H.A. Ojha, PT, DPT, OCS, FAAOMPT, Department of Physical Therapy, College of Health Professions and Social Work, Temple University, 3307 N Broad St, Philadelphia, PA 19140 (USA).
Phys Ther. 2014 Jan;94(1):14-30. doi: 10.2522/ptj.20130096. Epub 2013 Sep 12.
Evidence suggests that physical therapy through direct access may help decrease costs and improve patient outcomes compared with physical therapy by physician referral.
The purpose of this study was to conduct a systematic review of the literature on patients with musculoskeletal injuries and compare health care costs and patient outcomes in episodes of physical therapy by direct access compared with referred physical therapy.
Ovid MEDLINE, CINAHL (EBSCO), Web of Science, and PEDro were searched using terms related to physical therapy and direct access. Included articles were hand searched for additional references.
Included studies compared data from physical therapy by direct access with physical therapy by physician referral, studying cost, outcomes, or harm. The studies were appraised using the Centre for Evidence-Based Medicine (CEBM) levels of evidence criteria and assigned a methodological score.
Of the 1,501 articles that were screened, 8 articles at levels 3 to 4 on the CEBM scale were included. There were statistically significant and clinically meaningful findings across studies that satisfaction and outcomes were superior, and numbers of physical therapy visits, imaging ordered, medications prescribed, and additional non-physical therapy appointments were less in cohorts receiving physical therapy by direct access compared with referred episodes of care. There was no evidence for harm.
There is evidence across level 3 and 4 studies (grade B to C CEBM level of recommendation) that physical therapy by direct access compared with referred episodes of care is associated with improved patient outcomes and decreased costs.
Primary limitations were lack of group randomization, potential for selection bias, and limited generalizability.
Physical therapy by way of direct access may contain health care costs and promote high-quality health care. Third-party payers should consider paying for physical therapy by direct access to decrease health care costs and incentivize optimal patient outcomes.
有证据表明，与医生转诊的物理治疗相比，直接获得的物理治疗可能有助于降低成本并改善患者的治疗效果。
本研究旨在对有关肌肉骨骼损伤患者的文献进行系统评价，并比较直接获得的物理治疗与转诊的物理治疗在治疗期间的医疗费用和患者治疗效果。
通过与物理治疗和直接访问相关的术语，在 Ovid MEDLINE、CINAHL（EBSCO）、Web of Science 和 PEDro 上进行了搜索。纳入的文章被手工搜索以获取其他参考文献。
纳入的研究比较了直接获得的物理治疗与医生转诊的物理治疗的数据，研究了成本、治疗效果或伤害。使用循证医学中心（CEBM）证据水平标准对研究进行评估，并分配了方法学评分。
在筛选出的 1501 篇文章中，有 8 篇文章在 CEBM 量表的 3 到 4 级，具有统计学意义和临床意义的发现是，在接受直接获得的物理治疗的队列中，满意度和治疗效果更好，物理治疗就诊次数、所开影像检查、所开药物以及其他非物理治疗预约次数都更少。没有证据表明存在伤害。
有 3 级和 4 级研究（CEBM 推荐等级 B 到 C）的证据表明，与转诊治疗相比，直接获得的物理治疗与改善患者治疗效果和降低成本有关。
主要局限性是缺乏分组随机化、潜在选择偏倚和有限的普遍性。
直接获得的物理治疗可能控制医疗费用并促进高质量的医疗保健。第三方支付者应考虑支付直接获得的物理治疗费用，以降低医疗费用并激励最佳的患者治疗效果。
