Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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Imaging SIG Infographic Development

The Imaging SIG is developing a series of infographics with the focus of the first being on advocacy for imaging in physical therapist practice. Please consider a creative contribution for visual appeal and impact. The creators of the infographic selected as or contributing the most to the final product will receive a $250 cash prize and recognition from the Imaging SIG. All AOPT members, including student members, are included in this invitation.

Target date for submission: March 1, 2021.

Please click here to access the submission form

Files of infographics containing the content sought by the Imaging SIG and meeting the technical requirements may be submitted as described below.

Content:

  1. Include a suggested title
  2. Purpose: Advocacy informative to other medical providers, legislators, and lobbyists.
  3. Structure:
    1. Must use standard colors and fonts consistent with AOPT branding (please click here for this information).
    2.  Must submit single page draft in a mobile format (consistent with Twitter and Instagram posts) & print format (must be 8.5” x 11” or smaller).
    3. Must preserve an “unflattened” working version for future editing within Adobe Photoshop, Adobe Lightroom, Adobe Acrobat, Microsoft Publisher, or Microsoft PowerPoint.
    4. The lower two corners should be reserved for AOPT and Imaging SIG logos. e. Submissions must be original material, must not use copyrighted material, and must cite any sources used.
  4. Concept:
    1. Comparison/contrast of two flows of patient management with patients needing imaging going through other providers as a traditional approach with multiple steps/referrals vs. direct access and referral for imaging by a physical therapist.
    2. Consider using “idea bubbles” to demonstrate the thinking of the providers involved.
    3. Main Message: Physical therapists can utilize imaging effectively and efficiently in patient management.
    4. Main Themes:
      1. Patient Benefit/Clinical Impact
      2. Time efficiency
      3. Cost, including no additional cost from physical therapist referral; paid by third party payer, and potential cost savings when appropriately ordered.
      4. Patient satisfaction
      5. Appropriateness of imaging utilization based on clinical reasoning and decisions being within the scope of practice and practitioner competence, derived from the patient history and clinical examination. Evidence indicates physical therapists do not overutilize imaging.
      6. History of physical therapist use of imaging, including US Military, US civilian, and world-wide context.
      7. Physical therapists are capable of using consensus derived guidelines, specifically the American College of Radiology (ACR) Appropriateness Criteria. 
      8. Physical therapists are capable of completing the indicated follow-up care subsequent to imaging, whether referral to another provider, a course of physical therapy, or a combination thereof.

Supporting Facts:

  • History of Use 
  • Physical therapists in the military have had imaging referral privileges for almost 50 years. 
  • Imaging referral is considered part of regular physical therapist practice in the Veteran’s Administration.
  • Physiotherapists in multiple other countries, including Australia, the United Kingdom and some provinces in Canada, have imaging referral privileges.
  • Physical therapists utilize the ACR Appropriateness Criteria equally as other providers.

Education, Training & Competency:

  • Physical therapy educational curricula include training in medical screening for conditions beyond the scope of physical therapist practice and instruction regarding diagnostic imaging. The criteria in guidelines upon which imaging referral is based consists of fundamental skills and decision-making taught in every physical therapy school curriculum.
  • Physical therapists follow the ACR Appropriateness Criteria and other clinical practice guidelines to determine if imaging is indicated.
  • The basis for imaging decision making in ACR Appropriateness Criteria: (Age, Trauma presence/absence, Mechanism of injury, Prior surgery, Risk factors, Appearance, Pain provocation / physical function tests, Other imaging results, Weight-bearing ability, and Tenderness to palpation) are all well established in physical therapy educational curricula & clinical practice.
  • In most states, patients can see a physical therapist directly without the requirement to see another medical provider first.
  • Physical therapists with appropriate training have safely referred patients with musculoskeletal injuries for imaging in direct access settings.
  • In a growing number of states, physical therapists can refer directly. In other states, physical therapists work with other providers to get patients what they need

Keil AP, Baranyi B, Mehta S, Maurer A. Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis, Physical Therapy, Volume 99, Issue 8, August 2019, Pages 1020–1026.

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.

Research has shown physical therapist competence in referring patients for imaging.

Springer BA, Arciero RA, Tenuta JJ, Taylor DC. A prospective study of modified Ottawa ankle rules in a military population. Interobserver agreement between physical therapists and orthopaedic surgeons. Am J Sports Med. 2000 Nov-Dec;28(6):864-8.

Follow-up Care:
Referral to other needed services is part of physical therapist practice throughout the US. Physical therapists are part of a multidisciplinary health care team and are required to refer to other practitioners when a patient's needs are outside of their scope of practice.

Overutilization?
Research from states where physical therapists have direct imaging referral show that physical therapists refer for imaging judiciously and at a lower rate than other providers.

Keil AP, Baranyi B, Mehta S, Maurer A. Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis. Phys Ther. Aug 1 2019;99(8):1020-1026.

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. International journal of sports physical therapy. 2016;11(5):708-717.

Patrick K, Kareha S. The appropriateness and efficiency of diagnostic imaging orders recommended by physical therapists. J Orthop Sports Phys Ther (abstract-in press).

Reimbursement:
Research from states where physical therapists have direct imaging referral privileges show that reimbursement for those services have occurred to the imaging services.

Keil AP, Baranyi B, Mehta S, Maurer A. Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis. Phys Ther. Aug 1 2019;99(8):1020-1026.

Benefit:
Direct imaging referral by physical therapists can prevent delays in treatment and reduce the need for additional medical visits for imaging referral.

Rendeiro DG, Deyle GD, Boissonnault WG. Imaging in conjunction with physical therapy in management of a patient with history of thoracic tumour. Journal of Manual & Manipulative Therapy. 2015;23(3):123-127.

Patrick K, Kareha S. The appropriateness and efficiency of diagnostic imaging orders recommended by physical therapists. J Orthop Sports Phys Ther (abstract-in press).

Please click here to access the submission form

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