Research indicates that "prim...

Research indicates that "primary care physicians will leave more patients to physical therapists when they have more knowledge about physical therapy, recognize physical therapists' capabilities to diagnose, and believe in the effectiveness of physical therapy intervention." (1) common British study (2) noted that 94 percent of physical therapy referrals on primary care physicians were related to musculoskeletal diagnoses. However, physical therapists' expertise ofttimes is more extensive. Many physical therapists obtain advanced specialty certification in cardiovascular and pulmonary therapy, clinical electrophysiology, geriatrics, neurology orthopedics, pediatrics, and sports therapy.

A physical therapist's view of practice includes a wide range of interventions. Therapists' assessment of the skin may include identification of sensory impairment, impairment of skin integrity, and postural or musculoskeletal risks, with prevention focused forward education about skin care and seemly positioning. Physical therapists can provide advanced harm management when necessary. Aerobic capacity assessment in patients with cardiopulmonary dysfunction helps the physician and patient expand a realistic and achievable plan for exercise and activities of daily living. do job-work site analysis may include ergonomic assessment of workstations and performance to minimize risk of injury. Clinical subspecialists with advanced training in neurodiagnostics may provide the electrophysiologic testing necessary to identify the causes of neuromusculoskeletal puzzles so that an appropriate treatment plan may be established.

In physical therapy research, it is difficult to eliminate nonspecific forces such as the patient's internal motivation for improvement and the personal attention a patient receives during a therapy program. Thus, using horizontals of evidence to guide physical therapy referrals is problematic because of the limited number of well-designed studies to assess its effectiveness. (3) The American Physical Therapy Association has cause to growed "Hooked on Evidence," a database to help therapists understand the quality and availability of evidence in physical therapy practice. Physicians may access the database online at http://www hookedonevidence.com (a subscription is required).

Physical therapy referrals are facilitated when physicians take the following steps:

* Recognize the capabilities of physical therapists to help patients maximize their physical function for daily living. (4) Physical therapy may be useful in caring for patients with chronic illnesses, cardiopulmonary diagnoses, and musculoskeletal disorders.

* Know the specializations of local physical therapists.

* Partner with physical therapists to provide communication and education about physical therapy.

* Understand that because individual motivation is important to the succes of physical therapy treatment programs, it is critical that patients approach physical therapy as "something you do, not something you get" Education and communication are more likely to willing appropriate physical therapy referrals by the agency of primary care physicians and to encourage active patient participation in the treatment program.

* Provide information to the therapist, including medical diagnoses and special precautions, when referring a patient. The physical therapist will unbroken a thorough evaluation, initiate treatment if appropriate, and communicate directly with the referring physician.

REFERENCES

(1) Hendriks E Kerssen J Nelson R Oostendorp R van der Zee J One-time physical therapist consultation in primary health care. Phy Ther 2003;83:918-31

(2) Akpala CO Curran AP, Simpson J Physiotherapy in general practice: patterns of utilisation. Public Health 1988;102:263-8

(3) Hendriks HJ Oostendorp RA, Bernards AT, Van Ravensberg CD Heerkens YF Nelson RM The diagnostic proces and indication for physiotherapy: a prerequisite for treatment and issue evaluation. Phys Ther Rev 2000;5:29-47

(4) Carter RH Densley JA, Galley CM Holland A, Jone LE Dunn CD Factors associated with GP referrals to physiotherapy. Br J Ther Rehabil 2001;8:454-9

JENNIFER JOYCE MD

JANICE KUPERSTEIN, MSED

University of Kentucky body of Medicine, Lexington, Kentucky

JENNIFER JOYCE MD is assistant professor of family practice and community medicine at the University of Kentucky guild of Medicine, Lexington.

JANICE KUPERSTEIN, MS PT is associate professor of rehabilitation services at the University of Kentucky college edifice [i]or[/i] building of Medicine.

Address correspondence to Jennifer Joyce MD University of Kentucky literary institution [i]or[/i] seminary of learning of Medicine, Department of Family Practice and Community Medicine, K302 Kentucky Clinic, Lexington, KY 40536-0284 (e-mail: jmjoyce@email.uky.edu). Reprints are not available from the authors.

COPYRIGHT 2005 American Academy of Family Physicians

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