywords related to physical therapy (physical therapist, physiotherapist) in combination with advanced practice, first contact, entry point, initial contact, direct access, extended scope, physician extender, or primary care (Suppl. Material 1). Although the aim of this scoping review was to gather information on PCPT models, a preliminary search prior to defining inclusion and exclusion criteria indicated that many studies described care by physical therapists operating within primary care pathways, yet the exact details of how patients accessed the physical therapist was ambiguously defined. As an example, Crowell et al¹⁸ compared imaging referral rates among patients at the United States Military Academy at West Point who were initially seen by a physical therapist versus a medical provider for musculoskeletal injuries. Physical therapists in this setting were reported to have imaging privileges equivalent to those of medical providers, as well as limited pharmaceutical prescribing authority. Although the pathway to physical therapy was described as “direct access,” military health systems often employ informal or formal triage processes in which injured active-duty service members are expected to seek initial care from a physical therapist. This was not explicitly described in the methods but Crowell et al¹⁸ mentioned that the physical therapist clinic held primary responsibility for evaluating musculoskeletal injuries of cadets. The authors of this scoping review felt that the health care service delivery described in the aforementioned paper aligned with the PCPT definition, specifically that the physical therapist functioned as entry-point provider and managed care, including the potential for imaging referrals and medication prescribing. To avoid excluding similar, potentially relevant studies that use variable terminology or imprecisely defined access pathways, “direct access” was included as a search term.

Publications were limited to those published from January 2014 through December 2023 and in the English language. Studies were eligible for inclusion if methods described: (1) the physical therapist physically co-located at the primary care location or integrated within the initial primary care visit, (2) the primary care clinic utilized a triage process to direct patients to a physical therapist for their initial visit for the episode of care, or (3) the physical therapist serving as the entry-point provider. To focus specifically on primary care, we excluded studies describing physical therapists in specialty care settings, including when physical therapists provided screening services for that care. We also excluded physical therapists in emergency or urgent care settings, because providers in these settings are unable to provide ongoing care related to the presenting concern after discharge.¹⁹ For inclusion, studies must have addressed the value of this delivery approach by comparing outcomes between PCPT and the traditional primary care medical model for either: (1) health care utilization/costs or (2) patient outcomes. Pre/post studies where the comparison was pre-implementation of PCPT were eligible. Published abstracts without full-text articles were eligible for inclusion. Case reports, study protocols, editorials, reviews, and meta-analyses were excluded.

A pair of reviewers (A.C., M.W., K.O., D.L.) independently screened title and abstracts using inclusion criteria in Covidence (Veritas Health Innovation, Melbourne, Australia). A pair of reviewers (K.O., D.L.) read eligible full-text studies to determine inclusion. If reviewers disagreed on exclusion, discussion and decision by a third reviewer was used for tie-breaking. We created a flow diagram to report the exclusions at each time period (Figure 1) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Review.

PRISMA flow diagram detailing the literature search, screening, and selection process for the scoping review, ultimately resulting in 39 included studies. — Flow Diagram for Studies Included in the Scoping Review.

Data extraction and presentation

A data collection form was established a priori. A pair of reviewers (A.C., M.W.) extracted data, including article identifiers, intervention time period, research design, model of primary care physical therapy, number of participants, age of participants, diagnoses, patient outcomes (pain, functional mobility, return to activity/participation, recurrence of symptoms, satisfaction, patient safety, and other outcomes) and health care costs/utilization (specialist referrals, imaging recommendations, pharmaceutical prescriptions/use, subsequent procedure/surgical interventions, medical provider, and physical therapist visits). Extracted data were assembled in tabular form. If testing for statistical significance was performed, significance levels were used to determine direction of outcomes (favoring either the PCPT or medical model). For studies without statistical testing, available data were reported alongside the authors’ interpretations of the results, when provided.

Results

Our search yielded 3565 articles from 3 databases (Figure 1). After removal of duplicate articles and abstract screening, we reviewed 116 full-text articles, of which 36 articles met inclusion for this scoping review. We hand-searched the included articles and identified 3 additional studies. We reviewed these 3 full-text articles; all met inclusion criteria, and we included 39 articles in total for the scoping review.

Models of primary care physical therapy

No studies included in this review used the terminology “primary care physical therapy” in describing their model of service delivery. Sixteen studies contained sufficient methodological detail to describe the purposeful integration of physical therapists into primary care, achieved through mechanisms such as team-based care, co-location, or a formalized triage system that directed patients to consult a physical therapist first (Suppl. Material 2).⁷^,^20–34 In contrast, 16 studies described the physical therapist as the entry-point provider in the episode of care; however, their methods either explicitly described self-referral or did not indicate the purposeful integration of a physical therapist into primary care.^35–50 Insufficient methodologic detail in 7 studies precluded determination of how patients accessed the physical therapist.¹⁸^,^51–56 While the physical therapist was described as the first-contact provider, it was unclear if co-location or triage processes were present.

Among 16 studies that clearly described a purposeful integration of physical therapists in primary care, 10 were conducted internationally—in England, Scotland, Sweden, Poland, and Canada (Suppl. Material 2).²⁰^,^25–30^,^32–34 In England, several studies focused on “First Contact Practitioners” in the National Health Service (NHS),³⁰^,³²^,⁵⁵ where physical therapists were co-located within primary care (general practitioner) settings.³⁰^,³² These “First Contact Practitioners” were described as having advanced training and scope, with privileges to order imaging, provide injection therapy, and prescribe medication.³⁰ Goodwin et al²⁹ describes “1^st Line Physiotherapy Service” in Nottingham, UK, where physical therapists were co-located in primary care practices to serve as the first point of contact for musculoskeletal conditions, with the ability to order imaging and refer for specialist care. Downie et al²⁸ described “Extended Scope Physiotherapists” who were co-located in 2 primary care settings in Scotland’s NHS. Reception staff and the telephone triage nurse would schedule appropriate patients directly with the co-located physical therapists. In Sweden, Bornhöft et al²⁵ described the use of a “Primary Care Triage” system to address shortages of primary care medical providers. Nurses followed an established protocol for telephone and in-person triage, and patients presenting to primary care with musculoskeletal concerns were directed to an initial visit with the physical therapist, co-located in the primary care clinic. In Poland, Kiljańska et al²⁰ described the use of phone and online triage system, in which patients with back pain were scheduled directly with a physical therapist, unless patients reported reg flag symptoms with the triage system questions. Patients retained the option to decline and request an appointment with a physician instead.

In the US, the purposeful integration of physical therapists in primary care was described in military settings, Veterans Affairs (VA) settings, an employee health clinic, and 1 private health care system. Szymanek et al²⁴ described a military base’s triage system; physical therapists were available during primary care walk-in appointment hours, and an algorithm was used to direct patients to either a physical therapist or medical provider based on the patient’s responses. McGill et al²¹ described the use of triage at the reception desk for scheduling at a military treatment facility. In the VA, McKay et al³¹ described the use of team-based primary care visits, where the physical therapist and medical provider evaluated the patient collaboratively. Authors reported that the primary care team-based visit could also include psychology, pharmacology, or social work, depending on initial presentation/concern discussed by the patient. Authors contrasted this VA team-based model with the PCPT approach reported previously in the literature for VA settings, in which an on-call physical therapist is placed within a primary care clinic.⁵ In an employee health clinic in Pennsylvania, a triage approach was implemented, in which patients presenting with musculoskeletal conditions and meeting certain criteria were directed for evaluation and management by a physical therapist.²² One study described PCPT in a US private health care system, Bellin Health.⁷ In this setting, patients with musculoskeletal complaints briefly met first with their PCP and then with the physical therapist on the same visit. The physical therapist could evaluate, provide brief therapeutic interventions, and refer to a physical therapy clinic or other specialty care as needed.

There were also several randomized trials included in this scoping review, in which patients seeking primary care were randomized to be assessed by a physician or physical therapist. In Sweden, Ho et al³³^,³⁴ randomized patients with suspected knee osteoarthritis to receive an initial evaluation by physical therapist or a physician, with studies evaluating health outcomes and cost-effectiveness. A similar randomized trial, also conducted in Sweden, included patients presenting with broader range of musculoskeletal complaints to primary care.²⁶^,²⁷ The study used primary care locations that had co-located physical therapist and randomly assigned patients for an initial evaluation by a physical therapist or physician. In the US, Ojha et al²³ randomly assigned patients presenting to an employee health clinic with musculoskeletal complaints to a physician or physical therapist for evaluation and management.

Costs/Utilization

Of the 16 studies that compared total health care costs in PCPT versus a traditional medical referral pathway, 9 (56.3%) reported reduced costs with PCPT,²¹^,²²^,²⁴^,²⁹^,³⁶^,³⁹^,⁴⁹^,⁵²^,⁵⁴ and 6 (37.5%) reported no difference,²³^,²⁷^,³⁴^,³⁷^,⁴¹^,⁴² and 1 (6.3%) reported higher 90-day costs (Suppl. Material 2, Suppl. Material 3).⁴³ Three studies assessed cost-effectiveness; 2 that found comparable overall costs reported greater cost-effectiveness with PCPT,²⁷^,³⁴ and a third, performing economic modelling, reached the same cost-effectiveness conclusion.⁵⁰

Of the 19 studies evaluating specialist referrals or costs, 11 studies (57.9%) reporting lower utilization with PCPT,²⁰^,²⁴^,²⁵^,^27–30^,³²^,³⁶^,⁵³^,⁵⁵ 7 (36.8%) found similar utilization,¹⁸^,²³^,³⁴^,^37–39^,⁴¹ and 1 (5.3%) reported physical therapist evaluators were more likely than nurse practitioner evaluators to recommend specialist referral for patients with chronic back pain.⁴⁷

Seventeen of 19 studies (89.5%) reported reductions in imaging use or costs with PCPT.¹⁸^,²⁰^,²¹^,²³^,²⁴^,²⁹^,³⁴^,³⁶^,^38–42^,⁵¹^,⁵³^,⁵⁵^,⁵⁶ Four of these studies found that radiograph utilization was reduced, but advanced imaging (computed tomography or magnetic resonance imaging) was similar between groups.²³^,²⁹^,³⁸^,⁴¹ Horn et al⁴⁴ was the only study reporting increased utilization; no difference was reported with radiographs but there was a statistically significant increase in advanced imaging for patients with neck pain who received PCPT.

Eleven of 17 articles (64.7%) reported either fewer prescriptions or reduced medication use in the PCPT group.¹⁸^,²¹^,²⁵^,²⁹^,³⁶^,⁴²^,⁴⁴^,⁴⁵^,⁵³^,⁵⁵^,⁵⁶ For opioids specifically, all 5 studies (100%) assessing the topic reported lower opioid use or prescriptions in the PCPT group.³⁶^,⁴²^,⁴⁴^,⁴⁵^,⁵⁶ For medication utilization, only 1 study favored the medical model; a Canadian study reported that physical therapists evaluating patients with low back pain were more likely than nurse practitioner evaluators to recommend a physician visit for medication referrals.⁴⁷ However, study authors reported that ordering medications is within the scope of nurse practitioner; nurse practitioner evaluators did not recommend a physician visit for any of the patients for purpose of medications.⁴⁷

Among 9 studies evaluating the use or cost of joint injections, 2 studies reported lower use with PCPT,³⁶^,⁵⁶ and 6 reported no difference.²³^,³⁷^,^39–41^,⁴⁴ Only 1 study reported an increase in utilization of injections; Downie et al²⁸ reported an increase in use of steroid injections at NHS clinics in Scotland (clinic-level data) following the implementation of a triage system to direct patients with musculoskeletal concerns to co-located physical therapists. For surgeries, 1 study found lower utilization among patients receiving PCPT,³⁶ and 5 studies found no difference in use or costs between groups.²³^,³⁷^,³⁹^,⁴⁰^,⁴⁴

Two studies reported lower emergency room or urgent care utilization among patients receiving PCPT,³⁶^,⁴² and 3 reported no difference between groups.²³^,³⁹^,⁴¹ Emergency room/urgent care visits were relatively uncommon in all studies addressing the topic.

The proportion of patients receiving physical therapy referrals or treatment after the initial visit was higher with PCPT than traditional medical model in 7 studies.⁷^,²³^,²⁸^,³¹^,⁴⁰^,⁴⁷^,⁵⁵ However, the average number of rehabilitation sessions per episode were fewer in the PCPT pathway in 4²⁰^,²⁴^,³⁹^,⁴⁶ of 6 studies (66.7%) evaluating the outcome. Costs of physical therapist services were similar in 2 studies that compared the PCPT model with traditional medical PCPT modeal²⁷^,³⁴ and higher for patients receiving PCPT in 1 study²⁹ among the 3 studies evaluating the outcome. Overall number of any type of follow-up health care visits were lower in the PCPT group in 3 studies⁴⁹^,⁵⁵^,⁵⁶ of 4 (75%) evaluating the outcome.

Patient outcomes

There was relatively less available evidence focused on patient outcomes (Suppl. Material 2, Suppl. Material 4). There were no reported statistical differences in pain outcomes between the PCPT and comparison groups in the 3 articles evaluating pain.²³^,²⁶^,³⁹ Standardized quality of life or disability scores were similar between groups as measured by the Oswestry Disability Index, Neck Disability Index, Short-Form Health Survey, Patient-Reported Outcomes Measurement Information System, and EuroQol- 5 Dimension among 7 studies.²³^,²⁶^,³³^,³⁴^,³⁷^,³⁹^,⁴⁹ Findings regarding productivity loss and restrictions in work suggest a trend toward fewer work absences. Five studies (62.5%) found less frequent or shorter sick leaves,²⁰^,²²^,²⁴^,²⁵^,³⁷ while 3 studies(37.5%) reported no difference in whether sick leave medical notes were issued.²⁶^,³⁴^,³⁸ Szymanek et al²⁴ found significantly fewer patients with permanent limitations in military duty when active-duty service members with ankle injuries were triaged directly to a physical therapist.

Three articles reported on a comparison of adverse events or safety reports between PCPT and a traditional pathway, with no study reporting a statistically significant difference between groups.²³^,³⁷^,⁵³

Discussion

The purpose of this scoping review was to gather evidence about where and how physical therapists are being integrated into primary care, as well as the value of this approach. “Primary care physical therapy” is an emerging terminology that is not universally known nor used in the literature, even when the model itself is being described. Nevertheless, the model of physical therapists functioning within primary care has been described most prominently in international settings, including the United Kingdom’s NHS. In the US, this approach is less common and generally found in settings with unique payment systems—such as the military, VA, or employee health settings—rather than within traditional private health care systems. Overall, evidence gathered from a variety of settings and delivery models suggests that PCPT may be associated with reduced health care costs and non-inferior health outcomes in populations with musculoskeletal complaints.

The reduction in health care utilization observed in PCPT models was primarily attributed to decreased rates of prescription medication use and imaging orders, which aligns with the findings of several prior systematic reviews on direct access or early access to a physical therapist.²³^,^57–59 The reduced use of prescription medications and imaging for musculoskeletal conditions may reflect a decrease in unnecessary medical procedures and treatments, which could have significant implications for both medical care and public health. A reduction in opioid prescriptions could have profound public health benefits. The opioid epidemic in the US is a public health crisis, and the integration of physical therapists in primary care could assist in public health and medical efforts to prioritize nonopioid therapies for musculoskeletal conditions.⁶⁰ Physical therapists provide restorative treatments for acute pain, educate patients on self-management strategies, and refer to or collaborate with other health care team members as needed for comprehensive pain management. Previous studies have highlighted that physical therapy utilization earlier in the disease or injury process can result in lower rates of opioid use,⁶¹^,⁶² and the 5 studies evaluating opioids with PCPT consistently found lower opioid use compared with traditional medical model pathway.

Inappropriate use of imaging can be costly to the health care system.⁶³^,⁶⁴ Imaging overuse not only results in increased costs, but potentially exposes patients to unnecessary risks. Incidental findings can result in a snowball effect of additional unnecessary procedures. For example, inappropriate imaging orders for low back pain have been shown to result in downstream consequences of higher rates of back surgeries, pharmaceutical prescriptions, and higher pain outcomes.⁶⁵ Inappropriate use of imaging is not limited to overuse. Failure to order imaging when clinically indicated can be equally detrimental and costly.⁶⁶ This scoping review focused on imaging utilization rather than appropriateness, and it is important to consider the possibility that lower utilization could represent underutilization of a necessary test. Nonetheless, existing evidence has demonstrated the appropriate use of imaging by physical therapists.^67–70

The PCPT model appears to result in higher utilization of physical therapist clinical services. A recent survey by the American Physical Therapy Association (APTA) found PCPs routinely refer patients with conditions such as back pain, musculoskeletal injury, falls, deconditioning, weakness, and pain to physical therapy and would like to refer more patients to physical therapy but encounter challenges in patients’ interest in referrals.⁷¹ Patients that might benefit from physical therapy frequently do not follow-through with referrals due to barriers including self-perceived lack of need, difficulty in scheduling or transportation, and costs.⁷² PCPT addresses some of these challenges, as systems implementing PCPT have reported reduced rates of “no-show” first-visit physical therapist clinic appointment.³¹^,⁴⁹ Authors of the VA study attributed this higher follow-through with physical therapy referrals to the “warm hand-off,” in which patients are introduced by their PCP to a physical therapist within their primary care visit.³¹ With this approach, the patient-physical therapist introduction can be established, allowing patients to ask questions and understand the expectations, benefits, and limitations of physical therapy. While physical therapy utilization may increase with PCPT, this may be favorable, particularly if patients recover faster or have better outcomes, highlighting the need for additional research on patient outcomes.

Patient safety is essential in health care. The current entry-level education for physical therapists in the US is a doctoral degree in which students must demonstrate competency in review of systems, medical screening, and neuromuscular differential diagnosis and management.³ It is encouraging that all 3 studies included in this review that evaluated adverse events found no increase in safety concerns with PCPT compared with the traditional medical model. Evidence from military settings, where physical therapists have historically held more advanced privileges than civilian health settings, supports the findings from this scoping review that physical therapists can safely and effectively provide clinical management of patients presenting with musculoskeletal concerns.⁶^,⁷³^,⁷⁴ However, the military population may represent a younger and healthier demographic than the general US population. Two of the 3 studies addressing safety in this scoping review involved non-military populations, but additional published literature from civilian US populations would further support the safety of the PCPT approach in a broader population.

Gaps in the research

This scoping review did not restrict articles based on specific patient populations, but almost all of included articles focused on populations with musculoskeletal complaints. The scope of a physical therapist is broader than management of musculoskeletal conditions, and physical therapists integrated in primary care pathways could serve more heterogenous populations. As an example, physical therapists may be able to play a substantial role within primary care for patients with vestibular disorders, pelvic dysfunction, obesity, developmental disorders, and chronic diseases.^75–78 However, the lack of published literature supporting the use of primary care physical therapists for populations other than those with musculoskeletal complaints highlights a gap in scientific evidence. The evaluation of PCPT in more heterogenous populations, not limited to musculoskeletal concerns, may support broader implementation across the scope of a physical therapist.

Evidence regarding patient outcomes, including pain, function, quality of life, and satisfaction is less robust than health care utilization. Available data suggests similar patient outcomes between PCPT and the traditional medical model of primary care, but many of the studies that focused on patient outcomes had small sample sizes, which likely reduced power to detect statistical differences. Additionally, nearly one-third of the studies assessing patient outcomes used a comparison group of patients who were medically-referred to physical therapy, potentially overlooking the benefit of PCPT compared to those that never reach a physical therapist due to barriers discussed previously. One of the biggest hypothesized benefits of PCPT is that by getting the patient in front of the right provider at the right time, appropriate intervention can be initiated earlier. Current literature provides only limited direct support that PCPT results in faster resolution of symptoms,²²^,²⁴ but the reduced number of physical therapist sessions received during the episode of care is suggestive of faster recovery.²⁰^,²⁴^,³⁹^,⁴⁶ Future studies should specifically address time to recovery, as well as patient confidence in their self-management of the presenting conditions, and patient satisfaction throughout the cascade of care.

No papers included in this scoping review referred to the model of delivery as “primary care physical therapy,” highlighting that this term is not yet well-established in the literature nor universally-used internationally. Few papers had methods clearly describing the pathway to a physical therapist as the entry-point provider, and therefore a clear delineation of the primary care model versus direct access was not possible in a number of studies. To more clearly establish the benefits of integrating physical therapists in the primary care pathway, future studies about PCPT should explicitly describe the health care delivery model. A consensus definition of PCPT now exists, and using this term consistently in future publications may help promote clarity and standardization in the field.⁹

Implications for clinical practice

Literature detailing the purposeful integration of physical therapists in primary care in the US private health care systems is sparse. The fee-for-service reimbursement structure may disincentivize the adoption of PCPT because of a potential loss in revenue generated from imaging and other services. Stronger evidence of improved patient outcomes or satisfaction may be needed before fee-for-service US health care settings adopt PCPT. However, even in a fee-for-service payment model, alternative economic benefits of PCPT may exist and should be explored. Physician shortages and the high cost of physician recruitment represent substantial expenses. Given the shortage and high burn-out of medical PCPs, shifting appropriate tasks to the management by PTs may free up physicians to effectively focus their attention on their patients with complex medical needs. Potential outcomes, including health care provider satisfaction, retention, financial sustainability, and overall primary care clinic productivity, may serve as indirect indicators of the economic benefit of PCPT and incentivize a wider adoption of PCPT in the US.

A triage system may serve as a feasible initial step for incorporating physical therapists into a primary care pathway, particularly in settings where co-located space is not available. Scheduling logistics and the decision-making algorithm used to direct patients to the appropriate provider will likely need to be tailored to each site, taking into account patient population characteristics and applicable regulatory requirements (Figure 2). Ongoing evaluation and refinement of the triage algorithm may further enhance efficiency, safety, and appropriate patient routing.

Flowchart titled "Primary Care Clinic Triage Example." The process begins with "Primary Care Visit Request," where a patient initiates contact by phone call to the office, call center, triage nurse, online booking, or another clinic scheduling method. The next step is "Patient responds to Triage Screening Questions." The final step is "Provider Assigned and Patient Scheduled," indicating assignment to either a physical therapist or medical provider. — Primary Care Clinic Triage Example. ^*Triage approaches can be designed and implemented in multiple ways, depending on existing scheduling workflows, available staffing (eg, front desk staff or nurses), and the technological capacity of a practice to integrate triage algorithms into online scheduling systems. ^**Triage algorithms can be used to guide initial provider assignment for a patient’s first visit for a new complaint. Algorithms may be developed to reflect contextual factors such as practice setting, patient population needs and complexity, with consideration of local regulations and scope-of-practice requirements. ^***The provider receiving the triage decision may subsequently refer the patient to, or collaborate with, an additional provider.

Several limitations of this scoping review should be acknowledged. First, this scoping review included US and international settings. Findings from international settings may have some limited generalizability to US health care, particularly with regards to costs, due to differences in structure and reimbursement. Second, there is a heterogeneity of descriptions of PCPT model, and methods in the available literature often do not fully describe the patient pathway to receive physical therapy. In an effort not to exclude systems that triage patients to a physical therapist, any studies that described the physical therapist as the first-contact provider were included. However, many studies that met inclusion criteria were more likely to represent self-referred direct access to a physical therapist rather than the integration of physical therapists into a primary care system. The recently established consensus definition of PCPT may help to refine inclusion criteria for future synthesis reviews. Third, this study evaluated utilization and costs without assessing appropriateness of that utilization. It is possible that in some studies, patients triaged to PCPT were healthier, with less complex medical situations, thus resulting in less health care utilization and lower costs. Future studies should address whether PCPT leads to appropriate utilization of necessary health care services.

Conclusions

In this scoping review, purposeful integration of physical therapists in primary care was most commonly described in international contexts and US governmental health care systems, including military settings. Current evidence suggests PCPT may result in lower health care costs without sacrificing patient outcomes for patients with musculoskeletal complaints. Identified gaps in the research include limited methodological detail regarding health care delivery models, narrow patient populations, and limited data on patient outcomes comparing PCPT to traditional primary care—areas that warrant further investigation in the future.

Supplementary Material

PTJ-2025-0373_R2_Supplementary_Material_pzag052

ptj-2025-0373_r2_supplementary_material_pzag052.pdf^{(840.3KB, pdf)}

Contributor Information

Alyson M Cavanaugh, Graduate College of Health Sciences, Hawai'i Pacific University, Honolulu, HI 96813, United States.

Micah Wong, Department of Physical Therapy and Rehabilitation Sciences, The University of Iowa, Iowa City, IA 52242, United States.

Katie O’Bright, Redefine Health Education, Chicago, IL 60067, United States.

Dylan Lewis, IvyRehab Physical Therapy, Decatur, IL 62521, United States.

CRediT—Contributor roles

Alyson M. Cavanaugh (Conceptualization [Lead], Investigation [Lead], Methodology [Lead], Writing—original draft [Lead], Writing—review & editing [Lead]), Micah Wong (Conceptualization [Supporting], Investigation [Equal], Methodology [Supporting], Writing—review & editing [Equal]), Katie O’Bright (Conceptualization [Supporting], Investigation [Supporting], Methodology [Supporting], Writing—original draft [Supporting], Writing—review & editing [Supporting]), Dylan Lewis (Conceptualization [Supporting], Investigation [Supporting], Methodology [Supporting], Writing—original draft [Supporting], Writing—review & editing [Supporting])

Funding

There are no funders to report.

Data availability

All data supporting the findings of this review are included within the article and its supplementary materials. The review protocol was prospectively registered on the Open Science Framework (OSF) https://osf.io/4x3wy/overview.

Disclosure

The authors completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no conflicts of interest.

References

1. Health Resources and Services Administration . Workforce Projections. Published online October 2023. https://data.hrsa.gov/topics/health-workforce/workforce-projections
2. American Academy of Family Physicians . Family Physician Burnout, Well-Being, and Professional Satisfaction (Position Paper). https://www.aafp.org/about/policies/all/family-physician-burnout.html
3. Commission on Accreditation in Physical Therapy Education (CAPTE) . Standards and Required Elements for Accreditation of Physical Therapist Education Programs. Published online October 31, 2023. Accessed May 24, 2025. https://www.capteonline.org/globalassets/capte-docs/2024-capte-pt-standards-required-elements.pdf
4. Young BA, Ross MD, Heick J, Greathouse DG, Green Guerrero H, Boissonnault WG. Exploration of medical screening and differential diagnosis instructional methods and faculty perceptions in physical therapist educational programs. J Allied Health. 2020;49(2):e89–e97. [PubMed] [Google Scholar]
5. Murphy BP, Greathouse D, Matsui I. Primary care physical therapy practice models. J Orthop Sports Phys Ther. 2005;35(11):699–707. 10.2519/jospt.2005.35.11.699 [DOI] [PubMed] [Google Scholar]
6. Clark B, Clark L, Showalter C, Stoner T. A call to action: direct access to physical therapy is highly successful in the US military. When will professional bodies, legislatures, and payors provide the same advantages to all US civilian physical therapists? J Man Manip Ther. 2022;30(4):199–206. 10.1080/10669817.2022.2099893 [DOI] [PMC free article] [PubMed] [Google Scholar]
7. Bodenheimer T, Kucksdorf J, Torn A, Jerzak J. Integrating physical therapists into primary care within a large health care system. J Am Board Fam Med. 2021;34(4):866–870. 10.3122/jabfm.2021.04.200432 [DOI] [PubMed] [Google Scholar]
8. World Physiotherapy . Policy Statement: Advanced Physiotherapy Practice. London, UK: World Physiotherapy; 2023: Available from: https://World.Physio/Policy/Ps-Advanced-Pt-Practic. [Google Scholar]
9. O’Bright K, Cavanaugh AM, Cassel A, et al. Primary care physical therapy: 2025 consensus definition. Phys Ther J. 2026;pzag035. 10.1093/ptj/pzag035 [DOI] [PubMed] [Google Scholar]
10. World Health Organization . International Classification of Functioning, Disability and Health (ICF). https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
11. O’Bright K, Peterson S. Physical therapists in primary care in the United States: an overview of current practice models and implementation strategies. Phys Ther. 2024;104(12):pzae123. 10.1093/ptj/pzae123 [DOI] [PubMed] [Google Scholar]
12. Edmonds MM, Warren RC, Miles-Richardson S, et al. Educating Physical Therapists as Primary Care Practitioners. First ed. Darbonne and Bartolett Publishers; 2004. [Google Scholar]
13. Donato EB, DuVall RE, Godges JJ, Zimmerman GJ, Greathouse DG. Practice analysis: defining the clinical practice of primary contact physical therapy. J Orthop Sports Phys Ther. 2004;34(6):284–304. 10.2519/jospt.2004.34.6.284 [DOI] [PubMed] [Google Scholar]
14. American Physical Therapy Association . APTA Practice Advisory: Primary Care Physical Therapy. Published online 2025. https://www.apta.org/contentassets/5561fbdd9f4540f49642c43ab1642a97/apta-practice-advisory-primary-care.pdf
15. American Physical Therapy Association - Kentucky . 2025 APTA House of Delegates Motions Summary for APTA-KY. Published online 2025. https://aptaky.org/_resources/documents/resources/APTA-House-of-Delegates-Motions.pdf
16. American Physical Therapy Association . Physical Therapist Services in Primary Care. Published online 2024. https://www.apta.org/siteassets/pdfs/policies/ptservicesinprimarycare_hodp07-24-05-07.pdf
17. The Value of Primary Care Physical Therapy, Including Patient Outcomes and Healthcare Costs: A Scoping Review Protocol. OSF registries; 2023: https://osf.io/4x3wy/overview [Google Scholar]
18. Crowell MS, Mason JS, McGinniss JH. Musculoskeletal imaging for low back pain in direct access physical therapy compared to primary care: an observational study. Int J Sports Phys Ther. 2022;17(2):237–246. 10.26603/001c.31720 [DOI] [PMC free article] [PubMed] [Google Scholar]
19. American Academy of Family Physicians . Primary Care. https://www.aafp.org/about/policies/all/primary-care.html. Published online 2019.
20. Kiljańska M, Soszyński P, Motyl A, Walewska-Zielecka B. Impacts of a Re-designed care path for back pain directing patients to physiotherapists: a pre–post intervention study. J Occup Environ Med. 2021;63(5):e276–e282. 10.1097/JOM.0000000000002178 [DOI] [PubMed] [Google Scholar]
21. Mcgill TE, Stern DF, Kolber MJ, Mcgee J. Cost outcomes of physical therapist providers compared to cost outcomes of physical therapist providers compared to primary care providers in the treatment of musculoskeletal primary care providers in the treatment of musculoskeletal patients in a military treatment facility: a retrospective chart patients in a military treatment facility: a retrospective chart review. Internet J Allied Health Sci Int J Allied Health Sci Pract Pract. 2021;19(2):Article 4. 10.46743/1540-580X/2021.2000 [DOI] [Google Scholar]
22. Ojha HA, Brandi JA, Finn KM, Wright WG. Cost efficiency of direct access physical therapy for Temple University employees with musculoskeletal injuries. Orthopaedic Practice. 2015;27(4):228–233. [Google Scholar]
23. Ojha HA, Fritz JM, Malitsky AL, et al. Comparison of physical therapy and physician pathways for employees with recent onset musculoskeletal pain: a randomized controlled trial. PM&R. 2020;12(11):1071–1080. 10.1002/pmrj.12382 [DOI] [PubMed] [Google Scholar]
24. Szymanek E, Jones M, Shutt-Hoblet C, Halle R. Implementation of direct access physical therapy within the military medical system. Mil Med. 2022;187(5–6):e649–e654. 10.1093/milmed/usab245 [DOI] [PubMed] [Google Scholar]
25. Bornhöft L, Larsson MEH, Thorn J. Physiotherapy in primary care triage – the effects on utilization of medical services at primary health care clinics by patients and sub-groups of patients with musculoskeletal disorders: a case-control study. Physiother Theory Pract. 2015;31(1):45–52. 10.3109/09593985.2014.932035 [DOI] [PubMed] [Google Scholar]
26. Bornhöft L, Larsson ME, Nordeman L, Eggertsen R, Thorn J. Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial. Therapeutic Adv Musculoskeletal. 2019;11:1759720X19827504. 10.1177/1759720X19827504 [DOI] [PMC free article] [PubMed] [Google Scholar]
27. Bornhöft L, Thorn J, Svensson M, Nordeman L, Eggertsen R, Larsson MEH. More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment. BMC Musculoskelet Disord. 2019;20(1):186. 10.1186/s12891-019-2553-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
28. Downie F, McRitchie C, Monteith W, Turner H. Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data. Br J Gen Pract. 2019;69(682):e314–e320. 10.3399/bjgp19X702245 [DOI] [PMC free article] [PubMed] [Google Scholar]
29. Goodwin RW, Hendrick PA. Physiotherapy as a first point of contact in general practice: a solution to a growing problem? Prim Health Care Res Dev. 2016;17(05):489–502. 10.1017/S1463423616000189 [DOI] [PubMed] [Google Scholar]
30. Ingram S, Pickup S, Acton T, Peek A, Smith L, Warner T. A two year service evaluation of first contact musculoskeletal (MSK) physiotherapy roles within primary care in Taunton. Physiotherapy. 2019;105(Supplement 1):e65. 10.1016/j.physio.2018.11.027 [DOI] [Google Scholar]
31. McKay SE, Buono FD, Walker J, Glinski C, Printz DMB, Brienza R. Impact of interprofessional embedding of physical therapy in a primary care training clinic. J Interprof Care. 2021;35(4):532–537. 10.1080/13561820.2020.1798898 [DOI] [PubMed] [Google Scholar]
32. Salmon P, Humphreys K, Price J, Smith C, Heaton R. Can physiotherapy first contact practitioners reduce the burden on general practitioners and improve the management of musculoskeletal conditions? Physiotherapy. 2017;103(Supplement 1):e143. 10.1016/j.physio.2017.11.137 [DOI] [Google Scholar]
33. Ho CM, Thorstensson CA, Nordeman L. Physiotherapist as primary assessor for patients with suspected knee osteoarthritis in primary care—a randomised controlled pragmatic study. BMC Musculoskelet Disord. 2019;20(1):329. 10.1186/s12891-019-2690-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
34. Ho-Henriksson CM, Svensson M, Thorstensson CA, Nordeman L. Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial. BMC Musculoskelet Disord. 2022;23(1):260. 10.1186/s12891-022-05201-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
35. Barten DJJ, Swinkels LC, Dorsman SA, Dekker J, Veenhof C, De Bakker DH. Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study. BMC Fam Pract. 2015;16(1):75. 10.1186/s12875-015-0295-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
36. Bise CG, Schneider M, Freburger J, et al. First provider seen for an acute episode of low back pain influences subsequent health care utilization. Phys Ther. 2023;103(9):pzad067. 10.1093/ptj/pzad067 [DOI] [PubMed] [Google Scholar]
37. Bishop A, Ogollah RO, Jowett S, et al. STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain. BMJ Open. 2017;7(3):e012987. 10.1136/bmjopen-2016-012987 [DOI] [PMC free article] [PubMed] [Google Scholar]
38. Bishop A, Chen Y, Protheroe J, et al. Providing patients with direct access to musculoskeletal physiotherapy: the impact on general practice musculoskeletal workload and resource use. The STEMS-2 study. Physiotherapy. 2021;111:48–56. 10.1016/j.physio.2020.04.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
39. Denninger TR, Cook CE, Chapman CG, McHenry T, Thigpen CA. The influence of patient choice of first provider on costs and outcomes: analysis from a physical therapy patient registry. J Orthop Sports Phys Ther. 2018;48(2):63–71. 10.2519/jospt.2018.7423 [DOI] [PubMed] [Google Scholar]
40. Fenton JJ, Fang SY, Ray M, et al. Longitudinal care patterns and utilization among patients with new-onset neck pain by initial provider specialty. Spine. 2023;48(20):1409–1418. 10.1097/BRS.0000000000004781 [DOI] [PubMed] [Google Scholar]
41. Fritz JM, Kim J, Dorius J. Importance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilization and costs. Eval Clin Practice. 2016;22(2):247–252. 10.1111/jep.12464 [DOI] [PubMed] [Google Scholar]
42. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical therapy as the first point of care to treat low back pain: an instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs. Health Serv Res. 2018;53(6):4629–4646. 10.1111/1475-6773.12984 [DOI] [PMC free article] [PubMed] [Google Scholar]
43. Garrity BM, McDonough CM, Ameli O, et al. Unrestricted direct access to physical therapist services is associated with lower health care utilization and costs in patients with new-onset low back pain. Phys Ther. 2020;100(1):107–115. 10.1093/ptj/pzz152 [DOI] [PubMed] [Google Scholar]
44. Horn ME, George SZ, Fritz JM. Influence of initial provider on health care utilization in patients seeking care for neck pain. Mayo Clin Proc Innov Qual Outcomes. 2017;1(3):226–233. 10.1016/j.mayocpiqo.2017.09.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
45. Kazis LE, Ameli O, Rothendler J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open. 2019;9(9):e028633. 10.1136/bmjopen-2018-028633 [DOI] [PMC free article] [PubMed] [Google Scholar]
46. Lankhorst NE, Barten JA, Meerhof R, Bierma-Zeinstra SMA, Van Middelkoop M. Characteristics of patients with knee and ankle symptoms accessing physiotherapy: self-referral vs general practitioner’s referral. Physiotherapy. 2020;108:112–119. 10.1016/j.physio.2017.03.008 [DOI] [PubMed] [Google Scholar]
47. Lovo S, Harrison L, O’Connell ME, Rotter T, Bath B. A physical therapist and nurse practitioner model of care for chronic back pain using telehealth: diagnostic and management concordance. J Telemed Telecare. 2022;30(5):842–850. 10.1177/1357633X221098904 [DOI] [PMC free article] [PubMed] [Google Scholar]
48. Mailuhu AKE, Van Middelkoop M, Bierma-Zeinstra SMA, Bindels PJE, Verhagen EALM. Outcome of a neuromuscular training program on recurrent ankle sprains. Does the initial type of healthcare matter? J Sci Med Sport. 2020;23(9):807–813. 10.1016/j.jsams.2020.03.010 [DOI] [PubMed] [Google Scholar]
49. Mallett R, Bakker E, Burton M. Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting? Musculoskeletal Care. 2014;12(4):251–260. 10.1002/msc.1075 [DOI] [PubMed] [Google Scholar]
50. Yang M, Bishop A, Sussex J, Roland M, Jowett S, Wilson ECF. Economic evaluation of patient direct access to NHS physiotherapy services. Physiotherapy. 2021;111:40–47. 10.1016/j.physio.2020.12.005 [DOI] [PubMed] [Google Scholar]
51. Halfpap J, Riebel L, Tognoni A, Coller M, Sheu RG, Rosenthal MD. Improving access and decreasing healthcare utilization for patients with acute spine pain: five-year results of a direct access clinic. Mil Med. 2022;188(7-8):e2340–e2346. 10.1093/milmed/usac064 [DOI] [PubMed] [Google Scholar]
52. Horne L, Slade V, Evans A. Transformation of MSK services in Halton Cheshire to first contact practitioner model. Physiotherapy. 2019;105(Supplement 1):e107. 10.1016/j.physio.2018.11.086 [DOI] [Google Scholar]
53. Mabry LM, Notestine JP, Moore JH, Bleakley CM, Taylor JB. Safety events and privilege utilization rates in advanced practice physical therapy compared to traditional primary care: an observational study. Mil Med. 2020;185(1–2):e290–e297. 10.1093/milmed/usz176 [DOI] [PubMed] [Google Scholar]
54. Peterson G, PortstrÖm M, Frick J. Extended roles in primary care when physiotherapist-initiated referral to X-ray can save time and reduce costs. Int J Qual Health Care. 2021;33(3):mzab122. 10.1093/intqhc/mzab122 [DOI] [PMC free article] [PubMed] [Google Scholar]
55. Wanless B, Owen G, Wood J. Implementing a first contact practitioner service - local challenges and deep dive into local data beyond the national evaluation. Physiotherapy. 2021;113(Supplement 1):e32. 10.1016/j.physio.2021.10.262 [DOI] [Google Scholar]
56. Young JL, Snodgrass SJ, Cleland JA, Rhon DI. Timing of physical therapy for individuals with patellofemoral pain and the influence on healthcare use, costs and recurrence rates: an observational study. BMC Health Serv Res. 2021;21(1):751. 10.1186/s12913-021-06768-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
57. Abuhl B, Ehrmantraut D, Wolden M. First-contact physical therapy compared to usual primary care for musculoskeletal disorders: a systematic review and meta-analysis of randomized controlled trials. Phys Ther. 2025;105(8):pzaf080. 10.1093/ptj/pzaf080 [DOI] [PubMed] [Google Scholar]
58. Arnold E, Barrie JL, DaSilva L, Patti M, Goode A, Clewley D. The effect of timing of physical therapy for acute low back pain on health services utilization: a systematic review. Arch Phys Med Rehabil. 2019;100(7):1324–1338. 10.1016/j.apmr.2018.11.025 [DOI] [PubMed] [Google Scholar]
59. Piscitelli D, Furmanek MP, Meroni R. Direct access in physical therapy: a systematic review. Clin Ter. 2018;169(5):249–260. [DOI] [PubMed] [Google Scholar]
60. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recomm Rep. 2022;71(3):1–95. 10.15585/mmwr.rr7103a1 [DOI] [PMC free article] [PubMed] [Google Scholar]
61. Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of early physical therapy with long-term opioid use among opioid-naive patients with musculoskeletal pain. JAMA Netw Open. 2018;1(8):e185909. 10.1001/jamanetworkopen.2018.5909 [DOI] [PMC free article] [PubMed] [Google Scholar]
62. Brown-Taylor L, Beckner A, Scaff KE, et al. Relationships between physical therapy intervention and opioid use: a scoping review. PM&R. 2022;14(7):837–854. 10.1002/pmrj.12654 [DOI] [PMC free article] [PubMed] [Google Scholar]
63. Rezaii PG, Fredericks N, Lincoln CM, et al. Assessment of the radiology support, communication and alignment network to reduce medical imaging overutilization: a multipractice cohort study. J Am Coll Radiol. 2020;17(5):597–605. 10.1016/j.jacr.2020.02.011 [DOI] [PubMed] [Google Scholar]
64. Wilson RJ, Zumsteg JW, Hartley KA, et al. Overutilization and cost of advanced imaging for long-bone cartilaginous lesions. Ann Surg Oncol. 2015;22(11):3466–3473. 10.1245/s10434-014-4325-y [DOI] [PubMed] [Google Scholar]
65. Jacobs JC, Jarvik JG, Chou R, et al. Observational study of the downstream consequences of inappropriate MRI of the lumbar spine. J Gen Intern Med. 2020;35(12):3605–3612. 10.1007/s11606-020-06181-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
66. Jenkins HJ, Downie AS, Maher CG, Moloney NA, Magnussen JS, Hancock MJ. Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis. Spine J. 2018;18(12):2266–2277. 10.1016/j.spinee.2018.05.004 [DOI] [PubMed] [Google Scholar]
67. Crowell MS, Dedekam EA, Johnson MR, Dembowski SC, Westrick RB, Goss DL. Diagnostic imaging in a direct-access sports physical therapy clinic: a 2-year retrospective practice analysis. Int J Sports Phys Ther. 2016;11(5):708–717. [PMC free article] [PubMed] [Google Scholar]
68. Keil AP, Baranyi B, Mehta S, Maurer A. Ordering of diagnostic imaging by physical therapists: a 5-year retrospective practice analysis. Phys Ther. 2019;99(8):1020–1026. 10.1093/ptj/pzz015 [DOI] [PubMed] [Google Scholar]
69. McColl L, Brace H, Brown D. An audit of the implementation of a pilot first contact practitioner service in south Tyneside. Physiotherapy. 2022;114(Supplement 1):e123. 10.1016/j.physio.2021.12.075 [DOI] [Google Scholar]
70. Moore JH, Goss DL, Baxter RE, et al. Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers. J Orthop Sports Phys Ther. 2005;35(2):67–71. 10.2519/jospt.2005.35.2.67 [DOI] [PubMed] [Google Scholar]
71. American Physical Therapy Association . Primary Care Physician Perceptions of Physical Therapy a Report from the American Physical Therapy Association. Published online 2024. https://www.apta.org/contentassets/d63d818e03c9448d8aad1a8be2ecf1da/primary-care-physician-perceptions-of-phy-sical-therapy---apta-report.pdf
72. American Physical Therapy Association . APTA Consumer Awareness Research Report. Published online 2022. https://www.apta.org/contentassets/0d8d21c351f74051943f0ff2a74976f6/apta-consumer-research-report-sept-2022.pdf
73. Ross M, Adams K, Engle K, et al. The knowledge of low back pain management between physical therapists and family practice physicians. J Manual Manipulat Ther. 2018;26(5):264–271. 10.1080/10669817.2018.1500772 [DOI] [PMC free article] [PubMed] [Google Scholar]
74. Ross MD, Childs JD, Middel C, et al. Physical therapist vs. family practitioner knowledge of simple low back pain management in the U.S. air force. Mil Med. 2014;179(2):162–168. 10.7205/MILMED-D-13-00099 [DOI] [PubMed] [Google Scholar]
75. Brown CL, Perrin EM. Obesity prevention and treatment in primary care. Acad Pediatr. 2018;18(7):736–745. 10.1016/j.acap.2018.05.004 [DOI] [PubMed] [Google Scholar]
76. Jochum SB, Legator H, Abraham RR, et al. It takes a village: the first 100 patients seen in a multidisciplinary pelvic floor clinic. Female Pelvic Med Reconstr Surg. 2021;27(4):e505–e509. 10.1097/SPV.0000000000000884 [DOI] [PubMed] [Google Scholar]
77. Lloyd M, Luscombe A, Grant C, et al. Specialised vestibular physiotherapy in the emergency department: a pilot safety and feasibility study. Emerg Medicine Australasia. 2020;32(5):860–863. 10.1111/1742-6723.13569 [DOI] [PubMed] [Google Scholar]
78. Jones KB, Wilson B, Weedon D, Bilder D. Care of adults with intellectual and developmental disabilities: cerebral palsy. FP Essent. 2015;439:26–30. [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

PTJ-2025-0373_R2_Supplementary_Material_pzag052

ptj-2025-0373_r2_supplementary_material_pzag052.pdf^{(840.3KB, pdf)}

Data Availability Statement

[ref1] 1. Health Resources and Services Administration . Workforce Projections. Published online October 2023. https://data.hrsa.gov/topics/health-workforce/workforce-projections

[ref2] 2. American Academy of Family Physicians . Family Physician Burnout, Well-Being, and Professional Satisfaction (Position Paper). https://www.aafp.org/about/policies/all/family-physician-burnout.html

[ref3] 3. Commission on Accreditation in Physical Therapy Education (CAPTE) . Standards and Required Elements for Accreditation of Physical Therapist Education Programs. Published online October 31, 2023. Accessed May 24, 2025. https://www.capteonline.org/globalassets/capte-docs/2024-capte-pt-standards-required-elements.pdf

[ref4] 4. Young BA, Ross MD, Heick J, Greathouse DG, Green Guerrero H, Boissonnault WG. Exploration of medical screening and differential diagnosis instructional methods and faculty perceptions in physical therapist educational programs. J Allied Health. 2020;49(2):e89–e97. [PubMed] [Google Scholar]

[ref5] 5. Murphy BP, Greathouse D, Matsui I. Primary care physical therapy practice models. J Orthop Sports Phys Ther. 2005;35(11):699–707. 10.2519/jospt.2005.35.11.699 [DOI] [PubMed] [Google Scholar]

[ref6] 6. Clark B, Clark L, Showalter C, Stoner T. A call to action: direct access to physical therapy is highly successful in the US military. When will professional bodies, legislatures, and payors provide the same advantages to all US civilian physical therapists? J Man Manip Ther. 2022;30(4):199–206. 10.1080/10669817.2022.2099893 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref7] 7. Bodenheimer T, Kucksdorf J, Torn A, Jerzak J. Integrating physical therapists into primary care within a large health care system. J Am Board Fam Med. 2021;34(4):866–870. 10.3122/jabfm.2021.04.200432 [DOI] [PubMed] [Google Scholar]

[ref8] 8. World Physiotherapy . Policy Statement: Advanced Physiotherapy Practice. London, UK: World Physiotherapy; 2023: Available from: https://World.Physio/Policy/Ps-Advanced-Pt-Practic. [Google Scholar]

[ref9] 9. O’Bright K, Cavanaugh AM, Cassel A, et al. Primary care physical therapy: 2025 consensus definition. Phys Ther J. 2026;pzag035. 10.1093/ptj/pzag035 [DOI] [PubMed] [Google Scholar]

[ref10] 10. World Health Organization . International Classification of Functioning, Disability and Health (ICF). https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health

[ref11] 11. O’Bright K, Peterson S. Physical therapists in primary care in the United States: an overview of current practice models and implementation strategies. Phys Ther. 2024;104(12):pzae123. 10.1093/ptj/pzae123 [DOI] [PubMed] [Google Scholar]

[ref12] 12. Edmonds MM, Warren RC, Miles-Richardson S, et al. Educating Physical Therapists as Primary Care Practitioners. First ed. Darbonne and Bartolett Publishers; 2004. [Google Scholar]

[ref13] 13. Donato EB, DuVall RE, Godges JJ, Zimmerman GJ, Greathouse DG. Practice analysis: defining the clinical practice of primary contact physical therapy. J Orthop Sports Phys Ther. 2004;34(6):284–304. 10.2519/jospt.2004.34.6.284 [DOI] [PubMed] [Google Scholar]

[ref14] 14. American Physical Therapy Association . APTA Practice Advisory: Primary Care Physical Therapy. Published online 2025. https://www.apta.org/contentassets/5561fbdd9f4540f49642c43ab1642a97/apta-practice-advisory-primary-care.pdf

[ref15] 15. American Physical Therapy Association - Kentucky . 2025 APTA House of Delegates Motions Summary for APTA-KY. Published online 2025. https://aptaky.org/_resources/documents/resources/APTA-House-of-Delegates-Motions.pdf

[ref16] 16. American Physical Therapy Association . Physical Therapist Services in Primary Care. Published online 2024. https://www.apta.org/siteassets/pdfs/policies/ptservicesinprimarycare_hodp07-24-05-07.pdf

[ref17] 17. The Value of Primary Care Physical Therapy, Including Patient Outcomes and Healthcare Costs: A Scoping Review Protocol. OSF registries; 2023: https://osf.io/4x3wy/overview [Google Scholar]

[ref18] 18. Crowell MS, Mason JS, McGinniss JH. Musculoskeletal imaging for low back pain in direct access physical therapy compared to primary care: an observational study. Int J Sports Phys Ther. 2022;17(2):237–246. 10.26603/001c.31720 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref19] 19. American Academy of Family Physicians . Primary Care. https://www.aafp.org/about/policies/all/primary-care.html. Published online 2019.

[ref20] 20. Kiljańska M, Soszyński P, Motyl A, Walewska-Zielecka B. Impacts of a Re-designed care path for back pain directing patients to physiotherapists: a pre–post intervention study. J Occup Environ Med. 2021;63(5):e276–e282. 10.1097/JOM.0000000000002178 [DOI] [PubMed] [Google Scholar]

[ref21] 21. Mcgill TE, Stern DF, Kolber MJ, Mcgee J. Cost outcomes of physical therapist providers compared to cost outcomes of physical therapist providers compared to primary care providers in the treatment of musculoskeletal primary care providers in the treatment of musculoskeletal patients in a military treatment facility: a retrospective chart patients in a military treatment facility: a retrospective chart review. Internet J Allied Health Sci Int J Allied Health Sci Pract Pract. 2021;19(2):Article 4. 10.46743/1540-580X/2021.2000 [DOI] [Google Scholar]

[ref22] 22. Ojha HA, Brandi JA, Finn KM, Wright WG. Cost efficiency of direct access physical therapy for Temple University employees with musculoskeletal injuries. Orthopaedic Practice. 2015;27(4):228–233. [Google Scholar]

[ref23] 23. Ojha HA, Fritz JM, Malitsky AL, et al. Comparison of physical therapy and physician pathways for employees with recent onset musculoskeletal pain: a randomized controlled trial. PM&R. 2020;12(11):1071–1080. 10.1002/pmrj.12382 [DOI] [PubMed] [Google Scholar]

[ref24] 24. Szymanek E, Jones M, Shutt-Hoblet C, Halle R. Implementation of direct access physical therapy within the military medical system. Mil Med. 2022;187(5–6):e649–e654. 10.1093/milmed/usab245 [DOI] [PubMed] [Google Scholar]

[ref25] 25. Bornhöft L, Larsson MEH, Thorn J. Physiotherapy in primary care triage – the effects on utilization of medical services at primary health care clinics by patients and sub-groups of patients with musculoskeletal disorders: a case-control study. Physiother Theory Pract. 2015;31(1):45–52. 10.3109/09593985.2014.932035 [DOI] [PubMed] [Google Scholar]

[ref26] 26. Bornhöft L, Larsson ME, Nordeman L, Eggertsen R, Thorn J. Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial. Therapeutic Adv Musculoskeletal. 2019;11:1759720X19827504. 10.1177/1759720X19827504 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref27] 27. Bornhöft L, Thorn J, Svensson M, Nordeman L, Eggertsen R, Larsson MEH. More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment. BMC Musculoskelet Disord. 2019;20(1):186. 10.1186/s12891-019-2553-9 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref28] 28. Downie F, McRitchie C, Monteith W, Turner H. Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data. Br J Gen Pract. 2019;69(682):e314–e320. 10.3399/bjgp19X702245 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref29] 29. Goodwin RW, Hendrick PA. Physiotherapy as a first point of contact in general practice: a solution to a growing problem? Prim Health Care Res Dev. 2016;17(05):489–502. 10.1017/S1463423616000189 [DOI] [PubMed] [Google Scholar]

[ref30] 30. Ingram S, Pickup S, Acton T, Peek A, Smith L, Warner T. A two year service evaluation of first contact musculoskeletal (MSK) physiotherapy roles within primary care in Taunton. Physiotherapy. 2019;105(Supplement 1):e65. 10.1016/j.physio.2018.11.027 [DOI] [Google Scholar]

[ref31] 31. McKay SE, Buono FD, Walker J, Glinski C, Printz DMB, Brienza R. Impact of interprofessional embedding of physical therapy in a primary care training clinic. J Interprof Care. 2021;35(4):532–537. 10.1080/13561820.2020.1798898 [DOI] [PubMed] [Google Scholar]

[ref32] 32. Salmon P, Humphreys K, Price J, Smith C, Heaton R. Can physiotherapy first contact practitioners reduce the burden on general practitioners and improve the management of musculoskeletal conditions? Physiotherapy. 2017;103(Supplement 1):e143. 10.1016/j.physio.2017.11.137 [DOI] [Google Scholar]

[ref33] 33. Ho CM, Thorstensson CA, Nordeman L. Physiotherapist as primary assessor for patients with suspected knee osteoarthritis in primary care—a randomised controlled pragmatic study. BMC Musculoskelet Disord. 2019;20(1):329. 10.1186/s12891-019-2690-1 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref34] 34. Ho-Henriksson CM, Svensson M, Thorstensson CA, Nordeman L. Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial. BMC Musculoskelet Disord. 2022;23(1):260. 10.1186/s12891-022-05201-3 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref35] 35. Barten DJJ, Swinkels LC, Dorsman SA, Dekker J, Veenhof C, De Bakker DH. Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study. BMC Fam Pract. 2015;16(1):75. 10.1186/s12875-015-0295-9 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref36] 36. Bise CG, Schneider M, Freburger J, et al. First provider seen for an acute episode of low back pain influences subsequent health care utilization. Phys Ther. 2023;103(9):pzad067. 10.1093/ptj/pzad067 [DOI] [PubMed] [Google Scholar]

[ref37] 37. Bishop A, Ogollah RO, Jowett S, et al. STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain. BMJ Open. 2017;7(3):e012987. 10.1136/bmjopen-2016-012987 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref38] 38. Bishop A, Chen Y, Protheroe J, et al. Providing patients with direct access to musculoskeletal physiotherapy: the impact on general practice musculoskeletal workload and resource use. The STEMS-2 study. Physiotherapy. 2021;111:48–56. 10.1016/j.physio.2020.04.006 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref39] 39. Denninger TR, Cook CE, Chapman CG, McHenry T, Thigpen CA. The influence of patient choice of first provider on costs and outcomes: analysis from a physical therapy patient registry. J Orthop Sports Phys Ther. 2018;48(2):63–71. 10.2519/jospt.2018.7423 [DOI] [PubMed] [Google Scholar]

[ref40] 40. Fenton JJ, Fang SY, Ray M, et al. Longitudinal care patterns and utilization among patients with new-onset neck pain by initial provider specialty. Spine. 2023;48(20):1409–1418. 10.1097/BRS.0000000000004781 [DOI] [PubMed] [Google Scholar]

[ref41] 41. Fritz JM, Kim J, Dorius J. Importance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilization and costs. Eval Clin Practice. 2016;22(2):247–252. 10.1111/jep.12464 [DOI] [PubMed] [Google Scholar]

[ref42] 42. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical therapy as the first point of care to treat low back pain: an instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs. Health Serv Res. 2018;53(6):4629–4646. 10.1111/1475-6773.12984 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref43] 43. Garrity BM, McDonough CM, Ameli O, et al. Unrestricted direct access to physical therapist services is associated with lower health care utilization and costs in patients with new-onset low back pain. Phys Ther. 2020;100(1):107–115. 10.1093/ptj/pzz152 [DOI] [PubMed] [Google Scholar]

[ref44] 44. Horn ME, George SZ, Fritz JM. Influence of initial provider on health care utilization in patients seeking care for neck pain. Mayo Clin Proc Innov Qual Outcomes. 2017;1(3):226–233. 10.1016/j.mayocpiqo.2017.09.001 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref45] 45. Kazis LE, Ameli O, Rothendler J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open. 2019;9(9):e028633. 10.1136/bmjopen-2018-028633 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref46] 46. Lankhorst NE, Barten JA, Meerhof R, Bierma-Zeinstra SMA, Van Middelkoop M. Characteristics of patients with knee and ankle symptoms accessing physiotherapy: self-referral vs general practitioner’s referral. Physiotherapy. 2020;108:112–119. 10.1016/j.physio.2017.03.008 [DOI] [PubMed] [Google Scholar]

[ref47] 47. Lovo S, Harrison L, O’Connell ME, Rotter T, Bath B. A physical therapist and nurse practitioner model of care for chronic back pain using telehealth: diagnostic and management concordance. J Telemed Telecare. 2022;30(5):842–850. 10.1177/1357633X221098904 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref48] 48. Mailuhu AKE, Van Middelkoop M, Bierma-Zeinstra SMA, Bindels PJE, Verhagen EALM. Outcome of a neuromuscular training program on recurrent ankle sprains. Does the initial type of healthcare matter? J Sci Med Sport. 2020;23(9):807–813. 10.1016/j.jsams.2020.03.010 [DOI] [PubMed] [Google Scholar]

[ref49] 49. Mallett R, Bakker E, Burton M. Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting? Musculoskeletal Care. 2014;12(4):251–260. 10.1002/msc.1075 [DOI] [PubMed] [Google Scholar]

[ref50] 50. Yang M, Bishop A, Sussex J, Roland M, Jowett S, Wilson ECF. Economic evaluation of patient direct access to NHS physiotherapy services. Physiotherapy. 2021;111:40–47. 10.1016/j.physio.2020.12.005 [DOI] [PubMed] [Google Scholar]

[ref51] 51. Halfpap J, Riebel L, Tognoni A, Coller M, Sheu RG, Rosenthal MD. Improving access and decreasing healthcare utilization for patients with acute spine pain: five-year results of a direct access clinic. Mil Med. 2022;188(7-8):e2340–e2346. 10.1093/milmed/usac064 [DOI] [PubMed] [Google Scholar]

[ref52] 52. Horne L, Slade V, Evans A. Transformation of MSK services in Halton Cheshire to first contact practitioner model. Physiotherapy. 2019;105(Supplement 1):e107. 10.1016/j.physio.2018.11.086 [DOI] [Google Scholar]

[ref53] 53. Mabry LM, Notestine JP, Moore JH, Bleakley CM, Taylor JB. Safety events and privilege utilization rates in advanced practice physical therapy compared to traditional primary care: an observational study. Mil Med. 2020;185(1–2):e290–e297. 10.1093/milmed/usz176 [DOI] [PubMed] [Google Scholar]

[ref54] 54. Peterson G, PortstrÖm M, Frick J. Extended roles in primary care when physiotherapist-initiated referral to X-ray can save time and reduce costs. Int J Qual Health Care. 2021;33(3):mzab122. 10.1093/intqhc/mzab122 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref55] 55. Wanless B, Owen G, Wood J. Implementing a first contact practitioner service - local challenges and deep dive into local data beyond the national evaluation. Physiotherapy. 2021;113(Supplement 1):e32. 10.1016/j.physio.2021.10.262 [DOI] [Google Scholar]

[ref56] 56. Young JL, Snodgrass SJ, Cleland JA, Rhon DI. Timing of physical therapy for individuals with patellofemoral pain and the influence on healthcare use, costs and recurrence rates: an observational study. BMC Health Serv Res. 2021;21(1):751. 10.1186/s12913-021-06768-8 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref57] 57. Abuhl B, Ehrmantraut D, Wolden M. First-contact physical therapy compared to usual primary care for musculoskeletal disorders: a systematic review and meta-analysis of randomized controlled trials. Phys Ther. 2025;105(8):pzaf080. 10.1093/ptj/pzaf080 [DOI] [PubMed] [Google Scholar]

[ref58] 58. Arnold E, Barrie JL, DaSilva L, Patti M, Goode A, Clewley D. The effect of timing of physical therapy for acute low back pain on health services utilization: a systematic review. Arch Phys Med Rehabil. 2019;100(7):1324–1338. 10.1016/j.apmr.2018.11.025 [DOI] [PubMed] [Google Scholar]

[ref59] 59. Piscitelli D, Furmanek MP, Meroni R. Direct access in physical therapy: a systematic review. Clin Ter. 2018;169(5):249–260. [DOI] [PubMed] [Google Scholar]

[ref60] 60. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recomm Rep. 2022;71(3):1–95. 10.15585/mmwr.rr7103a1 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref61] 61. Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of early physical therapy with long-term opioid use among opioid-naive patients with musculoskeletal pain. JAMA Netw Open. 2018;1(8):e185909. 10.1001/jamanetworkopen.2018.5909 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref62] 62. Brown-Taylor L, Beckner A, Scaff KE, et al. Relationships between physical therapy intervention and opioid use: a scoping review. PM&R. 2022;14(7):837–854. 10.1002/pmrj.12654 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref63] 63. Rezaii PG, Fredericks N, Lincoln CM, et al. Assessment of the radiology support, communication and alignment network to reduce medical imaging overutilization: a multipractice cohort study. J Am Coll Radiol. 2020;17(5):597–605. 10.1016/j.jacr.2020.02.011 [DOI] [PubMed] [Google Scholar]

[ref64] 64. Wilson RJ, Zumsteg JW, Hartley KA, et al. Overutilization and cost of advanced imaging for long-bone cartilaginous lesions. Ann Surg Oncol. 2015;22(11):3466–3473. 10.1245/s10434-014-4325-y [DOI] [PubMed] [Google Scholar]

[ref65] 65. Jacobs JC, Jarvik JG, Chou R, et al. Observational study of the downstream consequences of inappropriate MRI of the lumbar spine. J Gen Intern Med. 2020;35(12):3605–3612. 10.1007/s11606-020-06181-7 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref66] 66. Jenkins HJ, Downie AS, Maher CG, Moloney NA, Magnussen JS, Hancock MJ. Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis. Spine J. 2018;18(12):2266–2277. 10.1016/j.spinee.2018.05.004 [DOI] [PubMed] [Google Scholar]

[ref67] 67. Crowell MS, Dedekam EA, Johnson MR, Dembowski SC, Westrick RB, Goss DL. Diagnostic imaging in a direct-access sports physical therapy clinic: a 2-year retrospective practice analysis. Int J Sports Phys Ther. 2016;11(5):708–717. [PMC free article] [PubMed] [Google Scholar]

[ref68] 68. Keil AP, Baranyi B, Mehta S, Maurer A. Ordering of diagnostic imaging by physical therapists: a 5-year retrospective practice analysis. Phys Ther. 2019;99(8):1020–1026. 10.1093/ptj/pzz015 [DOI] [PubMed] [Google Scholar]

[ref69] 69. McColl L, Brace H, Brown D. An audit of the implementation of a pilot first contact practitioner service in south Tyneside. Physiotherapy. 2022;114(Supplement 1):e123. 10.1016/j.physio.2021.12.075 [DOI] [Google Scholar]

[ref70] 70. Moore JH, Goss DL, Baxter RE, et al. Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers. J Orthop Sports Phys Ther. 2005;35(2):67–71. 10.2519/jospt.2005.35.2.67 [DOI] [PubMed] [Google Scholar]

[ref71] 71. American Physical Therapy Association . Primary Care Physician Perceptions of Physical Therapy a Report from the American Physical Therapy Association. Published online 2024. https://www.apta.org/contentassets/d63d818e03c9448d8aad1a8be2ecf1da/primary-care-physician-perceptions-of-phy-sical-therapy---apta-report.pdf

[ref72] 72. American Physical Therapy Association . APTA Consumer Awareness Research Report. Published online 2022. https://www.apta.org/contentassets/0d8d21c351f74051943f0ff2a74976f6/apta-consumer-research-report-sept-2022.pdf

[ref73] 73. Ross M, Adams K, Engle K, et al. The knowledge of low back pain management between physical therapists and family practice physicians. J Manual Manipulat Ther. 2018;26(5):264–271. 10.1080/10669817.2018.1500772 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref74] 74. Ross MD, Childs JD, Middel C, et al. Physical therapist vs. family practitioner knowledge of simple low back pain management in the U.S. air force. Mil Med. 2014;179(2):162–168. 10.7205/MILMED-D-13-00099 [DOI] [PubMed] [Google Scholar]

[ref75] 75. Brown CL, Perrin EM. Obesity prevention and treatment in primary care. Acad Pediatr. 2018;18(7):736–745. 10.1016/j.acap.2018.05.004 [DOI] [PubMed] [Google Scholar]

[ref76] 76. Jochum SB, Legator H, Abraham RR, et al. It takes a village: the first 100 patients seen in a multidisciplinary pelvic floor clinic. Female Pelvic Med Reconstr Surg. 2021;27(4):e505–e509. 10.1097/SPV.0000000000000884 [DOI] [PubMed] [Google Scholar]

[ref77] 77. Lloyd M, Luscombe A, Grant C, et al. Specialised vestibular physiotherapy in the emergency department: a pilot safety and feasibility study. Emerg Medicine Australasia. 2020;32(5):860–863. 10.1111/1742-6723.13569 [DOI] [PubMed] [Google Scholar]

[ref78] 78. Jones KB, Wilson B, Weedon D, Bilder D. Care of adults with intellectual and developmental disabilities: cerebral palsy. FP Essent. 2015;439:26–30. [PubMed] [Google Scholar]

PERMALINK

The value of integrating physical therapists into primary care, including patient outcomes and health care costs: a scoping review

Alyson M Cavanaugh, DPT, PhD

Micah Wong, DPT

Katie O’Bright, DPT

Dylan Lewis, DPT

Roles

Abstract

Objective

Data Sources, Study Selection, Data Extraction, and Synthesis

Main Outcomes and Measures

Results

Conclusions and Relevance

Introduction

Methods

Figure 1.

Data extraction and presentation

Results

Models of primary care physical therapy

Costs/Utilization

Patient outcomes

Discussion

Gaps in the research

Implications for clinical practice

Figure 2.

Conclusions

Supplementary Material

Contributor Information

CRediT—Contributor roles

Funding

Data availability

Disclosure

References

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases